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Efficacy and Safety of Early Bronchoscopy in Patients with Hemoptysis (객혈환자에서 조기기관지경의 유용성 몇 안정성)

  • Kim, Ho-Cheol;Cheon, Eun-Mee;Chung, Man-Pyo;Kim, Ho-Joong;Choi, Dong-Chull;Kwon, O-Jung;Rhee, Chong-H.;Han, Yong-Chol
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.2
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    • pp.391-400
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    • 1997
  • Background : Bronchoscopy is an essential procedure for identifying the bleeding site and evaluating cause of hemoptysis. However, it is controversial regarding to the timing of bronchoscopy in patients with hemoptysis. Early bronchoscopy, which was performed during hemoptysis or with 48hour after cessation of bleeding, was better for identifying the site of bleeding compared with delayed bronchoscopy, which was performed 48 hours after cessation of bleeding. The diagnostic yield of identifying the bleeding site by bronchoscopy was variable in reported literature and the safety of early bronchoscopy was not mentioned in previous literature. Therefore, we evaluated the efficacy and safety of early bronchoscopy in patients with hemoptysis. Method : From October 1994 to August 1996 in Samsung Medical Center, bronchoscopy was performed in patients with hemoptysis. Early bronchoscopy was performed prospectively during hemoptysis or within 48 hours after cessation of bleeding from May 1995 to August 1996. Delayed bronchoscopy group included patients who did not received early bronchoscopy at the same period or in whom bronchoscopy was performed 48 hour after cessation of bleeding from October 1994 to May 1995. Results : Early bronchoscopy group was performed 73 times in 71 patients. Delayed bronchoscopy was performed in 57 times in 55 patients. There was no difference as to amount and underlying cause of hemoptysis between both groups. Indentification of bleeding site by visualizing active bleeding was significantly higher in early bronchoscopy (38.3%) than delayed bronchoscopy group (8.7%)(p < 0.05). Indentification of bleeding site by bleeding after clot removal was 8 in early and 10 in delayed bronchoscopy. Indentification of bleeding site by visualizing active bleeding and bleeding after clot removal was 36 in early and 15 patients in delayed bronchoscopy(p > 0.05). Causes of hemoptysis was found in 18 patients in early and 16 patients in delayed bronchoscopy group. patients who had early bronchoscopy underwent surgery. We diagnosed the site of bleeding in 4 patients preoperatively. In 3 patients we made a treatment plan promptly right after bronchoscopy. Among early bronchoscopy group, bleeding over 100cc during bronchoscopy occurred in 2 patients. In early bronchoscopy group there was no other major complication during bronchoscopy. Conclusion : In patients with hemoptysis, early bronchoscopy which performed within 48 hours after cessation of bleeding was more effective procedure for identifying the bleeding site than delayed bronchoscopy which was performed after 48 hour cessation of bleeding.

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Postoperative Clinical Courses According to the Length of Preoperative Drug Therapy in Pulmonary Tuberculosis (폐결핵 환자의 수술전 항결핵제 투여기간에 따른 수술후 임상경과)

