• Title/Summary/Keyword: 호흡역학

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The Effect of Pressure Support on Respiratory Mechanics in CPAP and SIMV (CPAP 및 SIMV Mode하에서 Pressure Support 사용이 호흡역학에 미치는 효과)

  • Lim, Chae-Man;Jang, Jae-Won;Choi, Kang-Hyun;Lee, Sang-Do;Koh, Youn-Suck;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Park, Pyung-Whan;Choi, Jong-Moo
    • Tuberculosis and Respiratory Diseases
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    • v.42 no.3
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    • pp.351-360
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    • 1995
  • Background: Pressure support(PS) is becomimg a widely accepted method of mechanical ventilation either for total unloading or for partial unloading of respiratory muscle. The aim of the study was to find out if PS exert different effects on respiratory mechanics in synchronized intermittent mandatory ventilation(SIMV) and continuous positive airway pressure (CPAP) modes. Methods: 5, 10 and 15 cm $H_2O$ of PS were sequentially applied in 14 patients($69{\pm}12$ yrs, M:F=9:5) and respiratory rate (RR), tidal volume($V_T$), work of breathing(WOB), pressure time product(PTP), $P_{0.1}$, and $T_1/T_{TOT}$ were measured using the CP-100 pulmonary monitor(Bicore, USA) in SIMV and CPAP modes respectively. Results: 1) Common effects of PS on respiratory mechanics in both CPAP and SIMV modes As the level of PS was increased(0, 5, 10, 15 cm $H_2O$), $V_T$ was increased in CPAP mode($0.28{\pm}0.09$, $0.29{\pm}0.09$, $0.31{\pm}0.11$, $0.34{\pm}0.12\;L$, respectively, p=0.001), and also in SIMV mode($0.31{\pm}0.15$, $0.32{\pm}0.09$, $0.34{\pm}0.16$, $0.36{\pm}0.15\;L$, respectively, p=0.0215). WOB was decreased in CPAP mode($1.40{\pm}1.02$, $1.01{\pm}0.80$, $0.80{\pm}0.85$, $0.68{\pm}0.76$ joule/L, respectively, p=0.0001), and in SIMV mode($0.97{\pm}0.77$, $0.76{\pm}0.64$, $0.57{\pm}0.55$, $0.49{\pm}0.49$ joule/L, respectively, p=0.0001). PTP was also decreased in CPAP mode($300{\pm}216$, $217{\pm}165$, $179{\pm}187$, $122{\pm}114cm$ $H_2O{\cdot}sec/min$, respectively, p=0.0001), and in SIMV mode($218{\pm}181$, $178{\pm}157$, $130{\pm}147$, $108{\pm}129cm$ $H_2O{\cdot}sec/min$, respectively, p=0.0017). 2) Different effects of PS on respiratory mechanics in CP AP and SIMV modes By application of PS (0, 5, 10, 15 cm $H_2O$), RR was not changed in CPAP mode($27.9{\pm}6.7$, $30.0{\pm}6.6$, $26.1{\pm}9.1$, $27.5{\pm}5.7/min$, respectively, p=0.505), but it was decreased in SIMV mode ($27.4{\pm}5.1$, $27.8{\pm}6.5$, $27.6{\pm}6.2$, $25.1{\pm}5.4/min$, respectively, p=0.0001). $P_{0.1}$ was reduced in CPAP mode($6.2{\pm}3.5$, $4.8{\pm}2.8$, $4.8{\pm}3.8$, $3.9{\pm}2.5\;cm$ $H_2O$, respectively, p=0.0061), but not in SIMV mode($4.3{\pm}2.1$, $4.0{\pm}1.8$, $3.5{\pm}1.6$, $3.5{\pm}1.9\;cm$ $H_2O$, respectively, p=0.054). $T_1/T_{TOT}$ was decreased in CPAP mode($0.40{\pm}0.05$, $0.39{\pm}0.04$, $0.37{\pm}0.04$, $0.35{\pm}0.04$, respectively, p=0.0004), but not in SIMV mode($0.40{\pm}0.08$, $0.35{\pm}0.07$, $0.38{\pm}0.10$, $0.37{\pm}0.10$, respectively, p=0.287). 3) Comparison of respiratory mechanics between CPAP+PS and SIMV alone at same tidal volume. The tidal volume in CPAP+PS 10 cm $H_2O$ was comparable to that of SIMV alone. Under this condition, the RR($26.1{\pm}9.1$, $27.4{\pm}5.1/min$, respectively, p=0.516), WOB($0.80{\pm}0.85$, 0.97+0.77 joule/L, respectively, p=0.485), $P_{0.1}$($3.9{\pm}2.5$, $4.3{\pm}2.1\;cm$ $H_2O$, respectively, p=0.481) were not different between the two methods, but PTP($179{\pm}187$, $218{\pm}181 cmH_2O{\cdot}sec/min$, respectively, p=0.042) and $T_1/T_{TOT}$($0.37{\pm}0.04$, $0.40{\pm}0.08$, respectively, p=0.026) were significantly lower in CPAP+PS than in SIMV alone. Conclusion: PS up to 15 cm $H_2O$ increased tidal volume, decreased work of breathing and pressure time product in both SIMV and CPAP modes. PS decreased respiration rate in SIMV mode but not in CPAP mode, while it reduced central respiratory drive($P_{0.1}$) and shortened duty cycle ($T_1/T_{TOT}$) in CPAP mode but not in SIMV mode. By 10 em $H_2O$ of PS in CPAP mode, same tidal volume was obtained as in SIMV mode, and both methods were comparable in respect to RR, WOB, $P_{0.1}$, but CPAP+PS was superior in respect to the efficiency of the respiratory muscle work (PTP) and duty cycle($T_1/T_{TOT}$).

