Hiroshima journal of medical sciences
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Hiroshima J. Med. Sci. · Dec 2009
Practical use of airway pressure release ventilation for severe ARDS--a preliminary report in comparison with a conventional ventilatory support.
Airway pressure release ventilation (APRV) is a ventilatory mode that allows unsupported spontaneous breathing at any phase of the ventilatory cycle with high mean airway pressures. We hypothesized that use of APRV might produce potential beneficial effects on oxygenation, reducing mortality in patients with severe acute respiratory distress syndrome (ARDS) in comparison with synchronized intermittent mandatory ventilation (SIMV) as a conventional mode of ventilation. We retrospectively reviewed data of 58 patients with severe ARDS (the ratios of partial arterial oxygen tension to fraction of inspired oxygen, PaO2/F(I)O2 ratio <150). ⋯ Use of APRV in patients with severe ARDS appears to be associated with improvements in oxygenation, and a trend toward lower mortality in ICU. No significant adverse effects were observed. Prospective controlled studies are required to confirm the benefits of this ventilatory mode in comparison with conventional methods for severe ARDS.
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Hiroshima J. Med. Sci. · Dec 2008
Early induction of PMX-DHP improves oxygenation in severe sepsis patients with acute lung injury.
Direct hemoperfusion with polymyxin B-immobilized fibers (PMX-DHP) has been widely regarded as a treatment modality for septic shock in Japan. Recently, it was reported that PMX significantly improved the P/F (PaO2/FiO2) ratio in patients with acute lung injury (ALI) or acute respiratory distress syndrome (ARDS). The aim of this study was to examine whether the phase of sepsis is related to the effects of PMX-DHP treatment on oxygenation in patients with ALI and ARDS. ⋯ In the H-R group, P/F ratio increased from 194 +/- 83 to 262 +/- 113 after PMX-DHP treatment, with a statistical significance, whereas no difference was found in the S-S group. There was no difference in the 28 days survival rate between the groups. It was suggested that early introduction of PMX-DHP for severe sepsis may improve oxygenation.
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Hiroshima J. Med. Sci. · Dec 2008
Airway Scope for emergency intubations: usefulness of a new video-laryngoscope.
The Airway Scope (AWS-S100, Pentax, Tokyo, Japan) is a new video-laryngoscope, which has a specially designed blade and a portable, battery-powered, 2.4-inch built-in liquid crystal device (LCD) full-color video screen at the top of the handle. In this study, we tested the usefulness of the AWS for tracheal intubation in acute, urgent situations. Patients admitted to the Advanced Emergency and Critical Care Center at Hiroshima University Hospital and who required orotracheal intubations were prospectively enrolled. ⋯ The durations from inserting the blade via the oral cavity until observing the glottis (T1), inserting the tube into the trachea (T2), and confirming the chest rise (T3) were 22 +/- 15, 34 +/- 21 and 49 +/- 27 sec, respectively. When the results were classified into t experienced and novice groups, T1, T2 and T3 were 17 +/- 10 vs. 26 +/- 17, 32 +/- 23 vs. 36 +/- 20, and 45 +/- 25 vs. 53 +/- 27 sec, respectively (the experienced vs. the novice group, n.s.). These results suggested that the AWS may be a suitable device particularly for less experienced personnel, such as novice Advanced Life Support providers.
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Hiroshima J. Med. Sci. · Dec 2007
Angiographic neovascularization after bypass surgery in moyamoya disease: our experience at Hiroshima University Hospital.
In this study, we investigated the effect of different bypass procedures on postoperative neovascularization in patients with moyamoya disease at Hiroshima University Hospital. Fourteen cerebral hemispheres of seven patients with moyamoya disease were investigated. Five of the 14 hemispheres underwent direct bypass surgery and the remaining 9 underwent indirect bypass. ⋯ Good neovascularization was observed in 8 hemispheres and the remaining 6 had poor neovascularization. Direct bypass surgery was significantly more effective for angiographic neovascularization than the indirect procedure in moyamoya patients (chi2-test, p<0.05). Therefore, we concluded that the direct bypass procedure is a better choice for moyamoya disease as evidenced by angiographic neovascularization.
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Hiroshima J. Med. Sci. · Jun 2007
Case ReportsEndobronchial ultrasonography with a guide-sheath and virtual bronchoscopy navigation aids management of peripheral pulmonary nodules.
Occasionally, we have difficulty in diagnosing small peripheral pulmonary nodules. However, efforts have been made to resolve this problem. For instance, computed-tomography (CT), positron emission tomography (PET), flexible bronchoscopy examination (BF), and video-assisted thoracic surgery (VATS) have been performed to investigate such nodules. ⋯ Furthermore, we precisely localized the lesion using EBUS-GS. Then a biopsy was performed, which demonstrated bronchiolitis obliterans organizing pneumonia (BOOP). As seen in this case, combining VB and EBUS-GS seems beneficial for diagnosing peripheral pulmonary nodules.