  • Kwon, Eun-Su;Kim, Dae-Yun;Park, Seung-Kyu
    • Tuberculosis and Respiratory Diseases
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    • v.47 no.6
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    • pp.775-785
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    • 1999
  • Background : Though surgery plays an important role in the management of patients with Mycobacterium tuberculosis infection, there is little information regarding the timing of resection. We tried to find out the ideal timing of operation. Method: A retrospective review was performed in 69 patients underwent pulmonary resection for pulmonary tuberculosis between January 1993 and December 1997. They were categorized into various groups according to the length of preoperative specific drug therapy. The rates of treatment failure, realpse and complication in each group were compared statistically by $x^2$-test. Results: Eighty one point two percent were men and 18.8 % women with a median age of 33 years(range, 16 to 63 years). The mean number of resistant drugs was 3.l(range, 0 to 9). Patients were treated preoperatively with multidrug regimens, which mean number of preoperative specific drugs was 4.6, in an effort to reduce the mycobacterial burden with the mean length of preoperative drug therapy, 5.0 months. Postoperative treatment was conducted for a mean period of 13.0 months with a mean number of postoperative specific drugs, 4.4. Postoperative treatment failures were confirmed in 8 among 69 patients(11.6%). 2 of these 8 patients were showed up in the preoperative 3 to 4 months medication group and each of the rest was occurred in the preoperative 2 to 3, 5 to 6, 6 to 7, 12 to 13, 17 to 18 months, less than one month medication group, respectively. 59 of 69 patients were available for evaluation of the relapse rate with the mean duration of the postoperative follow-up, 19.8 months. In 4 patients bacterial relapse was confirmed(6.8%). Each of these 4 was in the preoperative 1 to 2, 2 to 3, 3 to 4, 5 to 6 months medication group. Categorized into various groups according to the length of preoperative specific therapy, there were no statistical significances of the treatment failure rate, relapse rate and complication rate in the groups. There were seven treatment failures of 28 who were AFB culture positive until the time of operation(25%, p<0.01). Categorized the preoperative AFB culture positive group into various groups according to the length of preoperative drug therapy, there were no statistical significances, either. Conclusion: We believe that operation plays an important ancillary role in the treatment of pulmonary tuberculosis. Our results indicate that the timing of resection according to the length of preoperative drug therapy may not cause trouble.

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Context Sharing Framework Based on Time Dependent Metadata for Social News Service (소셜 뉴스를 위한 시간 종속적인 메타데이터 기반의 컨텍스트 공유 프레임워크)

  • Ga, Myung-Hyun;Oh, Kyeong-Jin;Hong, Myung-Duk;Jo, Geun-Sik
    • Journal of Intelligence and Information Systems
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    • v.19 no.4
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    • pp.39-53
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    • 2013
  • The emergence of the internet technology and SNS has increased the information flow and has changed the way people to communicate from one-way to two-way communication. Users not only consume and share the information, they also can create and share it among their friends across the social network service. It also changes the Social Media behavior to become one of the most important communication tools which also includes Social TV. Social TV is a form which people can watch a TV program and at the same share any information or its content with friends through Social media. Social News is getting popular and also known as a Participatory Social Media. It creates influences on user interest through Internet to represent society issues and creates news credibility based on user's reputation. However, the conventional platforms in news services only focus on the news recommendation domain. Recent development in SNS has changed this landscape to allow user to share and disseminate the news. Conventional platform does not provide any special way for news to be share. Currently, Social News Service only allows user to access the entire news. Nonetheless, they cannot access partial of the contents which related to users interest. For example user only have interested to a partial of the news and share the content, it is still hard for them to do so. In worst cases users might understand the news in different context. To solve this, Social News Service must provide a method to provide additional information. For example, Yovisto known as an academic video searching service provided time dependent metadata from the video. User can search and watch partial of video content according to time dependent metadata. They also can share content with a friend in social media. Yovisto applies a method to divide or synchronize a video based whenever the slides presentation is changed to another page. However, we are not able to employs this method on news video since the news video is not incorporating with any power point slides presentation. Segmentation method is required to separate the news video and to creating time dependent metadata. In this work, In this paper, a time dependent metadata-based framework is proposed to segment news contents and to provide time dependent metadata so that user can use context information to communicate with their friends. The transcript of the news is divided by using the proposed story segmentation method. We provide a tag to represent the entire content of the news. And provide the sub tag to indicate the segmented news which includes the starting time of the news. The time dependent metadata helps user to track the news information. It also allows them to leave a comment on each segment of the news. User also may share the news based on time metadata as segmented news or as a whole. Therefore, it helps the user to understand the shared news. To demonstrate the performance, we evaluate the story segmentation accuracy and also the tag generation. For this purpose, we measured accuracy of the story segmentation through semantic similarity and compared to the benchmark algorithm. Experimental results show that the proposed method outperforms benchmark algorithms in terms of the accuracy of story segmentation. It is important to note that sub tag accuracy is the most important as a part of the proposed framework to share the specific news context with others. To extract a more accurate sub tags, we have created stop word list that is not related to the content of the news such as name of the anchor or reporter. And we applied to framework. We have analyzed the accuracy of tags and sub tags which represent the context of news. From the analysis, it seems that proposed framework is helpful to users for sharing their opinions with context information in Social media and Social news.