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The Effects of Breathing Control on Kinetic Parameters of Lower Limbs during Walking Motion in Korean Dance (한국무용 걸음체 동작 시 호흡의 사용유무가 하지의 운동역학적 변인에 미치는 영향)

  • Park, Yang-Sun;Jang, Ji-Young
    • Korean Journal of Applied Biomechanics
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    • v.19 no.4
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    • pp.627-636
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    • 2009
  • This study aims to provide a scientific basis for the abstract beauty of dance by analyzing the effects of controlling the breath during the walking motion of Korean dance. The objective of the study is to determine the significance of breathing during Korean dance, as it is externally expressed and technologically segmented, let alone the internal beauty of Korean dance. The results of this study show that the position of the body center and ASIS during the walking motion that uses breath was lower than that of the walking motion that does not use the breath. In addition, in each replacement of the knee joint and ankle joint, a narrow angle, in which bending is used a lot, appeared during the walking motion that uses the breath, but not during the walking gesture that does not use the breath. This occurred during the bending motion. In the first peak point, the vertical ground reaction force during the walking motion that uses the breath was higher than that during the walking motion that does not use the breath.

A Review on Soil Respiration Measurement and Its Application in Korea (토양호흡의 측정과 국내 연구 현황에 대한 고찰)

  • Lee, Eun-Hye;Lim, Jong-Hwan;Lee, Jae-Seok
    • Korean Journal of Agricultural and Forest Meteorology
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    • v.12 no.4
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    • pp.264-276
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    • 2010
  • The objectives of this study were to introduce the methods of soil respiration measurement, to review soil respiration studies conducted in Korea, and to suggest potential issues generated from using various methods for soil respiration measurement. According to the measurement principles, the methods of soil respiration measurements are classified as: alkali absorption method (AA), closed chamber method (CC), closed dynamic chamber method (CDC), and open flow method (OF). Based on the litereaure review on soil respiration studies in Korea, the CDC method was mostly used by the researchers (62%), followed by the AA (17%), OF (13%) and CC (8%) methods. Along with these methods, various instruments were used such as LI-6400-09, EGM-3, EGM-4, and automatic soil respiration chamber. Most of the soil respiration measurements were carried out in forest ecosystems and the reported soil respiration showed a wide range of variations from 130 to 900 mg $CO_2\;m^{-2}h^{-1}$. Continuous monitoring of soil respiration with minimal disturbance and the potential inconsistency in measurements are still the challenges facing the researchers, causing a paucity in quality datasets of sufficient quantity. Few attempts of intercomparison among different methods hinder the data users from synthetic analysis and assessment of the collected datasets. In order to better estimate soil carbon budget and understand their exchange mechanisms in key ecosystems of Korea, it is necessary to measure soil respiration at various plant functional types, soils, and climate conditions over a decadal time scale along with the study on the partitioning of soil respiration into autotrophic and heteorotrophic components.

