集中治療英語：必須語彙とフレーズ

"mean arterial pressure"

The average blood pressure in the arteries during one cardiac cycle, calculated as diastolic pressure plus one-third of the pulse pressure; a target of at least 65 mmHg is commonly used in septic shock

"The nurse titrated noradrenaline to maintain a mean arterial pressure above 65 mmHg as per the sepsis resuscitation protocol."

"cardiac output"

The total volume of blood pumped by the heart per minute, equal to heart rate multiplied by stroke volume; normal is approximately 4–8 litres per minute

"Thermodilution via the pulmonary artery catheter measured a cardiac output of 3.1 litres per minute, confirming a low-output state."

"central venous pressure"

The pressure of blood in the superior vena cava or right atrium, measured via a central venous catheter and used as an estimate of right-sided cardiac filling

"A central venous pressure of 2 mmHg in the context of hypotension suggested the patient was significantly volume-depleted."

"stroke volume variation"

A dynamic measure of how much the stroke volume changes with each breath during mechanical ventilation, used to predict fluid responsiveness

"Stroke volume variation of 18% indicated fluid responsiveness, and the team administered a 500 mL fluid challenge with close haemodynamic reassessment."

"pulmonary artery catheter"

An invasive monitoring device inserted through the right side of the heart into the pulmonary artery to measure pressures, cardiac output, and mixed venous oxygen saturation

"The intensivist requested pulmonary artery catheter insertion to differentiate cardiogenic from distributive shock in the haemodynamically unstable patient."

"mixed venous oxygen saturation"

The oxygen saturation of blood in the pulmonary artery, reflecting the balance between oxygen delivery and consumption; normal is 65–75%

"A mixed venous oxygen saturation of 58% indicated inadequate oxygen delivery and prompted an increase in the noradrenaline infusion rate."

"systemic vascular resistance"

The resistance to blood flow offered by the peripheral circulation; low values indicate vasodilation as in septic shock, while high values suggest vasoconstriction

"Systemic vascular resistance was profoundly reduced at 450 dynes·sec·cm⁻⁵, consistent with the vasodilatory pattern of septic shock."

"arterial line"

A thin catheter inserted into an artery, most commonly the radial artery, providing continuous beat-to-beat blood pressure monitoring and easy access for arterial blood gas sampling

"The bedside nurse inserted a radial arterial line under ultrasound guidance to enable continuous blood pressure monitoring throughout vasopressor weaning."

"tidal volume"

The volume of air delivered with each mechanical breath, typically set at 6–8 mL per kilogram of ideal body weight in lung-protective ventilation strategies

"The respiratory therapist reduced the tidal volume to 6 mL/kg IBW to implement a lung-protective strategy in the patient with ARDS."

"positive end-expiratory pressure"

The pressure maintained in the airways at the end of exhalation during mechanical ventilation to keep alveoli open, prevent atelectasis, and improve oxygenation

"Positive end-expiratory pressure was increased from 8 to 12 cmH₂O after recruitment manoeuvres failed to maintain adequate oxygenation."

"plateau pressure"

The pressure measured in the airways at the end of inspiration when airflow has ceased, reflecting alveolar pressure and lung compliance; should be kept below 30 cmH₂O

"An elevated plateau pressure of 35 cmH₂O prompted the team to reduce tidal volume and reassess the patient for pneumothorax or worsening bronchospasm."

"spontaneous breathing trial"

A daily assessment in which the ventilator is reduced to minimal support or switched to a T-piece to evaluate the patient's ability to breathe independently before extubation

"The patient successfully completed a 30-minute spontaneous breathing trial on pressure support of 5 cmH₂O with no signs of respiratory distress."

"extubation"

The planned removal of the endotracheal tube from a patient's airway following successful weaning from mechanical ventilation

"Extubation was performed after the patient passed the spontaneous breathing trial, demonstrated adequate cough reflex, and maintained an oxygen saturation above 95% on 40% FiO₂."

"non-invasive ventilation"

Respiratory support delivered through a tight-fitting mask rather than an endotracheal tube, including CPAP and BiPAP, used to avoid or delay intubation

"Non-invasive ventilation via a full-face mask was initiated for the hypercapnic COPD patient to correct the respiratory acidosis without endotracheal intubation."

"driving pressure"

The difference between plateau pressure and positive end-expiratory pressure, representing the stress applied to the functional lung in each breath; lower values are associated with better outcomes in ARDS

"The team aimed to keep driving pressure below 15 cmH₂O by limiting tidal volume and optimising PEEP in the mechanically ventilated ARDS patient."

"prone positioning"

Turning the ventilated patient face-down to redistribute pulmonary perfusion, recruit dependent lung regions, and improve oxygenation in severe ARDS

"Prone positioning was initiated for 16 hours after the PaO₂/FiO₂ ratio fell below 150 despite high PEEP and optimised ventilator settings."

"septic shock"

A life-threatening state of circulatory, cellular, and metabolic dysfunction caused by infection, characterised by persistent hypotension requiring vasopressors and a serum lactate above 2 mmol/L

"The patient fulfilled criteria for septic shock with a MAP of 58 mmHg despite 2 litres of crystalloid and a lactate of 4.2 mmol/L, and noradrenaline was commenced."