A Study on the Determinants of Patent Citation Relationships among Companies : MR-QAP Analysis (기업 간 특허인용 관계 결정요인에 관한 연구 : MR-QAP분석)

  • Park, Jun Hyung;Kwahk, Kee-Young;Han, Heejun;Kim, Yunjeong
    • Journal of Intelligence and Information Systems
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    • v.19 no.4
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    • pp.21-37
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    • 2013
  • Recently, as the advent of the knowledge-based society, there are more people getting interested in the intellectual property. Especially, the ICT companies leading the high-tech industry are working hard to strive for systematic management of intellectual property. As we know, the patent information represents the intellectual capital of the company. Also now the quantitative analysis on the continuously accumulated patent information becomes possible. The analysis at various levels becomes also possible by utilizing the patent information, ranging from the patent level to the enterprise level, industrial level and country level. Through the patent information, we can identify the technology status and analyze the impact of the performance. We are also able to find out the flow of the knowledge through the network analysis. By that, we can not only identify the changes in technology, but also predict the direction of the future research. In the field using the network analysis there are two important analyses which utilize the patent citation information; citation indicator analysis utilizing the frequency of the citation and network analysis based on the citation relationships. Furthermore, this study analyzes whether there are any impacts between the size of the company and patent citation relationships. 74 S&P 500 registered companies that provide IT and communication services are selected for this study. In order to determine the relationship of patent citation between the companies, the patent citation in 2009 and 2010 is collected and sociomatrices which show the patent citation relationship between the companies are created. In addition, the companies' total assets are collected as an index of company size. The distance between companies is defined as the absolute value of the difference between the total assets. And simple differences are considered to be described as the hierarchy of the company. The QAP Correlation analysis and MR-QAP analysis is carried out by using the distance and hierarchy between companies, and also the sociomatrices that shows the patent citation in 2009 and 2010. Through the result of QAP Correlation analysis, the patent citation relationship between companies in the 2009's company's patent citation network and the 2010's company's patent citation network shows the highest correlation. In addition, positive correlation is shown in the patent citation relationships between companies and the distance between companies. This is because the patent citation relationship is increased when there is a difference of size between companies. Not only that, negative correlation is found through the analysis using the patent citation relationship between companies and the hierarchy between companies. Relatively it is indicated that there is a high evaluation about the patent of the higher tier companies influenced toward the lower tier companies. MR-QAP analysis is carried out as follow. The sociomatrix that is generated by using the year 2010 patent citation relationship is used as the dependent variable. Additionally the 2009's company's patent citation network and the distance and hierarchy networks between the companies are used as the independent variables. This study performed MR-QAP analysis to find the main factors influencing the patent citation relationship between the companies in 2010. The analysis results show that all independent variables have positively influenced the 2010's patent citation relationship between the companies. In particular, the 2009's patent citation relationship between the companies has the most significant impact on the 2010's, which means that there is consecutiveness regarding the patent citation relationships. Through the result of QAP correlation analysis and MR-QAP analysis, the patent citation relationship between companies is affected by the size of the companies. But the most significant impact is the patent citation relationships that had been done in the past. The reason why we need to maintain the patent citation relationship between companies is it might be important in the use of strategic aspect of the companies to look into relationships to share intellectual property between each other, also seen as an important auxiliary of the partner companies to cooperate with.