The Respiratory and Hemodynamic Effect of Prone Position in Patients with ARDS (급성호흡부전증후군에서 Prone Position의 호흡 및 혈류역학적 효과)

  • Lim, Chae-Man;Koh, Youn-Suck;Jung, Bok-Hyun;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.5
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    • pp.1105-1113
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    • 1997
  • Background : Prone position improves oxygenation in some patients with ARDS. According to some authors, prone position can also improve the deteriorated hemodynamics induced by PEEP. But these respiratory and hemodynamic effects of prone position has not yet been fully established. Methods : Twentythree consequtive patients with ARDS(M : F= 11 : 12, $62.1{\pm}20.8yrs$) were the subjects for this study. ABGA, static compliance of the respiratory system, mean arterial pressure and pulse rate were obtained in supine position and at 5min, 0.5h and 2h of prone position. Positive respiratory response was defined as 20mmHg or more increase in $PaO_2/FIO_2$ within 2h of prone position. Early of late respiratory responses were defined if the positive response was observed within of after 3 day of ARDS onset, respectively. Positive hemodynamic response was defined as 10mmHg or more increase in mean arterial pressure at 5min of prone position. Results : Fifteen patients (65%) showed positive respiratory response. In the respiratory responders, $PaO_2$ was $69.8{\pm}17.6mmHg$ in supine position, $83.2{\pm}22.6mmHg$ in prone position 0.5h, $96.8{\pm}22.7mmHg$ in prone position 2h(p<0.001), and $PaO_2/FIO_2$ was $108{\pm}41mmHg$, $137{\pm}57mmHg$, $158{\pm}50mmHg$, respectively(p=0.001). Age, sex, cause of ARDS, supine $PaO_2$ and $PaO_2/FIO_2$ were not different between the respiratory responders and the nonresponders. The respiratory responders, however, showed higher mean arterial pressure than the nonresponders($91.1{\pm}13.1mmHg$ vs. $76.0{\pm}18.7mmHg$, p=0.035), and tendency of higher survival rate(9/15 vs. 2/8, p=0.074). Static compliance of the respiratory system was decreased in prone position 0.5h($28.4{\pm}7.9ml/cm$ $H_2O$ vs. $23.8{\pm}7.6ml/cm$ $H_2O$, p=0.007). The overall rate of early response(n=23) and late response(n=11) were similar(14/23 vs. 7/11, p>0.05). But patient without early response showed late response only in 25%(1/4), while patient with early response showed late response in 85.7%(6/7)(p=0.072). Five patients(22%) showed positive hemodynamic response, two of them being respiratory nonresponders. There were no differences in the baseline mean arterial pressure or the level of PEEP applied in supine between the hemodynamic responders and the hemodynamic nonresponders. Conclusions : Prone position either improved oxygenation or increased arterial pressure in significant proportion of patients with ARDS. And the respiratory response to prone position was thought to be determined in the early stage of ARDS.

