• Journal of Korean Academy of Nursing
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• v.53 no.3
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• pp.275-294
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• 2023

Purpose: This study aimed to develop an evidence-based extracorporeal membrane oxygenation (ECMO) nursing protocol for critically ill patients receiving ECMO treatment by using an adaptation process, and to verify the effects of the protocol. Methods: The protocol was developed according to the adaptation guidelines. A non-randomized controlled trial was conducted to test the protocol's effects. Data were collected between April 2019 and March 2021. The differences in physiological indicators and complication rates between the two groups were investigated using a chart review to evaluate patient outcomes. The nurses' outcome variables were evaluated using a questionnaire. Results: First, after reviewing 11 guidelines by appraisal of the guidelines for research and evaluation collaboration II, 5 guidelines with a standardization grade of over 50 points were selected. An ECMO nursing protocol was developed based on these guidelines. Second, there were no statistically significant differences in physiological indicators between the two groups of patients. However, the experimental group showed a statistically significant decrease in the infection rate (p = .026) and pressure injury rates (p = .041). The levels of satisfaction with ECMO nursing care, and empowerment and performance of the nurses who used the ECMO nursing protocol were higher than those of nurses who did not (p < .001). Conclusion: This protocol may help prevent infections and pressure injuries in patients, and improve nurses' satisfaction and empowerment. The nursing protocol developed for critically ill patients receiving ECMO treatment can be utilized in evidence-based nursing practice.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1995.04a
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• pp.92.1-92
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• 1995

Weerdar 개폐식 후두경은 Kleinsasser 후두경과 Killian-Lynch 현가 후두경의 장점을 혼합하여 개발한 것으로서 광학장치, 흡인관, injection cannula 등을 후두경에 부착할 수 있다. 그리고 후두경 내강에 injection cannula를 장치하여 고빈도 제트환기법, 고빈도 진동법, 고빈도 양압환기법을 시행할 수 있다. 이 경우 기관내 삽관을 배제하여 cannula선단이 성대 위에 위치하기 때문에 성대의 후교련까지 시야를 확보할 수 있고, 후두경 양측에 넓은 틈이 있기에 수술조작이 용이하며, 레이저 사용시에 화재의 위험을 최소로 할 수 있다. 이에 성대수술시 cannula를 통한 제트환기 중 시간 경과에 따른 활력징후, 동맥혈산소화, 이산화탄소의 배출상태 변화를 관찰하였다. 그 결과 수슬시간 30분까지 동맥혈 산소분압의 감소나 이산화탄소 축적은 관찰되지 않았기에 30분 이내의 성대수술시 기관내 삽관없이도 시행할 수 있는 안전한 마취관리의 한 방법이라 생각한다.

• Clinical and Experimental Pediatrics
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• v.50 no.12
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• pp.1200-1205
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• 2007

Purpose : We performed this study to investigate the outcome of surfactant replacement therapy (SRT) in above nearterm neonates who were required mechanical ventilatory care due to meconium aspiration pneumonia (MAP), respiratory distress syndrome (RDS) or other severe pneumonia (PN). Methods : 48 patients, gestational period ${\geq}36weeks$, who were admitted in NICU of Dongsan Medical Center, Keimyung University between July 1999 and June 2004 were enrolled. They were divided into three groups, MAP group (15 cases), RDS group (27 cases) and PN group (6 cases). All patients were received SRT and evaluated several clinical data (gestational age, oxygen index, duration of ventilator care) and outcome (complications and mortality rate) between pre-SRT and post-SRT. The mean dose of surfactant (modified bovine surfactant, Newfacten, Yuhan Co., Seoul, Korea) was 120 mg/kg. Results : Among each groups, mean pre-SRT OI was higher in MAP group ($21{\pm}3.2$) than other groups, mean duration (days) of ventilatory care and oxygen therapy were similar distributions. Compared with pre-SRT values, significant improvements (P<0.05) in mean values for FiO2 and oxygenation index were documented at 12 hours after SRT. Early complications (persistent pulmonary hypertension of newborm, pneumothorax) and survival rate were lower in MAP group. Within RDS group, earlier SRT (given before 12 hours of life) revealed significantly lower early complication rate than later SRT (given after 12 hours of life) (13.3% vs 58.3%, P<0.05) Conclusion : Our study suggested that SRT seems to be an effective therapy in above nearterm neonates with severe pulmonary disease, and earlier SRT tends to reduce complications in RDS group than later therapy.