Evaluating Reverse Logistics Networks with Centralized Centers : Hybrid Genetic Algorithm Approach (집중형센터를 가진 역물류네트워크 평가 : 혼합형 유전알고리즘 접근법)

  • Yun, YoungSu
    • Journal of Intelligence and Information Systems
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    • v.19 no.4
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    • pp.55-79
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    • 2013
  • In this paper, we propose a hybrid genetic algorithm (HGA) approach to effectively solve the reverse logistics network with centralized centers (RLNCC). For the proposed HGA approach, genetic algorithm (GA) is used as a main algorithm. For implementing GA, a new bit-string representation scheme using 0 and 1 values is suggested, which can easily make initial population of GA. As genetic operators, the elitist strategy in enlarged sampling space developed by Gen and Chang (1997), a new two-point crossover operator, and a new random mutation operator are used for selection, crossover and mutation, respectively. For hybrid concept of GA, an iterative hill climbing method (IHCM) developed by Michalewicz (1994) is inserted into HGA search loop. The IHCM is one of local search techniques and precisely explores the space converged by GA search. The RLNCC is composed of collection centers, remanufacturing centers, redistribution centers, and secondary markets in reverse logistics networks. Of the centers and secondary markets, only one collection center, remanufacturing center, redistribution center, and secondary market should be opened in reverse logistics networks. Some assumptions are considered for effectively implementing the RLNCC The RLNCC is represented by a mixed integer programming (MIP) model using indexes, parameters and decision variables. The objective function of the MIP model is to minimize the total cost which is consisted of transportation cost, fixed cost, and handling cost. The transportation cost is obtained by transporting the returned products between each centers and secondary markets. The fixed cost is calculated by opening or closing decision at each center and secondary markets. That is, if there are three collection centers (the opening costs of collection center 1 2, and 3 are 10.5, 12.1, 8.9, respectively), and the collection center 1 is opened and the remainders are all closed, then the fixed cost is 10.5. The handling cost means the cost of treating the products returned from customers at each center and secondary markets which are opened at each RLNCC stage. The RLNCC is solved by the proposed HGA approach. In numerical experiment, the proposed HGA and a conventional competing approach is compared with each other using various measures of performance. For the conventional competing approach, the GA approach by Yun (2013) is used. The GA approach has not any local search technique such as the IHCM proposed the HGA approach. As measures of performance, CPU time, optimal solution, and optimal setting are used. Two types of the RLNCC with different numbers of customers, collection centers, remanufacturing centers, redistribution centers and secondary markets are presented for comparing the performances of the HGA and GA approaches. The MIP models using the two types of the RLNCC are programmed by Visual Basic Version 6.0, and the computer implementing environment is the IBM compatible PC with 3.06Ghz CPU speed and 1GB RAM on Windows XP. The parameters used in the HGA and GA approaches are that the total number of generations is 10,000, population size 20, crossover rate 0.5, mutation rate 0.1, and the search range for the IHCM is 2.0. Total 20 iterations are made for eliminating the randomness of the searches of the HGA and GA approaches. With performance comparisons, network representations by opening/closing decision, and convergence processes using two types of the RLNCCs, the experimental result shows that the HGA has significantly better performance in terms of the optimal solution than the GA, though the GA is slightly quicker than the HGA in terms of the CPU time. Finally, it has been proved that the proposed HGA approach is more efficient than conventional GA approach in two types of the RLNCC since the former has a GA search process as well as a local search process for additional search scheme, while the latter has a GA search process alone. For a future study, much more large-sized RLNCCs will be tested for robustness of our approach.

An Analysis on the Conditions for Successful Economic Sanctions on North Korea : Focusing on the Maritime Aspects of Economic Sanctions (대북경제제재의 효과성과 미래 발전 방향에 대한 고찰: 해상대북제재를 중심으로)

