• Title/Summary/Keyword: 이중 이탈

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Weaning Following a 60 Minutes Spontaneous Breathing Trial (1시간 자가호흡관찰에 의한 기계적 호흡치료로부터의 이탈)

  • Park, Keon-Uk;Won, Kyoung-Sook;Koh, Young-Min;Baik, Jae-Jung;Chung, Yeon-Tae
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.3
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    • pp.361-369
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    • 1995
  • Background: A number of different weaning techniques can be employed such as spontaneous breathing trial, Intermittent mandatory ventilation(IMV) or Pressure support ventilation(PSV). However, the conclusive data indicating the superiority of one technique over another have not been published. Usually, a conventional spontaneous breathing trial is undertaken by supplying humidified $O_2$ through T-shaped adaptor connected to endotracheal tube or tracheostomy tube. In Korea, T-tube trial is not popular because the high-flow oxygen system is not always available. Also, the timing of extubation is not conclusive and depends on clinical experiences. It is known that to withdraw the endotracheal tube after weaning is far better than to go through any period. The tube produces varying degrees of resistance depending on its internal diameter and the flow rates encountered. The purpose of present study is to evaluate the effectiveness of weaning and extubation following a 60 minutes spontaneous breathing trial with simple oxygen supply through the endotracheal tube. Methods: We analyzed the result of weaning and extubation following a 60 minutes spontaneous breathing trial with simple oxygen supply through the endotracheal tube in 18 subjects from June, 1993 to June, 1994. They consisted of 9 males and 9 females. The duration of mechanical ventilation was from 38 hours to 341 hours(mean: $105.9{\pm}83.4$ hours). In all cases, the cause of ventilator dependency should be identified and precipitating factors should be corrected. The weaning trial was done when the patient became alert and arterial $O_2$ tension was adequate($PaO_2$ > 55mmHg) with an inspired oxygen fraction of 40%. We conducted a careful physical examination when the patient was breathing spontaneously through the endotracheal tube. Failure of weaning trial was signaled by cyanosis, sweating, paradoxical respiration, intercostal recession. Weaning failure was defined as the need for mechanical ventilation within 48 hours. Results: In 19 weaning trials of 18 patients, successful weaning and extubation was possible in 16/19(84.2 %). During the trial of spontaneous breathing for 60 minutes through the endotracheal tube, the patients who could wean developed slight increase in respiratory rates but significant changes of arterial blood gas values were not noted. But, the patients who failed weaning trial showed the marked increase in respiratory rates without significant changes of arterial blood gas values. Conclusion: The result of present study indicates that weaning from mechanical ventilation following a 60 minutes spontaneous breathing with $O_2$ supply through the endotracheal tube is a simple and effective method. Extubation can be done at the same time of successful weaning except for endobronchial toilet or airway protection.

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The Synthesis, NMR Sepectrum and MO Theoretical Studies on MBBA and EBBA (MBBA와 EBBA의 합성 NMR 스펙트럼과 분자궤도함수론적 연구)

  • Kim, Ui Rak;Jeon, Mu Sik;Kim, Un Seop;Chae, Yeong Bok
    • Journal of the Korean Chemical Society
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    • v.18 no.4
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    • pp.239-243
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    • 1974
  • By means of NMR spectrum analysis of the synthesized MBBA and EBBA, it has been found that benzene rings of p-n-butylaniline in both MBBA and EBBA molecules do not conjugate with the central double bond and the benzene ring is twisted from molecular plane of N-(p-methoxy or ethoxy benzylidene) group. And as a result of MO studies, the minimum energy conformation is found for the conformation of $30^{\circ}$ twisted angle. One sees reasonable agreement between theory and experiment.

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A Comparison of Clinical Efficacy of Weaning Method Between the Mode of Intermittent Mandatory Ventilation and Intermittent Mandatory Ventilation Plus Pressure Support (기계적 호흡 치료로부터의 이탈방법으로서 Intermittent Mandatory Ventilation 단독 사용과 Pressure Support를 병용한 Intermittent Mandatory Ventilation의 비교)

