• Tuberculosis and Respiratory Diseases
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• 제81권4호
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• pp.319-329
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• 2018

Background: Bronchoalveolar lavage (BAL) is a necessary procedure for diagnosis of various lung diseases. High-flow nasal cannula (HFNC) oxygen delivery was recently introduced. This study aimed to investigate the safety and effectiveness of HFNC oxygen supply during BAL procedure in patients with acute respiratory failure (ARF). Methods: Patients who underwent BAL while using HFNC at a partial pressure of oxygen in arterial blood/fraction of inspired oxygen ($PaO_2/FiO_2$; PF) ratio of 300 or below among patients who had been admitted from March 2013 to May 2017 were retrospectively investigated. Results: Thirty-three BAL procedures were confirmed. Their baseline PF ratio was $166.1{\pm}46.7$. $FiO_2$ values before, during, and after BAL were $0.45{\pm}0.12$, $0.74{\pm}0.19$, and $0.57{\pm}0.14$, respectively. Flow (L/min) values before, during, and after BAL were $26.5{\pm}20.3$, $49.0{\pm}7.2$, and $40.8{\pm}14.2$, respectively. Both $FiO_2$ and flow during and after the procedure were significantly different from those before the procedure (both p<0.001). Oxygen saturation levels before, during, and after BAL measured by pulse oximeter were $94.8{\pm}2.9$, $94.6{\pm}3.5$, and $95.2{\pm}2.8%$, respectively. There were no significant differences in oxygen saturation among the three groups. Complications of BAL procedure included transient hypoxemia, hypotension, and fever. However, there was no endotracheal intubation within 24 hours. Baseline PF ratio in "without HFNC" group was significantly higher than that in "with HFNC" group. There were no differences in complications between the two groups. Conclusion: The use of HFNC during BAL procedure in ARF patients was effective and safe. However, there were no significant differences in oxygen saturation level and complications comparing "without HFNC" group in mild ARF. More studies are needed for moderate to severe ARF patients.

• Tuberculosis and Respiratory Diseases
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• 제48권2호
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• pp.210-222
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• 2000

한국산 잡견 11마리를 대상으로 자가 혈병을 이용한 급성 폐색전증을 만들고 ET 수용체 길항제를 투여하여 다음과 같은 결과를 얻었다. 1. 혈병 투여후 폐동맥압은 상승하였고 심박출량은 감소하였으며 페혈관 저항은 증가하였다. 동맥혈 산소분압과 혼합 정맥혈의 산소 분압이 감소하였고 사강호흡이 증가하였고 생리적 단락이 증가하였으나 전신혈압은 변동이 없었다. 모든 측정치는 수용체 길항제 투여군과 대조군간에 차이를 보이지 않았다. 2. ET-1 수용체 길항제 투여후 전신혈압, 동맥 및 혼합정맥혈산소 분압, 동정맥 단락, 및 사강호흡의 정도는 두군간에 차이를 보이지 않았으나, 폐동맥압, 심박출량, 폐혈관 저항은 길항제 투여 30분후부터 수용체 길항제 투여군과 대조군간에 차이를 보이기 시작하여 210분후까지 지속되었다. 3. ET-1의 농도는 색전전(Baseline)에 비하여 색전후 동맥혈, 혼합정맥혈, 및 그 비(동맥혈/혼합정맥혈)가 증가를 보였고, 수용체 길항제 투여후 투여군에서는 대조군에 비해 ET-1의 농도 증가가 의미 있게 높았다. 4. 면역조직화학염색상에서 폐색전증이 유발된 개의 폐혈관 및 폐조직에서 색전을 투여하지 않은 정상 개의 조직에 비해 ET-1의 발현이 증가되었다. 5. Northern blot 상에서 폐색전이 일어난 폐조직의 preproET-1 mRNA 발현은 색전이 일어나지 않은 개의 폐조직에 비하여 증가되었다.

• Journal of Trauma and Injury
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• 제18권2호
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• pp.81-86
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• 2005

Background: Cardiac troponin I (cTnI) is a sensitive cardiac marker of myocardial injury. In normal coronary angiogram, positive cTnI values may be detected in various events such as sepsis, stroke, trauma and so on. To investigate characteristics of cTnI positive group in trauma patients, we designed this study between cTnI positive group and cTnI negative group. Method: Trauma patients who visited emergency room within 24 hours after accidents were included. Patients who had renal failure, acute coronary syndrome, sepsis, spontaneous SAH were excluded. Retrospective study of 97 trauma patients was done. We investgated ISS (injury severity score), positive cTnI, EKG abnormality, shock class, ICU admission rate and mortality. Result: In comparing with non chest trauma group, chest trauma group, whose chest AIS (Abbreviated Injury Score) is more than 3 point, had significant values in ISS, positive cTnI, EKG abnormality, shock class and ICU admission rate. Also, in non chest trauma group, we found several patients whose cTnI level was positive. When non chest trauma group was divided into two subgroups, the mortality and shock class of positive cTnI group were higher than that of negative cTnI group. When all trauma patients were divided into two groups, a positive cTnI group had higher values in ISS, shock class, ICU admission rate and mortality than that in a negative cTnI group. Conclusion: We found that cTnI were positive in patients of cardiac contusion but also in various trauma cases. In non chest trauma patients, we assumed that hypotension caused cTnI elevating. The cTnI could play a role in predicting prognosis in trauma patients.

