• 제목/요약/키워드: 사강

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Tracheal gas insufflation (TGI) in patients with increased deadspace fraction: the effect and its determining factors (사강호흡율이 증가된 환자에서 기관내 가스주입법(Tracheal Gas Imsufflation)이 가스교환에 미치는 효과와 그 결정인자)

  • Lim, Chae Man;Jung, Bok Hyun;Koh, Youn Suck;Lee, Sang Do;Kim, Woo Sung;Park, Pyung Hwan;Kim, Dong Soon;Kim, Won Dong
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.1
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    • pp.136-145
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    • 1997
  • Background : Tracheal Gas Insufflation (TGI) is one of the newer ancillary measures in mechanical ventilation employed to enhance carbon dioxide elimination. TGI exerts its effect through reduction of deadspace ventilation, but the factors determining its effect are not well studied yet. Method : The subjects were seven mechanically-ventilated patients ($58.8{\pm}10.6$ yrs) who showed increased physiologic deadspace greater than 60%. After 30 nun of stabilization with 100% oxygen on pressure control ventilation, continuous flow TGI was administered via the insufflation lumen of Hi-Lo Jet Tracheal Tube (Mallincrodt, USA) for 15 min at 3 L/min and 5 L/min each. Results : $PaCO_2$ was decreased ($51.4{\pm}17.6$ at baseline, $49.1{\pm}18.9$ at TGJ 3 L/min $45.0{\pm}14.9$ mm Hg at TGI 5 L/min, p=0.050), and pH was increased ($7.37{\pm}0.12$, $7.38{\pm}0.13$, $7.39{\pm}0.12$, respectively, p=0.037) while mixed expired $CO_2$ ($P_ECO_2$) was not changed significantly from baseline (p=0.336) by TGI. Physiologic deadspace(Vdphy) was decreased ($73.0{\pm}7.9$% at baseline, $69.8{\pm}10.0$% at TGI 3 L/min, and $67.1{\pm}10.1$% at TGI 5 L/min, p=0.015). $AaDO_2$(p=0.147), Vt(p=0.2140), Pmean(p=0.7788) and mean arterial pressure(p=0.4169) were not changed. The correlation between % maximal decrease of Vdphy were r=0.790 with the ratio of baseline Vdana/Vdphy(p=0.035) and r=-0.754 with baseline Vdalv(p=0.050). Conclusion: TGI was effective in reducing $PaCO_2$ and deadspace, and the deadspace-reducing effect was best correlated with baseline anatomic/physiologic deadspace ratio.

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Acellular Dermal Matrix for Wound with Large Dead Space in 3 Dogs (개의 큰 사강을 갖는 창상에서 무세포성 진피기질의 적용 3례)

  • Youp, Kyoung-A;Byeon, Ye-Eun;Lee, Sun-Tae;Kim, Hee-Jung;Cho, Ji-Young;Kweon, Oh-Kyeong;Kim, Jin-Young;Kang, Ke-Won;Kim, Wan-Hee
    • Journal of Veterinary Clinics
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    • v.27 no.3
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    • pp.299-301
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    • 2010
  • An acellular human dermal matrix (ADM) was applied to wounds from dogs with significant dead space and delayed healing. This treatment is typically effective for the treatment of wounds with subcutaneous dead space and injuries between muscular planes. The size of the dead space defect and the amount of wound discharge decreased rapidly with ADM treatment in the present study. The average time to disappearance of the dead space defect was 10 days. In addition, complications including severe inflammation were not seen in this case report.

Tide and Sediment Transport in the Keum River Estuary (사강하구의 조석 및 토사이동)

  • 최병호;강경구;이석우
    • Journal of Korean Society of Coastal and Ocean Engineers
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    • v.1 no.1
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    • pp.31-43
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    • 1989
  • Tidal asymmetry and the associated sediment dynamics in the Keum River Estuary has been investigated from a numerical tidal model. Modeling efforts were focussed on the simulation of large drying sandflat exposed at the mouth of the Estuary and dynamic combination of two-dimensional estuary model and one-dimensional river model. Despite strong frictional attenuation within the estuary, the M4 tides reach significant amplitude, resulting in strong tidal distortion. Model results show that the asymmetry over the area exhibit more intense flood flows transport than do less intense ebb flows of longer duration. This causes filling of the estuary as evidenced by large sandflats spread over the inner area. The spatial distribution of peak bottom stress computed from the tidal model suggest that present tidal sedimentation regime may be altered significantly, especially in the approach channel to outer Kunsan port and downstream part of the dike, due to the construction of cross-channel barrier.