  • Kim, Sang-Hoon
    • Strategy21
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    • s.46
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    • pp.239-276
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    • 2020
  • The failure of early economic sanctions aimed at hurting the overall economies of targeted states called for a more sophisticated design of economic sanctions. This paved way for the advent of 'smart sanctions,' which target the supporters of the regime instead of the public mass. Despite controversies over the effectiveness of economic sanctions as a coercive tool to change the behavior of a targeted state, the transformation from 'comprehensive sanctions' to 'smart sanctions' is gaining the status of a legitimate method to impose punishment on states that do not conform to international norms, the nonproliferation of weapons of mass destruction in this particular context of the paper. The five permanent members of the United Nations Security Council proved that it can come to an accord on imposing economic sanctions over adopting resolutions on waging military war with targeted states. The North Korean nuclear issue has been the biggest security threat to countries in the region, even for China out of fear that further developments of nuclear weapons in North Korea might lead to a 'domino-effect,' leading to nuclear proliferation in the Northeast Asia region. Economic sanctions had been adopted by the UNSC as early as 2006 after the first North Korean nuclear test and has continually strengthened sanctions measures at each stage of North Korean weapons development. While dubious of the effectiveness of early sanctions on North Korea, recent sanctions that limit North Korea's exports of coal and imports of oil seem to have an impact on the regime, inducing Kim Jong-un to commit to peaceful talks since 2018. The purpose of this paper is to add a variable to the factors determining the success of economic sanctions on North Korea: preventing North Korea's evasion efforts by conducting illegal transshipments at sea. I first analyze the cause of recent success in the economic sanctions that led Kim Jong-un to engage in talks and add the maritime element to the argument. There are three conditions for the success of the sanctions regime, and they are: (1) smart sanctions, targeting commodities and support groups (elites) vital to regime survival., (2) China's faithful participation in the sanctions regime, and finally, (3) preventing North Korea's maritime evasion efforts.

A Study on the Liturgical Vestments of Catholic-With reference to the Liturgical Vestments Firm of Paderborn and kevelaer in Germany (카톨릭교 전례복에 관한 연구-독일 Paderborn 과 kevelaer의 전례복 회사를 중심으로)

  • Yang, Ri-Na
    • The Journal of Natural Sciences
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    • v.7
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    • pp.133-162
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    • 1995
  • Paderborn's companies, Wameling and Cassau, produce the liturgical vestments, which have much traditional artistic merit. And Kevelaerer Fahnen + Paramenten GmbH, located in Kevelater which is a place of pilgrimage of the Virgin Mary, was known to Europe, Africa, America and the Scandinavia Peninsula as the "Hidden Company" of liturgical vesments maker up to now. Paderborn and Kevelaer were the place of the center of the religious world and the Catholic ceremony during a good few centries. The Catholic liturgical vestiments of these 3 companies use versatile design, color, shape and techniques. These have not only the symbolism of religion, but also can meet our's expectations of utilization of modern textile art, art clothing and wide-all division of design. These give the understanding of symbolic meanings and harmony according to liturgical vestments to the believers. And these have an influence on mental thinking and induction of religious belief to the non-believers as the recognition and concerns about the religious art. The liturgical vestments are clothes which churchmen put on at the all ceremonial function of a mass, a sacrament, performance and a parade according to rules of church. These show the represen-tation of "Holy God" in silence and distinguish between common people and churchmen. And these represent a status and dignity of churchmen and induce majesty and respect to churchmen. Common clothes of the beginning of the Greece and Rome was developed to Christian clothes with the tendency of religion. There were no special uniforms distinguished from commen people until the Christianity was recognized officially by the Roman Emperor Constantinus at A.D.313. The color of liturgical vestments was originally white and changed to special colors according to liturgical day and each time by the Pope Innocentius at 12th century. The color and symbolic meaning of the liturgical vestments of present day was originated by the Pope St. Pius(1566-1572). Wool and Linen was used as decorations and materials in the beginnings and the special materials like silk was used after 4th century and beautiful materials made of gold thread was used at 12th century. It is expected that there is no critical changes to the liturgical vestments of future. But the development of liturgical vestments will continues slowly by the command of conservative church and will change to simple and convenient formes according to the culture, the trend of the times and the fashion of clothes. The companies of liturgical vestments develop versatile design, embroidery technique and realization of creative design for distinction of the liturgical vestments of each company and artistic progress. The cooperation of companies, artists and church will make the bright future of these 3 companies. We expect that our country will be a famous producing center of the liturgical vestments through the research and development of companies, participation of artists in religeous arts and concerts of church.

