Masui. The Japanese journal of anesthesiology
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The Pentax-AWS equipped with a new thinner blade (Introck-T) is an intubation device that provides a non-line-of sight view of the glottis. A non-line-of sight view is expected to cause less movement of the cervical spine during laryngeal visualization. We measured the degree of cervical spine movement during laryngoscopy with the device. ⋯ Laryngeal visualization using the Pentax-AWS with the new thinner Introck-T produces the anterior movement and extension of the cervical spine.
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Gum Elastic Bougie (GEB) was originally introduced into clinical practice in 1949 by Sir Robert Macintosh. British anesthesiologists choose this tracheal tube introducer than the malleable stylet to facilitate difficult intubation. However, the bougie may not always be used in an optimal manner in Japan. ⋯ GEB is superior to the stylet for a difficult intubation. It is easy to use, portable, and of relatively low cost. We believe that the GEB is useful in patients with and without difficult airways.
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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.