• Clinical and Experimental Pediatrics
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• v.48 no.6
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• pp.599-605
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• 2005

Purpose : The purpose of this study was to examine the causes, clinical courses and outcomes in children with acute respiratory distress syndrome(ARDS), and evaluate the physiologic variables as prognostic factors in the patients. Methods : Retrograde medical chart review was carried out in 24 patients who were diagnosed with ARDS at the pediatric intensive care unit(PICU) during 20-month period. Results : The incidence of ARDS among all PICU admission was 3.7 percent and the mortality rate was 37.5 percent, which was 14.8 percent of overall deaths in PICU. The most common causes of ARDS were pneumonia and sepsis. We found significant differences between survivors and nonsurvivors in $PaO_2/FiO_2$ ratio(P/F ratio), alveolar arterial oxygen gradient and oxygenation index(OI) on the second day from the onset of ARDS. Therapies for ARDS such as high frequency oscillator ventilation(HFOV), recruitment maneuver and low dose corticosteroid improved the P/F ratio and OI, especially in survivors. Conclusion : The mortality rate of children with ARDS was 37.5 percent; an important cause of death in PICU. HFOV, recruitment maneuver and low dose corticosteroid seemed to be effective in pediatric ARDS. The P/F ratio, alveolar arterial oxygen gradient and OI on the second day from the onset of ARDS may be useful as prognostic factors.

• Tuberculosis and Respiratory Diseases
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• v.45 no.6
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• pp.1223-1235
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• 1998

Background and Objective : Although prone positioning has been reported to improve gas exchange, prone positioning alone does not seem to be sufficient to increase systemic oxygen transport in an acute lung injury. The objective of this study was to investigate whether the combined therapy of low dose nitric oxide (NO) inhalation and prone positioning has an additive effect on the oxygenation and hemodynamics in patients with severe ARDS. Patients and Methods : Twelve patients with ARDS were included. Prone positioning alone, later combined with nitric oxide inhalation (5~10 ppm) from the supine position (baseline) were performed with serial measurement of gas exchange, respiratory mechanics and hemodynamic at sequential time points. The patient was regarded as a responder to prone positioning if an increase in $PaO_2/FiO_2$ of more than 20 mm Hg at 30 min or 120 min intervals after prone positioning was observed compared to that of the baseline. The same criterion was applied during nitric oxide inhalation. Results : Eight patients (66.5%) responded to prone positioning and ten patients (83.3%) including the eight just mentioned responded to the addition of NO inhalation. The $AaDO_2$ level also decreased promptly with the combination of prone positioning and NO inhalation compared to that of prone positioning alone ($191{\pm}109$ mm Hg vs. $256{\pm}137$ mm Hg, P<0.05). Hemodynamic parameters and lung compliance did not change significantly during prone positioning only. Following the addition of NO inhalation to prone positioning, the mean pulmonary artery pressure and pulmonary artery occlusion pressure decreased and cardiac output, stroke volume and oxygen delivery increased (P < 0.05) compared to those of prone 120 min. Conclusion : These findings indicate that NO inhalation would provide additional improvement in oxygenation and oxygen transport to mechanically ventilated patients with ARDS who are in a prone position.

• Tuberculosis and Respiratory Diseases
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• v.43 no.6
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• pp.987-996
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• 1996

Background : We prospectively evaluated the applicability and effect of noninvasive ventilation (NIV) in acute respiratory failure and tried to find out the parameters that could predict successful application of NIV. Methods : Twenty-six out of 106 patients with either acute ventilatory failure (VF: $PaCO_2$ > 43 mm Hg with pH < 7.35) or oxygenation failure (OF: $PaO_2/AO_2$ < 300 mm Hg with $pH{\geq}7.35$) requiring mechanical ventilation were managed by NIV (CPAP + pressure suppon, or BiPAP) with face mask. Eleven out of 19 cases with VF (57.9%) (M : F=7 : $55.4{\pm}14.6$ yrs) and 15 out of 87 cases with OF (17.2%) (M : F=12 : 3, $50.6{\pm}15.6$ yrs) were s uilable for NIY. Respiratory rates, arterial blood gases and success rate of NIV were analyzed in each group. Results: 81.8% (9/11) of YF and 40% (6/15) of OF were successfully managed on NIV and were weruled from mechanical ventilator without resorting to endotracheal intubation. Complications were noted in 2 cases (nasal skin necrosis 1, gaseous gastric distension 1). In NIV for ventilatory failure, the respiration rate was significantly decreased at 12 hour of NIV ($34{\pm}9$ /min pre-NIV, $26{\pm}6$ /min at 12 hour of NIV, p=0.045), while $PaCO_2$ ($87.3{\pm}20.6$ mm Hg pre-NIV, $81.2{\pm}9.1$ mm Hg at 24 hour of NIV) and pH ($7.26{\pm}0.04$, $7.32{\pm}0.02$, respectively, p <0.05) were both significantly decreased at 24 hour of NIV In NIV for oxygenation failure, $PaCO_2$ were not different between the successful and the failed cases at pre-NIV and till 12 hours after NIV. The $PaO_2/FIO_2$ ratio, however, significantly improved at 0.5 hour of NIV in successful cases and were maintained at around 200 mm Hg (n=6 : at baseline, 0.5h, 6h, 12h : $120.0{\pm}19.6$, $218.9{\pm}98.3$, $191.3{\pm}55.2$, $232.8{\pm}17.6$ mm Hg, respectively, p=0.0211), but it did not rise in the failed cases (n=9 : $127.9{\pm}63.0$, $116.8{\pm}24.4$, $100.6{\pm}34.6$, $129.8{\pm}50.3$ mm Hg, respectively, p=0.5319). Conclusion : From the above results we conclude that NIV is effective for hypercapnic respiratory failure and its success was heralded by reduction of respiration rale before the reduction in $PaCO_2$ level. In hypoxic respiratory failure, NIV is much less effective, and the immediate improvement of $PaO_2/FIO_2$ ratio at 0.5h after application is thought to be a predictor of successful NIV.