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The Determinants of Health Promoting Behavior in Students on Dept of Dental Hygiene (치위생과 학생의 건강증진행위 결정요인에 관한 연구)

  • Kim, Eun-Mi;Lee, Hyang-Nim
    • Journal of dental hygiene science
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    • v.4 no.3
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    • pp.141-148
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    • 2004
  • This study was examed in order to determine influential factors of health promoting behavior on Dental Hygiene students the health promoting behavior. So examed students' health promoting behavior, self-efficacy, perceived benefit, perceived barrier, a health locus of control, self-esteem. A the result of this study were as follows: (1) Performance mean score in health promoting behavior was 2.60, self achievement score was 2.89, health responsibility score was 2.12, exercise score was 1.89, nutrition score was 2.45, interpersonal support score was 2.97, stress management score was 2.63. Performance mean score in self-efficacy was 2.56, perceived benefit was 3.45, perceived barrier was 2.32, a health locus of control score was 3.04, self-esteem score was 2.81. (2) Performance in health promoting behavior was significant differences in year, religion, economical level, experience of disease on family, perceived health status(p<0.05), perceived oral health status(p<0.001). Performance in self achievement was significant differences in year, economical level, perceived health status(p<0.05), religion, perceived oral health status(p<0.01). Performance in health responsibility was significant differences in year, religion, economical level, BMI(p<0.05) and experience of disease on myself, perceived oral health status(p<0.001). Performance in excercise was significant differences in mother's educational level, experience of disease on family, perceived oral health status(p<0.05) and nutrient was economical level, perceived oral health status(p<0.01), perceived health status(p<0.05). Performance in interpersonal relations was only significant differences perceived oral health status(p<0.05) and in stress management was year, perceived oral health status(p<0.05). (3) Performance in self-efficacy was significant differences in economical level, health status(P<0.05) and perceived health status, perceived oral health status(p<0.01). Performance in perceived benefit was significant differences in religion(p<0.05). Performance in perceived barrier was significant differences economical level, perceived oral health status(p<0.05), experience of disease on myself(p<0.01). Performance in a health locus of control was significant differences year(p<0.05), performance in a perceived oral health status(p<0.01). (4) Performance in health promoting behavior was significantly correlated with self-efficacy(r=0.376), perceived benefit(r=0.188), perceived barrier(r=-0.155), a health locus of control (r=0.064), self-esteem(r=0.318). (5) Self-efficacy was the highest factor predicting health promoting behavior.

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Internal Changes and Countermeasure for Performance Improvement by Separation of Prescribing and Dispensing Practice in Health Center (의약분업(醫藥分業) 실시(實施)에 따른 보건소(保健所)의 내부변화(內部變化)와 업무개선방안(業務改善方案))

