• Title/Summary/Keyword: 호흡부전

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Tricespid Regurgitation Due to Rupture of a Chordae in Newborn -A Report of One Case (신생아에서의 건삭 파열에 의한 삼첨판 폐쇄 부전 -1례 보고-)

  • 김태이;이장훈
    • Journal of Chest Surgery
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    • v.30 no.9
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    • pp.927-931
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    • 1997
  • Tricuspid regurgitation due to rupture of a chorda is a rare disease in newborns. Recently, we experienced one day old male with tricuspid regurgitation due to rupture of a chorda of anterior papillary muscle, and who had suffered from severe hypoxemia, acidosis, cyanosis, and bradycardia. Preoperative diagnosis was pulmonary atresia with intact ventricular s ptum, massive tricuspid regurgitation, and patent ductus arteriosus by echocardiogram, which demonstrated no flow through the pulmonic valve. At operation, the pulmonic valve was intact and a chorda of anterior papillary muscle was ruptured. Tricuspid regurgitation was corrected successfully with reconstruction of the chords. Postoperative course was complicated by pneumonia and sepsis, but the infant recovered and discharged at postoperative 20 days.

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A Case of Kartagener's Syndrome Presenting as Respiratory and Right Heart Failures (호흡부전과 우심부전을 동반한 Kartagener 증후군 1예)

  • Yang, Suck-Chul;Lee, Kyung-Sang;Yoon, Ho-Joo;Shin, Dong-Ho;Park, Sung-Soo;Lee, Jung-Hee;Park, Choong-Ki
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.2
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    • pp.251-256
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    • 1996
  • Kartagener's syndrome, a congenital disease transmitted as an autosomal recessive illness with a prevalence of approximately 1:20,000 persons, is characterized by the triple association of situs inversus, bronchiectasis, and sinusitis. Affected persons have an incoordination of ciliary motility that leads to defective mucociliary transport, chronic bronchial infections. Kartagener's syndrome is a subset of the immotile cilia syndrome and therefore all patients with Kartagener's syndrome have immotile cilia with obvious ultrastructural defects in the ciliary axoneme. In the respiratory tract this inability presumably causes impaired clearance of mucus and inhaled particles and results in the chronic infections of the sinuses and bronchial trees that are characterized of the disease. The end-stage phenomenon in Kartagener's syndrome, respiratory or heart failure is a less common event and heart-lung transplantation is becoming an accepted therapy for patients with end-stage pulmonary disease in Kartagener's syndrome in many institutes. We report one case of Kartagener's syndrome in a 25-year-old young woman who was presented as respiratory and right heart failures, with review of literatures.

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Lateral Thoracic Expansion Surgery for Jeune's Syndrome (Jeune 증후군 환아에게 시행한 외측 흉벽 확장술)

  • Kim Joon Bum;Moon Il Hong;Choi Byung Min;Lee Kee Hyoung;Choi In Cheol;Park Seung Il
    • Journal of Chest Surgery
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    • v.38 no.12 s.257
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    • pp.873-877
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    • 2005
  • Jeune's asphyxiating thoracic dystrophy is a rare, complex malformation with a broad spectrum of clinical expression. The degree of chest wall deformity is the most important prognostic factor and the only part which is correctable. A 11 month-old male infant was diagnosed as having Jeune's syndrome and received right side lateral thoracic expansion surgery. But because respiratory distress symptom was sustained postoperatively, we performed left side procedure 3 months after the initial operation. Respiratory distress symptom got worse after fracturing the left titanium plate which was inserted to fix the expanded thoracic wall and reimplantation was performed. The patient was discharged 6 months after the initial operation. He was readmitted and received ventilator care for respiratory failure and died 10 months after the initial operation.

Clinical Efficacy of Pimobendan on Dogs with Chronic Mitral Valvular Diseases (만성 이첨판 폐쇄부전증 이환된 견에서 피모벤단의 임상적 효과)

  • Nam, So-Jeong;Park, In-Chul;Hyun, Chang-Baig
    • Journal of Veterinary Clinics
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    • v.26 no.1
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    • pp.17-22
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    • 2009
  • Pimobendan is a recently developed cardiac drug which is useful to control moderate to severe congestive heart failure (CHF) from chronic mitral valvular diseases (CMVI). Because of controversy related to the efficacy and safety of pimobendan in dogs, the optimal efficacy and safety of pimobendan was assessed in 20 dogs with CMVI in this study. Scores for quality of life, respiratory failure, circulatory failure and heart failure were evaluated along with radiographical and echocardiographical assessments for about 2 months period after the addition of pimobendan into the regular cardiac medications. This study proved clear evidence that pimobendan had beneficial therapeutic effects in dogs with advanced CMVI, without particular adverse effects. However, further studies are warranted to address the drug interaction with other cardiac therapeutics and to assess therapeutic effects in CHF from other type of heart diseases in dogs and other animals.

