Masui. The Japanese journal of anesthesiology
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The clinical criteria of acute respiratory distress syndrome (ARDS) defined by the American-European Consensus Conference (AECC) in 1994 was relevant to clinical practice, trials, and researches for two decades. However, a number of issues with the AECC definition have become apparent. ⋯ In the second section, the clinical significance and limitation of radiographic imaging, especially, high-resolution CT (HRCT) findings in ARDS were addressed. Although the early exudative phase of ARDS can not be detected even by HRCT, pulmonary fibroproliferation assessed by HRCT in patients with early ARDS predicts increased mortality with an increased susceptibility to multiple organ failure, along with ventilator dependency and its associated outcomes.
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Acute respiratory distress syndrome (ARDS) is a noncardiogenic pulmonary edema resulting from increased capillary permeability. Numerous pharmacologic therapies have been studied for prevention and treatment of ARDS. Although several pharmacological therapies could improve patient's respiratory function, there have been no controlled studies which clearly demonstrated the clinical benefit for ARDS-related mortality. ⋯ With regard to sivelestat sodium, a specific inhibitor of neutrophil elastase, although the effectiveness in decreasing mortality was not clarified, increases in lung oxygenation and ventilator-free days have consistently been revealed. Other probable pharmacologic therapies for ARDS include continuous infusion of cisatracurium. In conclusion, there are not established drugs for ARDS, and further studies are necessary to reveal the clinical effectiveness of the above mentioned and novel pharmacologic therapies.
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In this article lung protective strategy using low tidal volume and low plateau pressure is discussed based on the Acute Respiratory Distress Syndrome Network protocol. The ARDS Network study, which reported a lower mortality with a tidal volume target 6 ml x kg-1 of predicted body weight, remains the only study to show that mechanical ventilation strategy improves outcome in patients with acute lung injury/acute respiratory distress syndrome. To liberate patients from mechanical ventilation in timely manner, daily assessment with spontaneous breathing trial is essential. Using weaning predictors or gradual withdrawal with SIMV mode prolongs the duration of weaning, and is not recommended.
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Bacterial and viral pneumonia are the most frequent causes of ARDS. The other infectious risk of developing of ARDS is infections at nonpulmonary sites, and fungal as well as parasites pneumonia. Virtually all patients with ARDS require mechanical ventilation, a major risk factor for the development of VAP.
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Comparative Study
[Comparison of the effects of phosphodiesterase III inhibitors, milrinone and olprinone, in infant corrective cardiac surgery].
Clinical characteristics of phosphodiesterase (PDE) III inhibitors, milrinone and olprinone, is not fully understood in infants. We therefore retrospectively examined the hemodynamics, metabolism, and oxygenation of two different PDE III inhibitors in infants undergoing radical correction of ventricular septal defect with pulmonary hypertension. ⋯ The effects of the PDE III inhibitors, milrinone and olprinone, on hemodynamic parameters, acid-base balance and oxygenation were similar in these infants. Both milrinone and olprinone could be used safely in infant cardiac surgery.