• Tuberculosis and Respiratory Diseases
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• v.46 no.3
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• pp.350-362
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• 1999

Background: Acute Respiratory failure which is developed after extubation in the weaning process from mechanical ventilation is an important cause of weaning failure. Once it was developed, endotracheal reintubation has been done for respiratory support. Noninvasive Positive Pressure Ventilation (NIPPV) has been used in the management of acute or chronic respiratory failure, as an alternative to endotracheal intubation, using via nasal or facial mask. In this study, we evaluated the usefulness of NIPPV as an alternative method of reintubation in patients who developed acute respiratory failure after extubation. Method: We retrospectively analyzed thirty one patients(eighteen males and thirteen females, mean ages $63\pm13.2$ years) who were developed acute respiratory failure within forty eight hours after extubation, or were extubated unintentionally at medical intensive care unit(MICU) of Asan Medical Center. NIPPV was applied to the patients. Ventilatory mode of NIPPV, level of ventilatory support and inspiratory oxygen concentration were adjusted according to the patient condition and results of blood gas analysis by the attending doctors at MICU. NIPPV was completely weaned when the patients maintained stable clinical condition under 8 $cmH_2O$ of pressure support level. Weaning success was defined as maintenance of stable spontaneous breathing more than forty eight hours after discontinuation of NIPPV. Respiratory rate, heart rate, arterial blood gas analysis, level of pressure support, and level of PEEP were monitored just before extubation, at thirty minutes, six hours, twenty four hours after initiation of NIPPV. They were also measured at just before weaning from NIPPV in success group, and just before reintubation in failure group. Results: NIPPV was successfully applied to thirty-one patients of thirty-two trials and one patient could not tolerated NIPPV longer than thirty minutes. Endotracheal reintubation was successfully obviated in fourteen patients (45%) among them. There was no difference in age, sex, APACHE III score on admission at MICU, duration of intubation, interval from extubation to initiation of NIPPV, baseline heart rate, respiratory rate, arterial blood gas, and $PaO_2/FiO_2$ between the success and the failure group. Heart rate and respiration rate were significantly decreased with increase $SaO_2$ after thirty minutes of NIPPV in both groups(p<0.05). However, in the patients of failure group, heart rate and respiratory rate were increased again with decrease in $SaO_2$ leading to endotracheal reintubation. The success rate of NIPPV treatment was significantly higher in the patients with COPD compared to other diseases(62% vs 39%) (p=0.007). The causes of failure were deterioration of arterial blood gas without aggravation of underlying disease(n=9), aggravation of undelying disease(n=5), mask intolerance(n=2), and retained airway secretion(n=l). Conclusion: NIPPV would be a useful therapeutic alternative which can avoid reintubation in patient who developed acute respiratory failure after extubation.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1996.04a
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• pp.204-204
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• 1996

모체의 당뇨병은 신생아 호흡부전 증후군의 중요한 소인의 하나이며, 이것은 태아의 폐성숙이 지연되어 폐포를 안정화시키는 표면활성물질의 결여에 기인하는 것으로 알려져 있다. 폐의 표면활성물질은 지질과 소량의 단백으로 이루어진 복합물질로서 그 주성분은 phosphatidyl choline이며 동물의 종속에 관계없이 임신 말기에 그 양이 현저히 증가한다. 양수내 인지질은 주로 태아 폐에서 유래하므로 임신 말기의 양수내 lecithin/sphingomyelin(L/S)비 측정으로 태아의 호흡부전 증후군을 예측할 수 있다. 일반적으로 당뇨병 모체의 양수는 L/S비가 낮아 당뇨병 산모로 부터 출생한 신생아에서 호흡부전증의 발생빈도가 높으므로 이를 예방하기 위하여 부신피질호르몬의 투여가 고려되고 있다.

• 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.

• Journal of Chest Surgery
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• v.37 no.12
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• pp.1015-1018
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• 2004

Lymphangioleiomyomatosis (LAM) is a rare disease in women in childbearing age leading to progressive respiratory failure. LAM is characterized by an abnormal harmartomatous proliferation of smooth muscle cells surrounding the blood vessels, lymphatics and airways in the lung. This proliferation leads to airway obstruction, cystic alveolar change and lymphatic obstruction. Patients present with dyspnea, pneumothorax, cough, chest pain, hemoptysis, and chylous effusion. Although lung transplantation is the only therapeutic modality in end-stage LAM with respiratory failure, there has not been any report of successful treatment in Korea. We report one case of successful left single lung transplantation in a 40 year old woman suffering from end-stage LAM.