A Child of Severe Mycoplasma pneumoniae pneumonia with Multiple Organ Failure Treated with ECMO and CRRT

  • Hwang, Woojin;Lee, Yoonjin;Lee, Eunjee;Lee, Jiwon M.;Kil, Hong Ryang;Yu, Jae Hyeon;Chung, Eun Hee
    • Pediatric Infection and Vaccine
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    • v.26 no.1
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    • pp.71-79
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    • 2019
  • Mycoplasma pneumoniae (MP) is the most common causative agent of community-acquired pneumonia in school-aged children. An 8-year-old boy who had been diagnosed with autism looked severely ill when he presented to our hospital due to dyspnea and lethargy. He had fever and cough 7 days prior to hospitalization. He had signs and symptoms of severe respiratory distress. The percutaneous oxygen saturation was 88% at high oxygen supply. Chest radiography showed diffusely increased opacity with moderate pleural effusion. He was intubated immediately and admitted to the intensive care unit. Under the clinical impression of mycoplasmal pneumonia, intravenous clarithromycin was started. Laboratory findings showed leukocytosis, hepatitis, decreased renal function, and presence of serum MP immunoglobulin (Ig) M (+) IgG (+) and sputum MP polymerase chain reaction (+). On hospital day 2, the patient developed multiple organ failure with acute respiratory distress syndrome (ARDS). Veno-venous extracorporeal membrane oxygenation (ECMO) was performed with continuous renal replacement therapy (CRRT) and was weaned successfully. This is the first reported case of an ARDS due to MP infection complicated by multiple organ failure that was successfully treated with ECMO and CRRT in South Korea.

The Clinical Usefulness of Transbronchial Lung Biopsy in Critically III Patients with Pulmonary Infiltrates of Uncertain Etiology (폐 침윤과 호흡부전을 동반한 중환자에서 경기관지폐생검의 임상적 유용성에 관한 연구)

  • Jang, Eun-Ha;Koh, Youn-Suck;Shim, Tae-Sun;Lim, Chae-Man;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Go, Yun-Seok
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.2
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    • pp.236-245
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    • 2000
  • Background: Transbronchial lung biopsy(TBLB) has known to yield useful information for pulmonary infiltrates of uncertain etiology, However, its safety and usefulness have not been conclusive in the critically ill patients with respiratory failure. Moreover, TBLB has not been recommended for patients with mechanical ventilation. This study was conducted to investigate the diagnostic values and risks of Will performed on critically ill patients at bedside to obtain information on the pulmonary infiltrate of unknown etiology. Methods: Twenty patients(21 admissions with 23 cases) with diffuse pulmonary infiltrates who were treated in a medical intensive care unit of a tertiary referral hospital from January 1994 to May 1998, were enrolled for the study. Their medical records were retrospectively reviewed. TBLB was opted when a noninvasive diagnostic work-up failed to reveal the cause for the pulmonary infiltrate. The procedure was performed at patients' bedside without assistance of fluoroscopy. Bronchial washing or bronchoalveolar lavage was performed on the same pulmonary segment before performing TBLB. Results: Adequate specimens were obtained in 18 cases(78%). TBLB provided a specific diagnosis in two cases. The results of TBLB suggested the underlying etiology in 9 cases; bacterial pneumonitis(4), hypersensitivity pneumonitis(1), polymyositis(1), radiation fibrosis(1), idiopathic pulmonary fibrosis(1), and BOOP(1). Therapeutic decisions were altered in 11 cases(47.8%) based on the TBLB results. Pneumocystis carinii was found in the BAL fluid of another case. Ten patients with a therapeutic change and ten patients without a management change had mortality rates of 40% and 80%, respectively. The APACHE III scores were significantly higher in patients with complications($72.8{\pm}21.8$) compared with those without complications ($48.3{\pm}18.9$)(p<0.05). The complication rates were higher in those with mechanical ventilation(50%) than in those without Mechanical ventilation(33%), but the difference was not statistically significant(p=0.3). Conclusions: TBLB may be a useful diagnostic option for critically ill patients with unknown cause of pulmonary infiltrates. However, it should be cautious be used with care for patients with mechanical ventilation or for severely ill patients.