"SOFA score"

The Sequential Organ Failure Assessment score, a clinical tool that quantifies organ dysfunction across six systems—respiratory, coagulation, hepatic, cardiovascular, renal, and neurological—to define and monitor sepsis severity

"A SOFA score of 8 on ICU admission reflected significant multi-organ dysfunction affecting the respiratory, cardiovascular, and renal systems."

"blood cultures"

Laboratory specimens collected from venous blood to detect and identify microorganisms causing bloodstream infection, ideally obtained before antibiotic therapy is started

"Two sets of blood cultures were drawn from separate sites before the first dose of broad-spectrum antibiotics was administered to the febrile neutropenic patient."

"source control"

The identification and physical management of the anatomical site of infection through drainage, debridement, or removal of infected material to remove the source of ongoing sepsis

"Source control was achieved by emergency drainage of a 6 cm intra-abdominal abscess, after which the patient's vasopressor requirements decreased significantly."

"procalcitonin"

A serum biomarker that rises rapidly in bacterial infection and sepsis; used to support diagnosis, guide antibiotic initiation, and facilitate earlier de-escalation

"Serial procalcitonin levels falling from 45 ng/mL on day one to 3 ng/mL on day five guided antibiotic de-escalation and supported a plan to discontinue therapy on day seven."

"lactate clearance"

The reduction in serum lactate concentration over time following resuscitation, used as a marker of improving tissue perfusion and adequacy of treatment in septic shock

"Lactate clearance of 42% at two hours confirmed the patient was responding to fluid resuscitation, and vasopressor doses were cautiously reduced."

"broad-spectrum antibiotics"

Antimicrobial agents effective against a wide range of bacteria, initiated early in sepsis before culture results return to cover all likely causative organisms

"Broad-spectrum antibiotics including piperacillin-tazobactam and gentamicin were started within 45 minutes of sepsis recognition as per the hospital's one-hour bundle."

"de-escalation"

The process of narrowing antibiotic therapy from broad-spectrum agents to a targeted regimen once the causative organism and its sensitivities are identified from culture results

"De-escalation to benzylpenicillin was performed on day three when blood cultures confirmed penicillin-sensitive Streptococcus pneumoniae bacteraemia."

"RASS score"

The Richmond Agitation-Sedation Scale, a validated tool scoring sedation from +4 (combative) to -5 (unarousable), used to target and document the desired level of sedation

"The nurse documented a RASS score of -2, indicating the patient was lightly sedated, and reduced the propofol infusion to target a score of -1 as prescribed."

"critical care pain observation tool"

A behavioural pain assessment scale used in non-verbal ventilated patients, evaluating facial expression, body movements, muscle tension, and ventilator compliance

"The bedside nurse used the critical care pain observation tool and scored 5 out of 8, indicating significant pain, and administered a fentanyl bolus before repositioning."

"analgesia-first sedation"

An approach to ICU sedation in which pain is treated first with opioids or non-opioids and sedatives are added only if agitation persists after adequate analgesia

"The ICU team adopted an analgesia-first sedation protocol and found that many patients required no sedative infusion once their pain was adequately controlled."

"daily sedation hold"

A protocol in which sedative infusions are paused each day to allow patients to wake, assess neurological function, and reduce the risk of prolonged mechanical ventilation and ICU delirium

"During the daily sedation hold the patient followed commands, opened her eyes to voice, and held up three fingers, confirming intact neurological function."

"propofol infusion syndrome"

A rare but potentially fatal complication of prolonged high-dose propofol infusion characterised by metabolic acidosis, rhabdomyolysis, cardiac failure, and renal failure

"A rising creatine kinase, metabolic acidosis, and acute kidney injury prompted concern for propofol infusion syndrome; the drug was immediately discontinued and midazolam substituted."

"ICU delirium"

An acute brain dysfunction characterised by fluctuating confusion, inattention, and disorganised thinking, highly prevalent in mechanically ventilated patients and associated with worse outcomes

"ICU delirium was confirmed using the CAM-ICU tool and the team implemented non-pharmacological measures including early mobilisation, sleep hygiene, and reorientation."

"CAM-ICU"

The Confusion Assessment Method for the ICU, a validated two-step delirium screening tool that assesses acute onset, inattention, altered level of consciousness, and disorganised thinking

"The nurse performed CAM-ICU assessment twice daily and recorded a positive result on day three, triggering the unit's delirium management pathway."

"neuromuscular blockade"

The pharmacological paralysis of skeletal muscles using agents such as cisatracurium or rocuronium to facilitate ventilation, reduce oxygen consumption, or manage severe agitation in intubated ICU patients

"Neuromuscular blockade with cisatracurium was initiated for 48 hours in the patient with severe ARDS who was desynchronising from the ventilator despite maximal sedation."

"acute kidney injury"

A sudden decline in kidney function defined by a rise in serum creatinine, a fall in urine output, or both, classified by KDIGO staging into three severity grades

"Stage 2 acute kidney injury was diagnosed when creatinine doubled from baseline to 280 µmol/L and urine output fell below 0.5 mL/kg/hr for 12 hours."