  • Choi, Jeong-Eun;Koh, Youn-Suck;Cho, Won-Kyoung;Lim, Chae-Man;Kim, Woo-Sung;Park, Pyung-Hwan;Choi, Jong-Moo;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.41 no.4
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    • pp.372-378
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    • 1994
  • Background: Pressure support ventilation(PSV) is a new form of mechanical ventilatory support that assists spontaneous inspiraory effort of an intubated patient with a clinician-selected amount of positive airway pressure. Low level pressure support during inspiration can overcome the resistive component of inspiratory work imposed by an endotracheal tube. However the clinical efficacy of PSV as a weaning method has not been established yet. Object: The aim of study was to evaluate the efficacy of PSV when it is added to intermittent mandatory ventilation(IMV) in facilitating weaning precess compaired to IMV mode alone. Method: When the subject patients became clinically stable with their arterial blood gas analysis in acceptable range, they underwent weaning process either by IMV alone or by IMV plus PSV. The level of pressure support was held constant throught the weaning period. For the patients who required mechanical ventilation for less than 72 hr, 2h weaning trial was performed with IMV rate starting from 6/min. For the patients who required mechanical ventilation more than 72 hr, 7 hr weaning trial was performed with IMV rate starting from 8/min. For the patients who failed three consecutive trials of weaning, retrial of weaning was attempted over 3 days with IMV rate starting from 8/min. Clinical characteristics, APACHE II score and nutritional status were compared. For all patients, heart rate, mean blood pressure and respiratory rate were mornitored for 48 hrs after weaning trial started. Results: The total number of weaning trial was 37 in 23 patients(18 by IMV, 19 by IMV+PSV). Total ventilation time, APACHE II score and nutritional status were not statistically different between the two groups. The weaning success rate were not statistically different(38.3% by IMV, 42.1% by IMV+PSV) and the changes of mean blood pressure, heart rate, respiratory rate during first 48 hours were not different between the two groups. Conclusion: Low level PSV when added to IMV for weaning trial does not seem to improve the success rate of weaning from mechanical ventilation. PSV at 10cm $H_2O$ did not induce significant physiologic changes during weaning process.

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A Study on the Support of Intermediate Node Mobility by Double Paths in CCN Real-Time Services (CCN 실시간 서비스 간 이중 경로에 의한 중간노드 이동성 지원에 관한 연구)

  • Keum, Suk-Ju;Kwon, Tae-Wook
    • The Journal of the Korea institute of electronic communication sciences
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    • v.16 no.5
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    • pp.825-834
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    • 2021
  • With the development of various devices and Internet platforms, production and demand for content are increasing rapidly. However, effective response to exponentially increasing data usage is difficult in current TCP/IP schemes. As a result, with the emergence of an alternative called CCN, data can be transmitted and received from the host-centered to the content-oriented, and large-capacity content can be handled with more mitigated network resources. In this paper, we will address intermediate node mobility, which is one of the areas studied in CCN. In CCN, real-time services are a very important factor for information providers as well as requestors. However, when a node departure situation occurs, packet transmission and transmission speed decreases. Therefore, to ensure these numbers, even if the intermediate node deviates using a dual path, it provides a complete QoS (Quality of Service) using an alternative path.

Development of a Dynamic Offtracking Model on Horizontal Curve Sections (Based on Articulated Vehicles) (도로 평면곡선부에서 동적궤도이탈모형 개발에 관한 연구 (굴절차량을 중심으로))

  • 최재성;김우현
    • Journal of Korean Society of Transportation
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    • v.20 no.3
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    • pp.115-128
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    • 2002
  • Dislike the tangent sections, the horizontal curve sections of roads should be designed, considering several factors : one of such factors is widening. In other words, since widening results from that when a vehicle runs on the horizontal curve sections, the rear wheels of the vehicle run not along with tracks of the front wheels but out of that, such offtracking should be exactly investigated and reflected in design of the curve sections. Especially in the case of industrial roads which semi-trailers and large trucks run frequently or arterial roads with small curve radiuses in mountainous regions. serious offtracking Phenomenons result in increasing the risk of accidents. decreasing the capacities and jeopardizing pedestrians' safety on the curve sections. For the offtracking, widening amounts of roads has been determined under the traditional presumption that vehicles run at a low speed and there is no superelevation. In fact, however, since the vehicles run at a high speed as well as at a low speed and the superelevation is installed on the horizontal curve sections in the structural aspect of roads, the existing standards for installing widening have a limitation to reflect exactly actual Phenomenons. In particular, for articulated wheel axles of a tractor and a trailer and long articulated vehicles, not only the offtracking degree is very high but also the interpretation shows different aspects from one of single axles. Comparing and reviewing the results of Korean and foreign studies related to the trailer offtracking model theory and the standards for installing widening, this study developed a realistic dynamic offtracking model which considers geometric structures of roads and speeds of vehicles, suggested how to measure widening with this model and examined applicability of the model. The findings of this study are as follows ; First. a dynamic offtracking model. which considers dynamic movements of a tractor and a trailer and the superelevation, was developed. Second, a new method to measure widening with the developed dynamic offtracking model was developed and a method to measure widening with swept path width was suggested as well. Finally, validity of the current standards for installing widening was examined by determining actual offtracking and widening amounts with the developed model and the applicability was investigated through the case studies. Compared with the existing offtracking models, the dynamic offtracking model developed in this study can reflect practically vehicle speed. dimension and geometric structural aspects of roads. In conclusion, the meaning of this study is that it reviews validity of the current standards for installing widening and provides a base to establish such standards by suggesting new methods to measure the widening with this dynamic offtracking model.