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Treatment of Dead Space with Prolonged Air-leak after Lobectomy by Artificial Pneumoperitoneum -A case report- (인공기복으로 치료한 폐엽절제후 발생된 사강과 공기누출 -1례 보고-)

  • 이응석;윤용한;백완기;손국희;김광호;안승익
    • Journal of Chest Surgery
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    • v.34 no.7
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    • pp.578-581
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    • 2001
  • We successfully treated a 59-year-old male with adenocarcinoma in the right lower lobe who had developed a dead space with prolonged air-leak, which continued for 21 days after lower and middle lobectomy, by creating artificial pneumoperitoneum. He had a history of subtotal gastrectomy due to stomach cancer 5 years ago. Artificial pneumoperitoneum was made after introducing a peritoneal dialysis catheter into the right upper quardrant. The chest tube was removed 14 days after creating pneumoperitoneum.

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Pleurodesis with Autologous Blood Plus Sclerosing Agents (자가혈과 늑막유착제를 이용한 늑막유착술 -치험 2례 보고-)

  • 송종필;이종호;김병열;이정호;강경민
    • Journal of Chest Surgery
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    • v.32 no.1
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    • pp.92-95
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    • 1999
  • The patients with prolonged air leak after lung resection surgery were generally treated by pleurodesis with sclerosing agents such as talc, tetracyclin, doxycyclin, bleomycin, vibramycin, and OK432. However, for the case like dead space resulted by incomplete reexpansion of the remaining lung, chemical pleurodesis has shown to be not as effective as expected. If the patients keep the chest tube for long period of time, the risk of thoracic empyema would increase. Most thoracic surgeons have experienced prolonged airleak which developed after lung resection. Pleurodesis with autoblood was reported as an effective method in treatment of patients with prolonged airleak. The mechanism of blood pleurodesis may be direct obliteration of BPF and reduction of dead space by clot. Therefore we successfully treated the two patients with prolonged airleak using the autoblood plus OK432 or vibramycin.

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Comparison of Gas Exchange Parameters between Same Volume of $N_2-O_2$ and Heliox Inhalation (동일한 상시 호흡량의 $N_2-O_2$ 및 Heliox 투여 시 가스교환지표의 비교)

  • Sohn, Jang-Won;Lim, Chae-Man;Koh, Youn-Suck;Lee, Jong-Deog;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.1
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    • pp.169-175
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    • 1998
  • Background: Heliox is known to decrease $PaCO_2$ in patients with increased airway resistance by increasing minute ventilation and reducing work of breathing(WOB). Besides these effect, heliox is expected to decrease functional anatomic dead space owing to improvement of peak expiratory flow rate(PEFR) and enhancement of gas distribution. We investigated whether heliox can decrease $PaCO_2$ even at the same minute ventilation (VE) and WOB with $N_2-O_2$ to speculate the effect of the heliox on the anatomic dead space. Material and Method: The subjects were 8 mechanically ventilated patients with asthma or upper airway obstruction(M : F=5 : 3, $68{\pm}10$years) who were under neuromuscular paralysis. The study was consisted of three 15-minutes phases: basal $N_2-O_2$ heliox and washout Heliox was administered via the low pressure inlet of servo 900C, and respiratory parameters were measured by pulmonary monitor(CP-100 pulmonary monitor, Bicore, Irvine, CA, USA). To obtain the same tidal volume(Vt) in heliox phase, the Vt on monitor was adjusted by the factor of relative flow rate of heliox to $N_2-O_2$. Dead space was calculated by Bohr equation. Results: 1) Vt, VE, peak inspiratory pressure(PIP) and peak inspiratory flow rate(PIFR) were not different between $N_2-O_2$ and heliox. 2) PEFR was higher on heliox($0.52{\pm}0.19$L/sec) than $N_2-O_2$($0.44{\pm}0.13$L/sec)(p=0.024). 3) $PaCO_2$(mmHg) were decreased with heliox($56.1{\pm}14.1$) compared to $N_2-O_2$($60.5{\pm}15.9$)(p=0.027). 4) Dead space ventilation(%) were decreased with heliox($73{\pm}9$ with $N_2-O_2$ and $71{\pm}10$ with heliox)(p=0.026). Conclusion: Heliox decreased $PaCO_2$ even at the same VE and WOB with $N_2-O_2$, and the effect was considered to be related with the reduction of anatomic dead space.

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Treatment of Prolonged Air-leak after Bilobectomy by Artificial Pneumoperitoneum (폐엽절제 후 발생한 지속적 공기누출의 인공기복에 의한 치료)

  • 조성준;이성호
    • Journal of Chest Surgery
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    • v.35 no.12
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    • pp.902-905
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    • 2002
  • Pulmonary resection often leaves a pleural space problem that can cause prolonged air leaks. We describe a patient with lung cancer undergoing a right middle and lower lobectomy complicated by prolonged air leaks. He had a history of pulmonary tuberculosis and COPD. Artificial pneumoperitoneum was made by instillation of air via a small central vein catheter into the left lower quadrant on postoperative day(POD) 21. The air leak ceased on POD 23 and the chest tube was removed on POD 25.