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Kinetic Analysis of Proficiency in the Use of the Breathing of Korea Dance Movement (한국무용 동작 시 호흡사용의 숙련도에 따른 운동역학적 분석)

  • Na, An-Suk
    • The Journal of the Korea Contents Association
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    • v.14 no.9
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    • pp.131-140
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    • 2014
  • The purpose of this study was to kinetic analysis of using the skill of breathing korean dance movement will be to perform. To achieve the research objectives cheoyongmu Nakhwayousu the operation was performed. The selection of subjects like the following: Five people were skilled use of breathing and five unskilled person. The results are as follows. The skilled and the unskilled were no significant differences in the duration time. And the skilled and the unskilled z-axis position of the center of mass, there was a significant difference (p<.05). The skilled and the unskilled y-axis velocity of the center of mass, there was a significant difference of event 1 and event 4 (p<.05). And z-axis velocity of the center of mass, there was a significant difference of event 3 (p<.05). And the skilled and the unskilled Fx of GRF, there was a significant difference of event 2 and event 4 (p<.05). And Fy of GRF, there was a significant difference of event 1 and event 5 (p<.05). And Fz of GRF, there was a significant difference of event 4 (p<.05).

Comparison of Respiratory Mechanics and Gas Exchange Between Pressure-controlled and Volume-controlled Ventilation (압력조절환기법과 용적조절환기법의 호흡역학 몇 가스교환의 비교)

  • Jeong, Seong-Han;Choi, Won-Jun;Lee, Jung-A;Kim, Jin-A;Lee, Mun-Woo;Shin, Hyoung-Shik;Kim, Mi-Kyeong;Choe, Kang-Hyeon
    • Tuberculosis and Respiratory Diseases
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    • v.46 no.5
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    • pp.662-673
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    • 1999
  • Background : Pressure-controlled ventilation (PCV) is frequently used recently as the initial mode of mechanical ventilation in the patients with respiratory failure. Theoretically, because of its high initial inspiratory flow, pressure-controlled ventilation has lower peak inspiratory pressure and improved gas exchange than volume-controlled ventilation (VCV). But the data from previous studies showed controversial results about the gas exchange. Moreover, the comparison study between PCV and VCV with various inspiration : expiration time ratios (I : E ratios) is rare. So this study was performed to compare the respiratory mechanics and gas exchange between PCV and VCV with various I : E raitos. Methods : Nine patients receiving mechanical ventilation for respiratory failure were enrolled. They were ventilated by both PCV and VCV with various I : E ratios (1 : 2, 1 : 1.3 and 1.7 : 1). $FiO_2$, tidal volume, respiratory rate and external positive end-expiratory pressure (PEEP) were kept constant throughout the study. After 20 minutes of each ventilation mode, arterial blood gas, airway pressures, expired $CO_2$ were measured. Results : In both PCV and VCV, as the I : E ratio increased, the mean airway pressure was increased, and $PaCO_2$ and physiologic dead space fraction were decreased. But P(A-a)$O_2$ was not changed. In all three different I : E ratios, peak inspiratory pressure was lower during PCV, and mean airway pressure was higher during PCV. But $PaCO_2$ level, physiologic dead space fraction and P(A-a)$O_2$ were not different between PCV and VCV with three different I : E ratios. Conclusion : There was no difference in gas exchange between PCV and VCV under the same tidal volume, frequency and I : E ratio.

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발성치료

  • 남도현
    • Proceedings of the KSLP Conference
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    • 2003.11a
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    • pp.215-218
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    • 2003
  • 발성치료는 약400여년간 내려오고 있는 성악발성법 (벨칸토 발성)을 이용하여 음성을 교정하고 치료하는 방법으로 과학적이고 의학적으로 인정된 방법을 통하여 음성을 교육하고 교정하는 약물적이고 비 수술적인 치료 방법이다. 음성크리닉검사 1) 공기역학검사(Phonatory function analyzer test) 2) 최대발성지속시간(Maximum phonation time) 3) 컴퓨터 음성검사(Dotor speech. MDVP) 4) 듣기평가 5) 내시경검사(Stroboscopy) 6) 전기성문파형검사(EGG) 7) 호흡근력검사. (MIP. MEP. 등)및 호흡검사(FVC. FEVI. PF. 등) 8) 음성전문의사의 확진 후 발성치료권유 (중략)

