Ichiro Takeuchi - WordPress.com · 2020-03-31 · General Ward General Intensive Care Unit ECMO...
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E-mail [email protected] How we treat Cruise Ship` Diamond Princess` with 3700 passengers Ichiro Takeuchi Chief Professor Yokohama City University
Transcript of Ichiro Takeuchi - WordPress.com · 2020-03-31 · General Ward General Intensive Care Unit ECMO...
HowwetreatCruiseShip`DiamondPrincess`with3700passengers
IchiroTakeuchiChiefProfessor
YokohamaCityUniversity
JapaneseCorona(+) 1stcase
InJapanCOVID-19 1stcasewasJanuary16andthen,wehavemadeeffortsnottospreadCoronaVirus.
Spreadspeed
JapanesedeathrateandspreadingspeedisverylowSillnowJapanesemedicalsystemisnotcollapsed.
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FromWHOSituationReports
HowwetreatCruiseShip`DiamondPrincess`with3700passengers
(700Corona+pts)and
whyEMSsystemwasnotcollapsedinYokohama.
February3thecruiseshiparrivedYokohamaportQuarantinefor14daysbegan
2600passengers1000CrewTotal3700
NovelCoronavirusPCRwasexamined
PCR(+)passengersweretransferredtothehospitals
ThenumberofPCR(+)passengerswasincreaseddaybyday
FebruarySaturday Friday
Feb1060passengersweretransported
EMScollapse?By700passengers
PCR(+) 700passengers
WeafraidofEMScollapse
regularEMSpatients(Trauma,ACS・・・ etc)
YokohamaCityEmergencyHospital
EMScrisisinItaly
EmergencyHospital
Corona(+)Slightillness
Corona(+)seriousillness
Corona(+)Supersevereillnes
RegularEMSpatients（TraumaACS
EMScollapseinItalyAllpatientsgotoEmergencyhospital.
Medicalteamonboarddividedto3groups
MedicalJudgement
needurgenttreatmentDyspnea,Spo2≦ 94%,ACS,cerebralInfarction)Intubation
needmedicaltreatmentO2supply
PCR(+)withoutanysymptom
toEmergencyCenterinYokohama (assoonaspossibleviaFireAmbulance)
hospitalsinKanagawaprefecture(within2hour)
distanthospital(3hourandmorebybus)
MedicalteamonboarddividedthePCR(+)patientsto3group
3700passengers700PCR(+)patients
BalancingCOVID-19withregularEMSpts
WefocusbalancingwithregularEMSsystemParallelwithacceptingpatientsfromregularambulanceisveryimportant.
IchiroTakeuchi.COVID-19FirstStageinJapan-Howwetreat`DiamondPrincessCruiseShip`with3700passengers?AcuteMedicineandSurgery2020.onlinepublication
YokohamaCityUniversityMedicalCenter
COVID-19patients20pts
●SevereCOVID-19patients ECMO3pts Ventilator6pts●SevereDiseasewithcorona(+) ACSwithcorona(+)（immediatePCI） Perforationwithcorona(+)（Emergencysurgeryoperation） CerebralInfarctionwithcorona(+)（immediatecatheter）
LowDeathrateintheCruseShip
JohnsHopkinsUnivCOVID-19CCSE・厚労省高山先生作成
DeathrateinItaly 9.3％Spain 6.2％Japan 3.7％CruseShiponly 1.1％
Italy 9.3%
Spain 6.2%
Japan
CruseShip
3.7%
1.1%
LessonfromCruiseShip
ToavoidEmergencyMedicalCareSystemcollapseIfallPCR(+)patientsgotothehospital,itwouldbeovershootCorona(+)Slightillnesspatientsshouldbeintheirhome.Corona(+)seriousillnessptstoEmergencyhospital→needOxygenonbedCorona(+)SupersevereillnessptstoEmergencyCenter→needventilatorandECMO
BalancingwithacceptingregularEMSisimportant
SeethedetailinAMSjournalonline
IchiroTakeuchi.COVID-19firststageinJapan–howwetreat‘DiamondPrincessCruiseShip’with3700passengers? AcuteMed&Surg20201;e506
Treatment
Taniguchi,Takeuchi.Veno-VenousExtracorporealMembraneOxygenationforSeverePneumonia:FirstCOVID-19CaseinJapan. AcuteMed&Surg2020inpress
TVprograminJapan
ECMOCase(YokohamaCityuniversityhospital)
General Ward General Intensive Care Unit ECMO unit
Cefepime 1g Clindamycin 1800mg per day
Lopinavir 800mg/ Ritonavir 200mg per day
day1 day2 day3 day4 day5 day6 day7 day8 day9 day10 day11 day12 day13
400 350 300 250 200 150 100 50 0
50 40 30 20 10 0
+550 +335 +300 +286 +1826 +1071 +1068
-2594 -3487 -702
+537 +85 +870
MV:PCV mode (FiO21.0,ΔP15,PEEP12,RR20)
MV:PCV mode (FiO20.3 ΔP10, PEEP10,RR10)
Spontaneous Breathing (FIO20.6)
PaO2 /FiO
2 mm
Hg
Static lung compliance m
l/cmH
2 O
PaO2/FiO2
CRRT
VV-ECMO (FiO21.0, Flow4L, Sweep gas4L)
Static lung compliance
0.1γ
Norepinephrine
0.25γ 0.2γ 0.07γ
Taniguchi,Takeuchi.Veno-VenousExtracorporealMembraneOxygenationforSeverePneumonia:FirstCOVID-19CaseinJapan. AcuteMed&Surg2020inpress
ECMOCase(YokohamaCityuniversityhospital)
JapaneseECMOtoCOVID-19
ECMO total 36case Success 20case OngoingECMO 13case Death 3case
MedicalTreatment
JapaneseTVprogram
MedicalTreatment
AviganFavipiravir
Remdesivir Lopinavir/ritonavirCiclesonide
IL-6inhibitors(tocilizumab)?NowwearecheckingCOVID-19cytokinelevelincludingIL-6,IL-10andIFN-αβ
VaccineBCGmayprovideimmuneboostagainstcoronavirus,herpes,and
otherviralinfections
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Thankyouforyourattention! IchiroTakeuchi [email protected]
JapaneseCorona(+) 1stcase
COVID-19inJapan 1stcasewasJanuary16thandthen,wehavemadeeffortsnottospreadCoronaVirus.
Italy France
Japan
US
death
4032death
450death
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koreaUK
Daysafterfirstdeath
JapaneseCorona(+) 1stcase
COVID-19inJapan 1stcasewasJanuary16thandthen,wehavemadeeffortsnottospreadCoronaVirus.
Italy France
Japan
US
death
4032death
450death
201
35death
korea
UK
Daysafterfirstdeath