a-SiGe:H 박막의 고상결정화에 따른 주요 결험 스핀밀도의 변화

  • 노옥환;윤원주;이정근
    • Proceedings of the Korean Vacuum Society Conference
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    • 2000.02a
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    • pp.78-78
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    • 2000
  • 다결정 실리콘-게르마늄 (poly-SiGe)은 태양전지 개발에 있어서 중요한 물질이다. 우리는 소량의 Ge(x=0.05)으로부터 다량의 Ge(x=0.67)을 함유한 수소화된 비정질 실리콘-게르마늄 (a-SiGe:H) 박막의 고상결정화 과정을 ESR (electron spin resonance)방법으로 조사해보았다. 먼저 PECVD 방법으로 Corning 1737 glass 위에 a-Si1-xGex:H 박막을 증착시켰다. 증착가스는 SiH4, GeH4 가스를 썼으며, 기판온도는 20$0^{\circ}C$, r.f. 전력은 3W, 증착시 가스압력은 0.6 Torr 정도이었다. 증착된 a-SiGe:H 박막은 $600^{\circ}C$ N2 분위기에서 다시 가열되어 고상결정화 되었고, 결정화 정도는 XRD (111) peak의 세기로부터 구해졌다. ESR 측정은 상온 x-band 영역에서 수행되었다. 측정된 ESR스팩트럼은 두 개의 Gaussian 함수로써 Si dangling-bond와 Ge dangling-bond 신호로 분리되었다. 가열 초기의 a-SiGe:H 박막 결함들의 스핀밀도의 증가는 수소 이탈에 기인하고, 또 고상결정화 과정에서 결정화된 정도와 Ge-db 스핀밀도의 변화는 서로 깊은 상관관계가 있음을 알 수 있었다. 특히 Ge 함유량이 큰 박막 (x=0.21, 0.67)에서 뿐만 아니라 소량의 Ge이 함유된 박막(x=0.05)에서도 Ge dangling-bond가 Si dangliong-bond 보다 고상결정화 과정에서 더 중요한 역할을 한다는 것을 알수 있었다. 또한 초기 열처리시 Si-H, Ge-H 결합에서 H의 이탈로 인하여 나타나는 Si-dangling bond, Ge-dangling bond 스핀밀도의 최대 증가 시간은 x 값에 의존하였는데 이러한 결과는 x값에 의존하는 Si-H, Ge-H 해리에너리지로 설명되어 질 수 있다. 층의 두께가 500 미만인 커패시터의 경우에 TiN과 Si3N4 의 계면에서 형성되는 슬릿형 공동(slit-like void)에 의해 커패시터의 유전특성이 파괴된다는 사실을 알게 되었으며, 이러한 슬릿형 공동은 제조 공정 중 재료에 따른 열팽창 계수와 탄성 계수 등의 차이에 의해 형성된 잔류응력 상태가 유전막을 기준으로 압축응력에서 인장 응력으로 바뀌는 분포에 기인하였다는 사실을 확인하였다.SiO2 막을 약화시켜 절연막의 두께가 두꺼워졌음에도 기존의 SiO2 절연막의 절연 파괴 전압 및 누설 전류오 비교되는 특성을 가졌다. 이중막을 구성하고 있는 안티퓨즈의 ON-저항이 단일막과 비교해 비슷한 것을 볼 수 잇는데, 그 이유는 TiO2에 포함된 Ti가 필라멘트에 포함되어 있어 필라멘트의 저항을 감소시켰기 때문으로 사료된다. 결국 이중막을 구성시 ON-저항 증가에 의한 속도 저하 요인은 없다고 할 수 있다. 5V의 절연파괴 시간을 측정한느 TDDB 테스트 결과 1.1$\times$103 year로 기대수치인 수십 년보다 높아 제안된 안티퓨즈의 신뢰성을 확보 할 수 있었다. 제안된 안티퓨즈의 이중 절연막의 두께는 250 이고 프로그래밍 전압은 9.0V이고, 약 65$\Omega$의 on 저항을 얻을수 있었다.보았다.다.다양한 기능을 가진 신소재 제조에 있다. 또한 경제적인 측면에서도 고부가 가치의 제품 개발에 따른 새로운 수요 창출과 수익률 향상, 기존의 기능성 안료를 나노(nano)화하여 나노 입자를 제조, 기존의 기능성 안료에 대한 비용 절감 효과등을 유도 할 수 있다. 역시 기술적인 측면에서도 특수소재 개발에 있어 최적의 나노 입자 제어기술 개발 및 나노입자를 기능성 소재로 사용하여 새로운 제품의 제조와 고압 기상 분사기술의 최적화에 의한 기능성 나노 입자 제조 기술을 확립하고 2차 오염 발생원인 유기계 항균제를 무기계 항균제로 대체할 수 있다. 이와 더불

