キュウセイ コキュウ アッパク ショウコウグン ニタイスル サイシン ノ コキュウ カンリ

The mortality rate of acute respiratory distress syndrome (ARDS) has been still high.　A many kinds of strategies for ARDS are being tried in the world. The important factors which influence for pathological-physiology of ARDS during the mechanical ventilation are gravity consolidation, atelectasis, and ventilator induced lung injury (VILI). VILI is caused by shear stress that is induced by the repeated collapse and recruit of alveolus. Alveolar over-distention caused by large tidal volume also induces VILI. To prevent the VILI, the open lung strategy (The lung protective strategies for ARDS) is recommended. The high positive end expiratory pressure (PEEP) that prevents the shear stress and a small tidal volume are necessary for ARDS treatment.　The concept of the open lung strategy is re-open of alveolus and keeping the recruited alveolus. Recruitment maneuver, preventive therapy by PEEP, and prone positioning are lately proposed in the world. Recruitment maneuver is likely to inspire the gas at the level of vital capacity. Preventive PEEP is useful for the secondary lung injury of sepsis, burn and trauma. Prone position in Intensive Care Unit that is recognized to increase the oxygenation for lung injury patients may improve the mortality of severe ARDS patients.　Key words ： Acute Respiratory Distress Syndrome, acute lung injury, recruitment maneuver, pressure volume curve, prone positio

トウブ ノ ウゴキ ニ ヨル ナイケイ ジョウミャク カテーテル ノ センタン イチ ノ ヘンカ

Background: Endotracheal tube displacement due to head and neck movement has been well described. However, no similar study has been conducted with regard to the effect of head movement on internal jugular catheters. We hypothesized that head movement would also affect the internal jugular catheter tip position. This study aimed to determine whether head movement affects the internal jugular catheter tip position in pediatric patients less than 6 years old. Method: Twenty-four pediatric patients（aged 0-6 y）undergoing elective cardiac surgery were enrolled. Radiography was performed in both neutral and left head rotation positions. Using radiographs, we measured the change in distance between the catheter tip and the level of the upper edge of the 12th vertebra. Changes in catheter tip position between the neutral and left head rotation position were analyzed using a paired t-test. Results: There was no statistically significant displacement（P = 0.3）. The maximum displacement of the catheter tip position was 2.42 cm. Conclusion: Our data showed that left head rotation did not significantly displace the catheter tip position in most cases. However, in some cases, head movement caused catheter advancement or withdrawal, which could lead to severe complications

トウテイイ キフク ヲ トモナウ ロボット シエン シュジュツ ニ オケル ミャクハ デンパン ジカン ヲ モチイタ ヒシンシュウテキ シンハクシュツリョウケイ ノ シヨウ ケイケン

Background: Estimated continuous cardiac output（esCCO）is a non-invasive technique for monitoring continuous cardiac output（CCO）that is based on pulse-wave transit time. In this study, we report the use of CCO monitoring for patients undergoing robot-assisted surgery with pneumoperitoneum in a head-down position. Method: Thirteen patients undergoing radical robot-assisted prostatectomy under general anesthesia were enrolled. Intraoperatively, esCCO and arterial pressure-based cardiac output（APCO）were simultaneously recorded. The association between esCCO and APCO was then evaluated using correlation analysis and Bland-Altman analysis. The trending ability of esCCO was evaluated by 4-quadrant plot analysis. Results: The correlation coefficient between esCCO and APCO was 0.54（P < 0.0001）. According to the Bland-Altman plot, the bias and precision values were 1.38 and 0.79 L/min, respectively. The concordance analysis showed the concordance rate of 92.3%. Conclusion: These results indicate that esCCO is capable of tracking hemodynamic changes associated with pneumoperitoneum in the head-down position

Nurses' perceptions of aids and obstacles to the provision of optimal end of life care in ICU

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