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The Comparison of Work of Breathing Between Before Extubation and After Extubation of Endotracheal Tube (기계 호흡 치료후 기관내관 제거 전후 호흡 일(Work of Breathing)의 비교)

  • Jung, Bock-Hyun;Koh, Youn-Suck;Lim, Chae-Man;Choe, Kang-Hyeon;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.2
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    • pp.329-337
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    • 1997
  • Background : Since endotracheal tube is the most important factor involved in the imposed work of breathing during mechanical ventilation, extubation of endotracheal tube is supposed to reduce respiratory work of patient. However, some patients show labored breathing after extubation despite acceptable blood gases. We investigated the changes of work of breathing before and after extubation and the factors involved in the change of WOB after extubation. Methods : The subjects were 34 patients(M : F = 20 : 14, mean age = $61{\pm}17yre$) who recovered from respiratory failure after ventilatory support and were considered to be ready for extubation. The patients with clinical or radiologic evidences of upper airway obstruction before endotracheal intubation for mechanical ventilation were excluded. Vital sign, physical examination, chest X-ray, work of breathing and other respiratory mechanic indices were measured prior to, immediately, 6, 24 and 48 hours after extubation serially. Definition of weaning failure after extubation was resumption of ventilatory support or reintubation of endotracheal tube within 48 hour after extubation because of respiratory failure. The patients were classified into group 1(decreased work of breathing), group 2(unchanged work of breathing) and group 3(increased work of breathing) depending on the statistical difference in the change of work of breathing before and after extubation. Results : Work of breathing decreased in 33%(11/34, group 1), unchanged in 41%(14/34, group 2) and increased in 26%(9/34, group 3) of patients after extubation compared with before extubation. Weaning failure occurred 9%(1/11) of group, 1, 28.6%(4/14) of group 2 and 44%(4/9) of group 3 after extubation(p = 0.07). The change of work of breathing after extubation was positively correlated with change of mean airway resistance(mRaw). (r = 0.794, p > 0.01). In three cases of group 3 whose respiratory indices could be measured until 48 hr after extubation, the change in work of breathing paralleled with the sequential change of mRaw. The work of breathing was peaked at 6 hr after extubation, which showed a tendency to decrease thereafter. Conclusions : Reversible increase of work of breathing after extubation may occur in the patients who underwent extubation, and the increase in mRaw could be responsible for the increase in work of breathing. In addition, the risk of weaning failure after extubation may increase in the patients who have increased WOB immediately after extubation.

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The Effect of External PEEP on Work of Breathing in Patients with Auto-PEEP (Auto-PEEP이 존재하는 환자에서 호흡 일에 대한 External PEEP의 효과)