• Tuberculosis and Respiratory Diseases
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• v.64 no.1
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• pp.44-47
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• 2008

Gefitinib를 사용할 경우 발생할 수 있는 급성호흡부전은 주로 남성, 흡연자, 편평상피세포암 혹은 사이성 폐질환 등에서 발생하는 것으로 알려져 있다. 따라서 이와 같은 임상적 요인이 없는 경우 이 약제를 안전하게 사용할 수 있을 것이다. 연구자 등은 흡연한 적이 없고, EGFR 유전자의 19번 엑손 돌연변이를 보였던 47세 여성 선암 환자에서 gefitinib 투여 후 발생한 급성호흡부전을 보고하며, 부작용의 발생기전이 밝혀지지 않은 시점에서, 이들 임상적 특성을 보이는 환자에서도 호흡기계 부작용의 발생 가능성에 대한 임상의사의 주의를 촉구하는 바이다.

• 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.

• The Korean Chronic Disease News
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• no.84
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• pp.7-7
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• 1988

• Tuberculosis and Respiratory Diseases
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• v.61 no.6
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• pp.562-566
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• 2006

Fat embolism syndrome is a rare clinical diagnosis of dyspnea with acute respiratory failure and neurological signs caused by a traumatic long bone fracture. We report a case of fat embolism in a 22 year-old man after a traffic accident. Dyspnea and stuporous mental changes developed on the $1^{st}$ day after the external fixation operation of a left metaphyseal femur fracture. On the following day, he was transferred from a hospital to this one because of acute respiratory failure. After recovery, macrophages with fat droplets were found in the bronchoalveolar lavage fluid 1. It is important to diagnose a fat embolism as the correct cause of acute respiratory failure through the BAL in the acute state of fat embolism syndrome It is believed that clinically apparent or sometimes hidden fat embolism syndrome can be diagnosed from the BAL during the recovery state.

• Journal of Yeungnam Medical Science
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• v.10 no.1
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• pp.1-17
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• 1993

고빈도 환기법은 최근에 개발되어 임상에 응용되면서 호흡생리학, 마취학, 집중치료의 학등의 분야에서 호흡부전의 새로운 치료법으로 관심이 집중되고 있는 환기법이다. 현재까지 고빈도 환기법중 고빈도 양압 환기와 제트 환기는 비교적 많은 연구가 되고 있고 임상적으로 사용되고 있으나 고빈도 진동 환기법은 제한적으로 사용되고 있다. 앞으로 고빈도 진동 환기법에 대해서도 더 많은 연구가 되어야 할 것이다. 또한 최근 개발되고 있는 고빈도 흉벽 진동 환기와 체표면 진동 환기에도 관심을 기울이면 호흡부전 환자의 치료에 바람직한 새로운 환기법이 될 수 있을 것으로 기대된다. 현재 고빈도 환기법의 몇몇 적용형태는 기관지-늑막루등의 폐압손상으로 인한 병변의 치료외에도 기관수술, 흉부수술, 뇌수술에서 수술부위의 움직임을 최소화시키면서 충분한 가스교환율 이룩할 수 있어서 효과적으로 이용되고 있다. 그러나 응급심폐소생술, 폐쇄성 폐질환, 성인 또는 영아 호흡곤란증후군등과 같은 질환에서의 적용은 더 규명되어져야겠다. 고빈도 환기법의 여러가지 문제점중 적절한 환기빈도의 결정, 충분한 습도를 공급하는 장치, 고빈도 환기의 정확한 감시장치의 개발등은 앞으로 우선적으로 해결해야 할 문제점이다. 또한 임상에 더욱 효과적으로 응용될 수 있는 새로운 환기법이 되기 위해서는 고빈도 환기법의 호흡생리와 안정성등에 관한 연구도 병행되어야겠다.

• 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.