  • Jeong, Myeong-Sun;Kam, Sin;Kim, Tae-Woong
    • Journal of agricultural medicine and community health
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    • v.26 no.1
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    • pp.19-35
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    • 2001
  • This study was conducted to investigate the internal changes and the countermeasure for performance improvement by Separation of Prescribing and Dispensing Practice (SPDP) in Health Center. Data were collected from two sources: Performance report before and after SPDP of 25 Health Centers in Kyongsangbuk-do and 6 Health Centers in Daegu-City and self-administerd questionnaire survey of 221 officials at health center. The results of this study were summarized as follows: Twenty-four health centers(77.4%) of 31 health centers took convenience measures for medical treatment of citizens and convenience measures were getting map of pharmacy, improvement of health center interior, introduction of order communication system in order. After the SPDP in health centers, 19.4% of health centers increased doctors and 25.8% decreased pharmacists. 58.1% of health centers showed that number of medical treatments were decreased. 96.4%, 80.6% 80.6% 96.7% of health centers showed that number of prescriptions, total medical treatment expenses, amounts paid by the insureds and the expenses to purchase drugs, respectively, were decreased. More than fifty percent(54.2%) of health centers responded that the relative importance of health works increased compared to medical treatments after the SPDP, and number of patients decreased compared to those in before the SPDP. And there was a drastic reduction in number of prescriptions, total medical treatment expenses, amounts paid by insureds, the expenses to purchase drugs after the SPDP. Above fifty percent(57.6%) of officers at health center responded that the function of medical treatment should be reduced after the SPDP. Fields requested improvement in health centers were 'development of heath works contents'(62.4%), 'rearrangement of health center personnel'(51.6%), 'priority setting for health works'(48.4%), 'restructuring the organization'(36.2%), 'quality impro­vement for medical services'(32.1%), 'replaning the budgets'(23.1%) in order. And to better the image of health centers, health center officers replied that 'health information management'(60.7%), 'public relations for health center'(15.8%), 'kindness of health center officers'(15.3%) were necessary in order. Health center officers suggested that 'vaccination program', 'health promotion', 'maternal and children health', 'communicable disease management', 'community health planning' were relatively important works, in order, performed by health center after SPDP. In the future, medical services in health centers should be cut down with a momentum of the SPDP so that health centers might reestablish their functions and roles as public health organizations, but quality of medical services must be improved. Also health centers should pay attention to residents for improving health through 'vaccination program', 'health promotion', 'mother-children health', 'acute and chronic communicable disease management', 'community health planning', 'oral health', 'chronic degenerative disease management', etc. And there should be a differentiation of relative importance between health promotion services and medical treatment services by character of areas(metropolitan, city, county).

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Comparison of Imposed Work of Breathing Between Pressure-Triggered and Flow-Triggered Ventilation During Mechanical Ventilation (기계환기시 압력유발법과 유량유발법 차이에 의한 부가적 호흡일의 비교)

  • Choi, Jeong-Eun;Lim, Chae-Man;Koh, Youn-Suck;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.3
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    • pp.592-600
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    • 1997
  • Background : The level of imposed work of breathing (WOB) is important for patient-ventilator synchrony and during weaning from mechanical ventilation. Triggering methods and the sensitivity of demand system are important determining factors of the imposed WOB. Flow triggering method is available on several modern ventilator and is believed to impose less work to a patient-triggered breath than pressure triggering method. We intended to compare the level of imposed WOB on two different methods of triggering and also at different levels of sensitivities on each triggering method (0.7 L/min vs 2.0 L/min on flow triggering ; $-1\;cmH_2O$ vs $-2cm\;H_2O$ on pressure triggering). Methods : The subjects were 12 patients ($64.8{\pm}4.2\;yrs$) on mechanical ventilation and were stable in respiratory pattern on CPAP $3\;cmH_2O$. Four different triggering sensitivities were applied at random order. For determination of imposed WOB, tracheal end pressure was measured through the monitoring lumen of Hi-Lo Jet tracheal tube (Mallincrodt, New York, USA) using pneumotachograph/pressure transducer (CP-100 pulmonary monitor, Bicore, Irvine, CA, USA). Other data of respiratory mechanics were also obtained by CP-100 pulmonary monitor. Results : The imposed WOB was decreased by 37.5% during 0.7 L/min on flow triggering compared to $-2\;cmH_2O$ on pressure triggering and also decreased by 14% during $-1\;cmH_2O$ compared to $-2\;cmH_2O$ on pressure triggering (p < 0.05 in each). The PTP(Pressure Time Product) was also decreased significantly during 0.7 L/min on flow triggering and $-1\;cmH_2O$ on pressure triggering compared to $-2\;cmH_2O$ on pressure triggering (p < 0.05 in each). The proportions of imposed WOB in total WOB were ranged from 37% to 85% and no significant changes among different methods and sensitivities. The physiologic WOB showed no significant changes among different triggering methods and sensitivities. Conclusion : To reduce the imposed WOB, flow triggering with sensitivity of 0.7 L/min would be better method than pressure triggering with sensitivity of $-2\;cm\;H_2O$.

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