"continuous renal replacement therapy"

A slow, continuous form of dialysis performed over 24 hours that gradually removes waste products and fluid; preferred in haemodynamically unstable ICU patients who cannot tolerate intermittent haemodialysis

"Continuous renal replacement therapy was initiated via a femoral vascath after the patient became anuric and developed refractory hyperkalaemia unresponsive to medical management."

"vascath"

A large-bore, double-lumen venous catheter inserted into a central vein to allow the high blood flow rates required for renal replacement therapy and other extracorporeal circuits

"The intensivist inserted a femoral vascath under ultrasound guidance and the renal replacement circuit was primed and commenced within two hours of the decision to dialyse."

"effluent dose"

The volume of fluid processed per kilogram of patient body weight per hour during continuous renal replacement therapy, used to prescribe and monitor the intensity of solute clearance

"An effluent dose of 25 mL/kg/hr was prescribed in accordance with current guidelines, and achieved dose was documented hourly on the renal replacement therapy chart."

"filter clotting"

The premature occlusion of the extracorporeal circuit filter during renal replacement therapy due to thrombosis, requiring circuit change and anticoagulation reassessment

"Filter clotting occurred at hour 14, and the nurse changed the circuit and increased the regional citrate anticoagulation rate to prevent further early clotting."

"fluid balance"

The difference between all fluid inputs and outputs over a defined period, a critical daily calculation in ICU management informing decisions about diuresis, fluid restriction, and renal replacement therapy

"The 24-hour fluid balance showed a positive balance of 2,800 mL, prompting a discussion about initiating ultrafiltration via the renal replacement circuit."

"hyperkalaemia"

An abnormally high serum potassium level, above 5.5 mmol/L, which in the context of acute kidney injury can cause life-threatening cardiac arrhythmias and is an urgent indication for renal replacement therapy

"Hyperkalaemia of 6.8 mmol/L with ECG changes including tall peaked T waves and a widened QRS complex prompted emergency continuous renal replacement therapy initiation."

"renal recovery"

The return of adequate kidney function following an episode of acute kidney injury, assessed by improving urine output, falling creatinine, and reduced or discontinued need for renal replacement therapy

"Signs of renal recovery emerged on day nine as urine output exceeded 1 mL/kg/hr and creatinine trended downward, and renal replacement therapy was successfully discontinued."

"ECMO"

Extracorporeal membrane oxygenation; a life-support technology that uses an external pump and oxygenator to temporarily take over the function of the heart, the lungs, or both in patients with refractory cardiorespiratory failure

"Veno-venous ECMO was cannulated for a 34-year-old with influenza-related ARDS who had a PaO₂/FiO₂ ratio below 70 despite optimal conventional ventilation."

"vasopressor"

A drug that constricts blood vessels to raise blood pressure in states of haemodynamic compromise; the most commonly used agents in ICU are noradrenaline, vasopressin, and adrenaline

"Noradrenaline remained the first-line vasopressor and was titrated to a rate of 0.35 mcg/kg/min to maintain the target mean arterial pressure of 65 mmHg."

"inotrope"

A drug that increases the force of cardiac muscle contraction to improve cardiac output in low-output states; dobutamine and milrinone are commonly used inotropes in critical care

"Dobutamine was added as an inotrope when the cardiac index fell below 2.0 L/min/m² despite adequate filling pressures and vasopressor support."

"tracheostomy"

A surgical or percutaneous procedure creating an opening in the front of the neck directly into the trachea, performed in ICU patients expected to require prolonged mechanical ventilation

"Percutaneous tracheostomy was performed on day 12 to facilitate weaning, reduce sedation requirements, and improve patient comfort in the patient with Guillain-Barré syndrome."

"goals of care"

A patient-centred framework for discussing the priorities, values, and preferred outcomes that should guide treatment decisions, particularly in seriously ill patients where recovery is uncertain

"The intensivist held a goals-of-care family meeting on day seven to discuss the patient's prognosis, explore values around quality of life, and review the plan for ongoing organ support."

"limitation of treatment"

A decision agreed with the patient or their surrogate not to escalate or to withdraw specified life-sustaining therapies, based on the patient's values and the likely clinical outcome

"Following a family meeting and ethics consultation, a limitation of treatment order was documented that specified no further escalation of vasopressors and no cardiopulmonary resuscitation."

"do not attempt resuscitation"

A clinical order specifying that cardiopulmonary resuscitation should not be performed if a patient suffers a cardiac or respiratory arrest, based on patient wishes and clinical judgement

"After a detailed discussion with the patient, who retained capacity, a do not attempt resuscitation order was documented and communicated clearly to all team members during the handover."

"palliative extubation"

The planned removal of an endotracheal tube in a patient for whom continued mechanical ventilation is no longer consistent with their goals of care, with the primary aim of comfort rather than survival

"Palliative extubation was performed in a calm environment with family present, following administration of an opioid infusion to ensure the patient remained comfortable throughout."