Serum prepared from immunized humans or animals (e.g., horses), which contains antibodies, has been used for serum therapy or passive immunization to treat many diseases or envenomation events since its initial discovery in 1890, when Kitasato and von Behring observed the efficacy of this type of therapy against diphtheria and tetanus. At present, several types of serum therapies are used in clinical practice. Currently, three types of antitoxins--the gas gangrene equine antitoxin, diphtheria equine antitoxin, and botulism equine antitoxin are supplied by the government (Kokuyu vaccine), whereas tetanus human immune globulin, Mamushi (Gloydius blomhoffii) equine antivenom, and Habu (Protobothrops flavoviridis) equine antivenom are available commercially. Yamakagashi (Rhabdophis tigrinus) equine antivenom and red back spider equine antivenom are supplied by research groups in Japan. Summaries of clinical serum therapies are unavailable in the literature. As a result, clinicians have little opportunity to learn about and become familiar with these therapies. In this review, we attempt to clarify the benefits, precautions, and potential applications of serum therapies. Through this review, we hope that clinicians will have the opportunity to learn about and become familiar with clinical serum therapies.

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Spontaneous breathing during mechanical ventilation has long been recognized as beneficial, since spontaneous breathing increases aeration and oxygenation and preserves diaphragmatic muscle function. Spontaneous effort also reduces the pleural pressure and increases the transpulmonary pressure. Unlike the situation in normal lungs, however, the change in transpulmonary pressure is not uniformly transmitted in injured lungs, resulting in the pendelluft phenomenon. Clinical data suggest that the vigorous effort of spontaneous breathing may cause or worsen acute lung injury by increasing the transpulmonary pressure and pendelluft phenomenon. Ventilator strategies for patients with acute respiratory distress syndrome with and without spontaneous breathing should not be conflicting, but rather compatible, if spontaneous effort is adequately controlled.

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A randomized evaluation of a left ventricular assist device (LVAD) for treating congestive heart failure in the REMATCH (randomized evaluation of mechanical assistance for the treatment of congestive heart failure) trial revealed that the device was effective against end-stage heart failure. This finding will accelerate the use of LVAD implants in Japan, where the number of patients who undergo heart transplants is lower than that in the USA or European countries, and the wait for heart transplantation is far longer in Japan than in the USA. Therefore, in addition to the avoidance of complications, the maintenance of well-controlled physical function for those waiting for a heart transplant is important. Neuromuscular electrical stimulation is a good method for reducing skeletal muscle protein degradation and for improving physical function. We aimed to provide new rehabilitation methods using neuromuscular electrical stimulation in patients with an LVAD.

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A 73-year-old female was transferred to our hospital with respiratory distress, and suffered a cardiac arrest (CA) after her arrival. We immediately started cardiopulmonary resuscitation (CPR), during which we use a mechanical chest compression device, the AutoPulse^® (Asahi Kasei ZOLL Medical Corporation). We diagnosed the patient with a CA caused by a pulmonary thromboembolism. Although her hemodynamics were well maintained following the return of spontaneous circulation, they suddenly became unstable 15 hours after her admission to the ICU. Then, progressive anemia was detected. Abdominal ultrasonography and CT revealed injuries to the liver and spleen and multiple rib fractures; hence, we diagnosed the patient with hypovolemic shock. We performed splenectomy and coagulative hemostasis for the liver laceration. Conclusion: It was suggested that the shifting of the AutoPulse^® band to the caudal side due to the patient's obesity (BMI 38 kg/m²), might have caused these complications. When using mechanical chest compression devices, clinicians should be familiar with its characteristics, and must take care to avoid complications.

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[in Japanese]

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