Kyobu geka. The Japanese journal of thoracic surgery
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High-resolution manometry (HRM) has significant contribution in the field of esophageal motility disorders recently. The development of HRM has categorized various esophageal motility disorders focusing on patterns of esophageal motor function. Additionally, the Chicago classification criteria are widely used for manometric diagnosis. ⋯ First the lower esophageal sphincter (LES) function, and subsequently the esophageal pressure patterns are used to make a diagnosis. The hierarchical flow-chart has 4 groups; (1) incomplete LES relaxation( achalasia or esophagogastric junction outflow obstruction), (2) major motility disorders, (3) minor motility disorders, (4) normal esophageal motility. HRM is the gold standard for diagnosis of esophageal motility disorders.
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Mechanical ventilation is a useful treatment option for respiratory insufficiency following thoracic and cardiovascular surgery. Ventilation mode is classified as volume-controlled-ventilation(VCV) and pressure-controlled ventilation(PCV). Non-invasive ventilation(NIV) without tracheal intubation has been recently developed and is effective in patients with chronic obstructive pulmonary disease (COPD) exacerbation. ⋯ According to the protocol published from Japanese Society of Intensive Care Unit, Japanese Society of Respiratory Care Medicine, and Japan Academy of Critical Care Nursing, both spontaneous awakening trial(SAT) and spontaneous breathing trial(SBT) are recommended at the weaning from mechanical ventilation. I herein describe the utility of mechanical ventilation in patients with major pulmonary resection, myasthenia gravis, lung transplantation, and cardiac surgery, for each. We should understand not only the utility but also the non-physiological condition during mechanical ventilation.