Masui. The Japanese journal of anesthesiology
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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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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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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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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.