Masui. The Japanese journal of anesthesiology
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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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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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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.
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This study was designed to investigate the annual incidence and characteristics of perioperative pulmonary thromboembolism (PTE) in Japan from 2009 through 2011, and to compare the current trend with that observed in our previous studies conducted since 2002. ⋯ The incidence and mortality of perioperative PTE decreased;although the factor of decrease in an incidence was considered to be the result of preventive method, as in the decrease in the mortality, the survey should be continued.
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Comparative Study
[Perioperative management of lung transplantations in patients with pulmonary arterial hypertension compared with that in patients with lymphangiomyomatosis].
The number of lung transplantation has tended to increase as a treatment for patients with pulmonary arterial hypertension (PAH) and lymphangiomyomatosis (LAM) in Japan. However, we have little evidence about the comparison of perioperative management in patients with PAH and that in patients with LAM. ⋯ The large difference in perioperative management between patients with PAH and those with LAM is an important knowledge for anesthesist.