Okayama University Medical SchoolActa Medica Okayama0386-300X6562011Successful Extracorporeal Life Support for Life-threatening Hypercapnia with Bronchiolitis Obliterans after Allogeneic Hematopoietic Stem Cell Transplantation403406ENKoichiWasedaYasushiTanimotoShingoIchibaNobuakiMiyaharaToshiMurakamiNobuakiOchiMichihisaTeradoOsamuNaganoYoshinobuMaedaArihikoKanehiroYoshihitoUjikeMitsuneTanimotoCase Report10.18926/AMO/47266Bronchiolitis obliterans (BO) is a disease with a poor prognosis, and a key factor that limits long-term survival after allogeneic hematopoietic stem cell transplantation (HSCT). We here report a case of a 31-year woman with acute lymphatic leukemia, which was treated by chemotherapy and HSCT, and consequently developed BO 2 years after HSCT. A non-tuberculous mycobacterial infection occurred and showed gradual exacerbation. She started taking anti-mycobacterial drugs, but lost appetite, felt tired and finally lost consciousness one month after beginning medication. Arterial blood gas revealed marked hypercapnia. Using extracorporeal life support (ECLS), the carbon dioxide concentration was reduced and her consciousness recovered. To our knowledge, this is the first case in which ECLS was successfully used for hypercapnia in a patient with BO.No potential conflict of interest relevant to this article was reported.岡山医学会Acta Medica Okayama0030-155812332011新型インフルエンザウイルス（A/H1N1）感染後にARDSを来たした1例221225ENAkihikoTaniguchiNobuakiMiyaharaAtsushiNakaharaSaburoTakataRyoSakugawaOsamuNaganoYasushiTanimotoArihikoKanehiroKatsuyukiKiuraYoshitoUjikeMitsuneTanimotoA 28-year-old man with a history of mental retardation was admitted to our hospital because of dyspnea, cough and high fever. His SpO(2) level at room-environmental conditions was in the eighties, and his chest radiograph showed diffuse infiltrates in both lungs. He was diagnosed as suffering from influenza A by a rapid influenza virus antigen test. The echocardiogram showed no evidence of left cardiac failure; therefore, his symptoms were consistent with acute respiratory distress syndrome (ARDS). Oseltamivir was started, and antibiotics were also given because of the possibility of secondary bacterial infection. Due to respiratory failure and low blood pressure, which suggested septic shock, intensive treatments including mechanical ventilation were performed. Corticosteroid therapy was started for ARDS and sepsis, and these therapies improved his respiratory condition. Polymerase chain reaction of his pharyngeal swab revealed that he had influenza A (H1N1). This is the first case of ARDS following infection by influenza A (H1N1) virus in Japan.No potential conflict of interest relevant to this article was reported.Okayama University Medical SchoolActa Medica Okayama0386-300X6222008Evaluation of pressure support ventilation with seven different ventilators using Active Servo Lung 5000127133ENMichihisaTeradoShingoIchibaOsamuNaganoYoshihitoUjikeOriginal Article10.18926/AMO/30963<p>In modern emergency and critical care, physicians tend to choose the mode of mechanical ventilation based on spontaneous breathing for the purpose of promoting discharge of pulmonary secretion and preventing atelectasis in patients with acute respiratory insufficiency. However, we often observe "differences in recovery" among patients treated using the same PSV settings beyond "differences in individual characteristics." We evaluated the Pressure Support Ventilation (PSV) mode aiming to certify the difference among 7 representative mechanical ventilators using the Active Servo Lung 5000 (ASL5000) respiratory simulation system. The following parameters were measured: The time delay that resulted in the lowest inspiratory pressure from the point at which the ventilator recognized spontaneous breathing (TD), the lowest inspiratory airway pressure (cmH2O) generated prior to the initiation of PSV (DeltaPaw), the work of breathing while triggering required to achieve the lowest inspiratory negative pressure from the beginning of inspiratory support (WOBtrig), and the inspiratory work of breathing (WOBi). The mean TD of the Puritan-Bennett type 840 (PB840) was signifi cantly shorter than those of other ventilators (p0.01). The WOBtrig of the PB840 was significantly lower than those of others (p0.01). However, the WOBi values of the Servo-I and T-Bird were greater than the others, with the Evita series showing the smallest WOBi of the 7 ventilators tested. According to this simulation study using ASL 5000, we concluded that PB840 was the most rapid response ventilator, but the Evita series was the gentlest mechanical ventilator among 7 ventilators from the standpoint of the total work of breathing during the inspiration phase in the setting of PSV.</p>No potential conflict of interest relevant to this article was reported.Acta Medica Okayama1989代謝性酸･塩基平衡の変化ならびに呼吸性酸･塩基平衡の変化が非脱分極性筋弛緩薬の作用に及ぼす影響に関する研究ENNo potential conflict of interest relevant to this article was reported.