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The Usefulness of Noninvasive Positive Pressure Ventilation as a New Weaning Method (새로운 이탈방법으로서 비침습적 양압환기법의 유용성)

  • Shim, Tae-Sun;Koh, Youn-Suck;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Lim, Chae-Man
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.4
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    • pp.500-511
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    • 1999
  • Background: Noninvasive positive pressure ventilation (NPPV) using facial or nasal mask have been widely used for several years in stable patients with chronic neuromuscular disease or central alveolar hypoventilation, and recently have been tried in patients with acute respiratory failure. In a few studies, NPPV was also used to rescue the patients with post-extubation respiratory failure. However, yet it has not been adopted as a weaning method in patients on long-term mechanical ventilation. So we performed this prospective clinical study to evaluate the usefulness of NPPV as a weaning method after removing endotracheal tube intentionally in patients on long-term mechanical ventilation. Method: Twelve patients who had been on invasive mechanical ventilation over 10 days were enrolled and 14 trials of NPPV were done. All had failed at least one weaning trial and showed ventilator dependence(pressure support requirement between 8-15cm $H_2O$, and PEEP requirement between 5-10cm $H_2O$), so tracheostomy was being considered. After removing the endotracheal tube, NPPV was applied using facial mask. Respiratory rate, arterial blood gas, pressure support level, and PEEP level were monitored just before intended extubation, at 30 minutes, 1 to 6, 6 to 12, 12 to 24 hours, 2nd day, and 3rd day following initiation of NPPV, and just before weaning from NPPV. The successful weaning was defined as spontaneous breathing off the ventilator for 48 hours or longer without respiratory distress. Results: The weaning through NPPV after intended extubation was successful in 7(50%) of 14 trials, and tracheostomy could be avoided in them. There were no differences in age, sex, APACHE III score, duration of invasive mechanical ventilation, baseline respiratory rate, $PaCO_2$ $PaO_2/FiO_2$, and ventilatory requirement(PS and PEEP) between the success and failure groups. In the success group, respiratory rate, pH, $PaCO_2$, and $PaO_2/FiO_2$ were not different between invasive MV and NPPV period. But in the failure group, pH decreased after 30 minutes of NPPV initiation compared with that of invasive MV($7.40\pm0.08$ vs. $7.34\pm0.06$, p<0.05). The causes of failure were worsening of ABG(n=3), retained tracheal secretion(n=2), mask intolerance(n=1), and flail chest(n=1). Conclusion: NPPV may be worth trying as a bridge method in weaning patients on long-term invasive mechanical ventilation.

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The Effects of Training on the Proper Use of Respiratory Rate Measurement Devices for Providing High-Quality Artificial Ventilation

  • Jae-Ran Lim;Sung-Hwan Bang;Hyo-Suk Song;Gyu-Sik Shim;Ho-Jin Park
    • Journal of the Korea Society of Computer and Information
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    • v.29 no.3
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    • pp.165-171
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    • 2024
  • This study aims to investigate the appropriate volume of artificial ventilation and success rate when Basic - emergency medical Technician administer bag valve mask(BVM) artificial ventilation to patients experiencing respiratory failure or respiratory arrest using a respiratory rate measurement device. The research was conducted from December 11th to 12th, 2023, targeting 20 Basic - emergency medical Technicians enrolled at D University. Ten participants were selected for the experimental group, receiving BVM ventilation training with the use of a respiratory rate measurement device, while the other ten were assigned to the control group, receiving BVM ventilation training without the use of a respiratory rate measurement device. The experiment involved providing artificial ventilation for 2 minutes. The results of the study indicated that the control group did not provide accurate tidal volume (p=.025). The experimental group demonstrated a higher success rate of ventilation over the 2-minute period, while the control group showed a significant difference (p=.001). Subjective perception of tidal volume and objectively measured tidal volume also exhibited a significant difference in the control group (p=.010). Therefore, training with a respiratory rate measurement device can align the subjective perception of tidal volume with objective measurements, increase the success rate of ventilation, and potentially contribute to improving survival rates in patients experiencing respiratory failure or respiratory arrest during cardiopulmonary resuscitation.