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Factors Related to the Development of Myocardial Ischemia During Mechanical Ventilation (인공 호흡기 적용에 따른 심근 허혈의 발생에 관한 연구)

  • Kim, Tae-Hyung;Kim, You-Ho;Lim, Chae-Man;Kim, Won;Shim, Tae-Sun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Koh, Youn-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.5
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    • pp.645-653
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    • 1999
  • Introduction : Although myocardial ischemia tends to occur more frequently than can he documented in ventilated patients, it has not been well studied on the factors related to the occurrence of the ischemia. Methods : To investigate the related factors to ischemia development, a prospective study was done in 95 cases with consecutive 73 patients who had received mechanical ventilation(MV) in MICU. In addition to 24 h holter monitoring, echocardiogram, electrolytes, cardiac enzymes, hemodynamic, and gas exchange measurements were done within 24 h after initiation of MV in 69 cases. The measurements were repeated at weaning period in 26 cases. The ischemia was defined by the ST segment changes; up-sloping depression more than 1.5 mm or down-sloping or horizontal depression more than 1.0 mm from isoelectric baseline for 80 ms following J point. Results : Twelve patients(12.6% in 95 cases) developed ischemia in total. The incidence of ischemia development showed an increased tendency in the initial 24 hr after MV (15.9%) and in patients with left-sided heart failure found by echocardiogram (18.2%) compared with that of the weaning period (3.8%) and patients without heart failure (10.9%) (P=0.12, P=0.09, in each). There were no differences in APACHE III score, baseline ECG findings, electrolytes abnormalities, use of inotropics or bronchodilators, presence of sepsis or shock, mode of ventilation, and survival rate according to the development of ischemia. Maximal heart rates and mean arterial pressure also were not different between patients with ($137.2{\pm}30.9/min$, $82.5{\pm}15.9$ mm Hg) and without ischemia ($l29.5{\pm}29.7/min$, $83.8{\pm}17.6$ mm Hg). Conclusion : Although the incidence of myocardial ischemia was 12.6% in total, there were no clinically predictable factors to the development of ischemia during mechanical ventilation.

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Clinical Characteristics of Tuberculosis in North Korean Refugees (북한이탈주민에서의 결핵의 임상적 고찰)

  • Choi, Chang-Min;Jeong, Woo-Kyoung;Kang, Cheol-In;Kim, Doh-Hyung;Kim, Young-Keun;Heo, Sang-Taek;Kim, Hee-Jin
    • Tuberculosis and Respiratory Diseases
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    • v.60 no.3
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    • pp.285-289
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    • 2006
  • Background : North Korea's economic and public health problems began in the early 1990s as a result of the gradual loss of economic support from its communist allies, combined with an inordinate number of natural disasters. The decline in public health has increased the incidence of tuberculosis in North Koreans and refugees. This study investigated tuberculosis situation in North Korean refugees in order to prepare for the future impact of tuberculosis control in Korea. Material and Methods : From 2001 to 2005, tuberculosis patients among North Korean refugees who were diagnosed before or after arriving in South Korea, based on the official records of OO hospital, were enrolled in this study. The demographic and clinical data of the cases were evaluated retrospectively. Results : A total of 42 TB cases were reviewed during the study period. Of these, 37 (88.1%) cases were pulmonary TB. based on the cases identified among the number of North Korean refugees' arriving each year, the annual incidence of pulmonary TB were 900 per 100,000 in 2004, 700 in 2003, The number of smear-positive patients was 20 (47.6%) and the number of culture-positive patients was 18 (42.9%). Of the M. tuberculosis isolates, 2 cases were found to be susceptible to all anti-TB drugs available, 4 were resistant to isoniazid, and 3 were multi-drug resistant. Conclusion : The prevalence of pulmonary TB in North Korean Refugees is high. In addition, North Korean refugees suffer from more severe tuberculosis in bacteriological and radiological aspects.