• Korean Journal of Materials Research
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• v.7 no.2
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• pp.93-101
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• 1997

Lead titanate박막을 $Pt/Ti/SiO_{2}/Si(Pt/Ti기판)와\;Pt/Ta/SiO_{2}/SiO_{2}$Si(Pt/Ta 기판) 위에서 전자 사이크로트론 공명플라즈마 화학증착법(ECR PECVD)으로 증착하였다. 증착온도, 산소유입량, MO source유입비등의 증착변수에 따른 lead titanate박막의 조성과 미세구조를 주사전자현미경(SEM), 투과전자현미경(TEM), X선 회절법(XRD)으로 조사하였다. 산소유입량이 적을 경우,Tisource와 Pb source의 산소화의 반응성 차이 때문에 Pb 농도가 부족한 화학양론비가 잘 맞는 박막이 증착되었다. Pt/ti기판은 lead titanate박막증착도중 기판의 Ti층과 Pt층의 확산으로 기판변형이 발생하는 반면, Pt/Ta기판은 기판변형이 일어나지 않았다. Pt/Ta기판에서 페롭스카이트 화학양론비를 갖는 매우 평탄한 lead titanate박막을 증착 하였는데, 산소유입량이 lead titanate박막의 결정성을 크게 지배하였다.

• Journal of the Korean Chemical Society
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• v.26 no.5
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• pp.340-348
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• 1982

The presence of 10 mole percent triphenyl borate accelerated dramatically the rate of reduction of structurally different sulfoxides with borane in tetrahydrofuran at room temperature, compared to the slow reduction with borane itself. Tetramethylene sulfoxide underwent complete reduction in 5 min and diethyl sulfoxide, dibenzyl sulfoxide and benzylphenyl sulfoxide were reduced quantitatively within 1h, whereas the reduction of diphenyl sulfoxide was rather slow, giving diphenyl sulfide in 90% yield in 24h. Boron trifluoride etherate and triethyl borate were less effective than triphenyl borate. A possible mechanism is presented.

• Journal of Korean Academy of Fundamentals of Nursing
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• v.17 no.1
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• pp.45-54
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• 2010

Purpose: The purpose of this study was to develop and test an explanatory model of dyspnea in patients with chronic lung disease (CLD). Methods: Participants were 181 patients with CLD, recruited from the outpatient pulmonary clinic of one university hospital in Korea. Data were collected using questionnaires, as well as measurement of 6-minute walking distance (6MWD), oxygen saturation ($SpO_2$), FEV1% predicted, and Body Mass Index (BMI). Results: The results indicated a good fit between the proposed dyspnea model and the collected data [$x^2$=91.27, p= .13, $x^2$/d.f.=1.17, Normal Fit Index= .934]. Oxygenation ($SpO_2$, = -.530), self-efficacy (= -.429), anxiety (= .253), depression (= .224), exercise endurance (6MWD, = -.211), and pulmonary function (FEV1% predicted, = -.178) had a direct effect on dyspnea (all p< .05) and these variables explained 74% of variance in dyspnea. BMI, smoking history, and social support had an indirect effect on dyspnea. Conclusion: The findings of this study suggest that comprehensive nursing interventions should focus on recovery of respiratory health and improvement of emotions, exercise ability, and nutritional status. From this perspective, pulmonary rehabilitation would be an effective strategy for managing dyspnea in patients with CLD.

• Child Health Nursing Research
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• v.4 no.2
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• pp.245-254
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• 1998

Prematurity is the main cause for respiratory disorders in neonates. The goal in respiratory management is to maintain respiration with adequate oxygenation. Chest vibration(CV) prior to on dotracheal suctioning(ETS) has been arbitrarily applied to ventilated premature infants without the scientific evaluation of its safety and efficacy. A repeated measure within subjects experimental study was conducted to investigate the effects of CV prior to 875 on oxygenation and lung secretions in twenty-one ventilated premature infants. The independent variable was the type of research protocol, the control type (275 without C.V) and t he intervention(ETS with CV). The dependent variables were oxygen saturation(SpO₂), heart rate (HR), measured by pulse oximeter, and the amount of lung secretions measured in gram. The results showed there was no difference in SpO₂ responses regardless CV employed before ETS. But there was a significant difference in HR responses between the control and the intervention, even without clinical significance. There was a significant difference in the amount of lung secretions retrieved during ETS with CV, compared to ETS without CV. This study suggested the safety of CV by demonstrating no clinically significant changes in SpO₂ and HR in premature infants. The efficacy of CV could be supported by the increases in the amount of sputum during ETS with CV compared to ETS without CV in premature infants.