Masui. The Japanese journal of anesthesiology
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ARDS is a syndrome characterized by nonhydrostatic pulmonary edema and hypoxemia due to overwhelming pulmonary inflammation arising secondarily from several pulmonary or non-pulmonary diseases. Since its introduction in 1967 by Ashbough, there had not been any gold standard concerning its definitive diagnosis over the next 25 years. In 1994, American-European Consensus Conference (AECC) published a definition that thereafter has been used for nearly 20 years. ⋯ In 2011, European Society of Intensive Care Medicine convened a meeting with ARDS experts to make a new revised definition, now called Berlin definition. This definition is almost compatible with AECC criteria but more feasible and has more precise predictive validity and reliability. The Berlin definition should facilitate the recognition of ARDS and would offer more suitable treatment and enable clinical trials in accordance with disease severity.
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Review
[ECMO for the patients with severe respiratory failure associated with ARDS due to influenza].
Although the survival rate of H1N1-related severe respiratory failure following ECMO therapy was high in several countries, the rate in Japan has been low. Efforts should be made to supply suitable equipments, to train the physicians, and to establish transport system for the patient.
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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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Tracheal intubation (TI) is a difficult skill to acquire and its proficiency deteriorates over time if not regularly practiced. However, inexperienced personnel may be required to perform airway management in emergency situations. We compared a novel supraglottic device, i-gel, with laryngeal mask airway classic (cLMA) and TI devices in regard to total success count, time required for placement, and difficulties encountered by novice personnel using a manikin model. ⋯ An i-gel may be useful for emergency airway management by inexperienced personnel. Further studies in a clinical setting are necessary to confirm these findings.
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Case Reports
[Management of a child with Swyer-James syndrome who underwent flexible bronchoscopy under general anesthesia].
Swyer-James syndrome (SJS) is a rare syndrome characterized by hyperlucency of one or more lobes of the unilateral lung and decreased pulmonary vascularity which is considered to be secondary to the childhood obliterative bronchiolitis. We report anesthetic management of a girl with SJS who underwent flexible bronchoscopy. A 15-year-old girl weighing 47 kg was referred to our hospital with suspected SJS. ⋯ Spontaneous respiration was maintained by using laryngeal mask airway to prevent the pressure alveolar damage by positive pressure ventilation. Flexible bronchoscopy was performed safely by using topical laryngeal lidocaine administration and additional bolus of propofol. Her postoperative course was uncomplicated and she was discharged on the following day.