  • Chin, Jae-Yong;Lim, Chae-Man;Koh, Youn-Suck;Park, Pyung-Whan;Choi, Jong-Moo;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.2
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    • pp.201-209
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    • 1996
  • Background : Auto-PEEP which develops when expiratory lung emptying is not finished until the beginning of next inspiration is frequently found in patients on mechanical ventilation. Its presence imposes increased risk of barotrauma and hypotension, as well as increased work of breathing (WOB) by adding inspiratory threshold load and/or adversely affecting to inspiratory trigger sensitivity. The aim of this study is to evaluate the relationship of auto-PEEP with WOB and to evaluate the effect of PEEP applied by ventilator (external PEEP) on WOB in patients with auto-PEEP. Method : 15 patients, who required mechanical ventilation for management of acute respiratory failure, were studied. First, the differences in WOB and other indices of respiratory mechanics were examined between 7 patients with auto-PEEP and 8 patients without auto-PEEP. Then, we applied the 3 cm $H_2O$ of external PEEP to patients with auto-PEEP and evaluated its effects on lung mechanics as well as WOB. Indices of respiratory mechanics including tidal volume ($V_T$), repiratory rate, minute ventilation ($V_E$), peak inspiratory flow rate (PIFR), peak expiratory flow rate (PEFR), peak inspiratory pressure (PIP), $T_I/T_{TOT}$, auto-PEEP, dynamic compliance of lung (Cdyn), expiratory airway resistance (RAWe), mean airway resistance (RAWm), $p_{0.1}$, work of breathing performed by patient (WOB), and pressure-time product (PTP) were obtained by CP-100 Pulmonary Monitor (Bicore, USA). The values were expressed as mean $\pm$ SEM (standard error of mean). Results : 1) Comparison of WOB and other indices of respiratory mechanics in patients with and without auto-PEEP : There was significant increase in WOB ($l.71{\pm}0.24$ vs $0.50{\pm}0.19\;J/L$, p=0.007), PTP ($317{\pm}70$ vs $98{\pm}36\;cm$ $H_2O{\cdot}sec/min$, p=0.023), RAWe ($35.6{\pm}5.7$ vs $18.2{\pm}2.3\;cm$ H2O/L/sec, p=0.023), RAWm ($28.8{\pm}2.5$ vs $11.9{\pm}2.0cm$ H2O/L/sec, p=0.001) and $P_{0.1}$ ($6.2{\pm}1.0$ vs 2.9+0.6 cm H2O, p=0.021) in patients with auto-PEEP compared to patients without auto-PEEP. The differences of other indices including $V_T$, PEFR, $V_E$ and $T_I/T_{TOT}$ showed no significance. 2) Effect of 3 cm $H_2O$ external PEEP on respiratory mechanics in patients with auto-PEEP : When 3 cm $H_2O$ of external PEEP was applied, there were significant decrease in WOB ($1.71{\pm}0.24$ vs $1.20{\pm}0.21\;J/L$, p=0.021) and PTP ($317{\pm}70$ vs $231{\pm}55\;cm$ $H_2O{\cdot}sec/min$, p=0.038). RAWm showed a tendency to decrease ($28.8{\pm}2.5$ vs $23.9{\pm}2.1\;cm$ $H_2O$, p=0.051). But PIP was increased with application of 3 cm $H_2O$ of external PEEP ($16{\pm}2$ vs $22{\pm}3\;cm$ $H_2O$, p=0.008). $V_T$, $V_E$, PEFR, $T_I/T_{TOT}$ and Cdyn did not change significantly. Conclusion : The presence of auto-PEEP in mechanically ventilated patients was accompanied with increased WOB performed by patient, and this WOB was decreased by 3 cm $H_2O$ of externally applied PEEP. But, with 3 cm $H_2O$ of external PEEP, increased PIP was noted, implying the importance of close monitoring of the airway pressure during application of external PEEP.

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A comparison study of the characteristics of pauses and breath groups during paragraph reading for normal female adults with and without voice disorders (정상성인 여성 화자와 음성장애 성인 여성 화자의 문단 낭독 시 휴지 및 호흡단락 특성의 비교)

  • Pyo, Hwa Young
    • Phonetics and Speech Sciences
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    • v.11 no.4
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    • pp.109-116
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    • 2019
  • This study was conducted to identify the characteristics of pauses and breath groups made by normal adults and patients with voice disorders while reading a paragraph. Forty normal female adults and forty female patients with a functional voice disorder (18-45 yrs.) read the "Gaeul" paragraph with the "Running Speech" protocol of the Phonatory Aerodynamic System (PAS), by which the pauses with or without inspiration and between or within syntactic words and breath groups were analyzed. The number of pauses with inspiration was found to be higher in the patient group, but the number of pauses without inspiration was higher in the normal group. The rate of syntactic word boundaries with pauses with inspiration was higher in the patient group, while the number of syllables per breath group was higher in the normal group. As these results can be explained by patients' poor breath support due to glottal insufficiency, the question of whether voice disorder patients use their pauses and breath groups properly should be considered carefully in evaluation and intervention.