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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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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We have patients who develop lung injury after surgery even they are without lung diseases preoperatively. What is the cause of this perioperative complication? Can we prevent postoperative lung injury by any measures during surgery? In the present paper, the etiology of acute respiratory distress syndrome (ARDS) is reviewed and possible methods to prevent ARDS is discussed. Inflammation occurs during surgery, the degree of which depends on multiple factors including surgical insults, the use of cardiopulmonary bypass (CPB), ischemia and reperfusion of any organ during surgery, transfusion, and organ damages. ⋯ Mechanical ventilation does not initiate lung injury by itself; however, conventional mechanical ventilation (tidal volume of 10-12 ml x kg-1 ideal body weight) may induce ARDS if lungs are primed. Accordingly, lung protective strategies should be carried out if patients have such condition or does receive such surgery. The brief outline of the lung protective strategies is to reduce tidal volume, to apply open lung approach with positive end-expiratory pressure and lung recruitment maneuver, and to avoid any lung lesion causing hypoxia during CPB or one-lung ventilation.
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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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Randomized Controlled Trial
[Continuous infusion of low-dose remifentanil for palliation of pain with epidural catheterization].
To prospectively determine the safety and effectiveness of continuous infusion of low-dose remifentanil for the reduction of pain in patients for epidural catheterization. ⋯ Continuous infusion of low-dose remifentanil is a safe and effective method for palliation of pain in epidural catheterization.