• The Korean Journal of Pain
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• 제11권2호
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• pp.241-246
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• 1998

Background: Opioids and local anesthetics have been administered epidurally for the purpose of the postoperative analgesia. However opioids have a serious risk of respiratory depression and local anesthetics have the risks of hypotension, sensory block, or motor one. In recent years, reports of spinal administration of midazolam for acute postoperative pain control have appeared in the literature. This study was performed to observe the effect of epidural midazolam in patient-controlled analgesia (PCA) device. Methods: Forty-five patients scheduled for the elective total hysterectomy were randomly selected; epidurally take morphine only (group I, n=15), morphine plus 0.1% bupivacaine (group II, n=15), or morphine plus midazolam (group III, n=15). The visual analogue scale (VAS) at rest and with movement, the sedation score, the degree of the satisfaction, the total amounts of a morphine usage, and the incidence of the side effects were observed. Rusults: The VAS at rest of group II and III were decreased significantly than that of group I. The VAS with movement of group III was significantly decreased than that of group I and II. The sadation score and the cumulative dose of a morphine were statistically insignificant within groups. Conclusion: Epidural morphine plus midazolam was proven to be clinically effective in the post-operative pain control especially for the pain with movement, compared with epidural morphine only and morphine plus 0.1% bupivacaine.

• 대한임상독성학회지
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• 제8권1호
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• pp.24-29
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• 2010

Purpose: Neonicotinoid insecticides are widely used as they have been proven by experimental studies to have low toxicity to mammals, including humans. As the use of neonicotioids increases, the number of patients with neonicotinoid poisoning has also increased. We conducted a study to investigate the clinical manifestations of neonicotinid poisoning. Methods: We retrospectively analyzed the patients who ingested neonicotinids and who visited the emergency department located in Korea from March 2002 to February 2010. We reviewed the patients' age, gender, the amount of exposure, the elapsed time to presentation, the treatment and the outcome. According to the poisoning severity score, we divided the patients with a Poisoning severity score (PSS) of 0 or 1 into the mild/moderate toxicity group and the patients with a PSS of 2 or 3 into the severe/fatal toxicity group. Results: A total of 24 patients were analyzed. The most common clinical manifestations of neonicotinoid insecticide toxicity were gastrointestinal symptoms (66.7%) such as nausea, vomiting and abdominal pain and the others are respiratory symptoms (16.7%), cardiovascular symptoms (12.5%), metabolic imbalance (12.5%), renal dysfunction (8.3%), CNS symptoms (8.3%), and asymptomatic (29.2%). Twenty patients (83.3%) showed mild/moderate toxicity and 4 patients (16.7%) showed fatal conditions such as shock and mutiorgan failure. The mortality rate was 4.2%. In these fatal cases, the patients developed respiratory failure, hypotension, altered mentality and renal failure at the acute stage and they deteriorated to a more serious condition. This severe toxicity was caused by decreased renal excretion of neonicotinid metabolite, and this was improved after hemodialysis. Conclusion: Most patients with neonicotinoid poisoning and who showed mild toxicity usually improved after symptomatic treatment. However, some patients showed significant toxicity with respiratory failure and renal function deterioration, and intensive care needed, including mechanical ventilation and hemodialysis.

• 대한소화기학회지
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• 제72권6호
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• pp.308-312
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• 2018

Percutaneous endoscopic gastrostomy (PEG) is widely used to provide nutritional support for patients with dysphagia and/or disturbed consciousness preventing oral ingestion, and PEG tube placement is a relatively safe and convenient non-surgical procedure performed under local anesthesia. However, the prevention of PEG-insertion-related complications is important. A 64-year-old man with recurrent pneumonia underwent tracheostomy and nasogastric tube placement for nutritional support and opted for PEG tube insertion for long-term nutrition. However, during the insertion procedure, needle puncture had to be attempted twice before successful PEG tube placement was achieved, and a day after the procedure his hemoglobin had fallen and he developed hypotension. Abdominal computed tomography revealed injury to a pancreatic branch of the superior mesenteric artery (SMA) associated with bleeding, hemoperitoneum, and pancreatitis. Transarterial embolization was performed using a microcatheter to treat hemorrhage from the injured branch of the SMA, and the acute pancreatitis was treated using antibiotics and supportive care. The patient was discharged after an uneventful recovery. Clinicians should be mindful of possible pancreatic injury and bleeding after PEG tube insertion. Possible complications, such as visceral injuries or bleeding, should be considered in patients requiring multiple puncture attempts during a PEG procedure.

• 대한응급의학회지
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• 제29권5호
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• pp.500-508
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• 2018

Objective: The aim of this study was to evaluate the clinical characteristics of heat stroke in a bath facility and investigate predictive factors of multiple major complications in heat stroke patients. Methods: This was a retrospective study on heat stroke patients who visited an urban emergency center from January 2010 to March 2018. We compared clinical characteristics, complication, and outcomes of heat stroke patients in bath and non-bath facilities. Multivariate logistic regression analysis were performed to identify independent predictors of multiple major complications in heat stroke patients. Results: A total of 67 heat stroke patients with heat stroke were enrolled, of which 42 (62.6%) were in a bath facility and 25 (37.3%) were in a non-bath facility. Patients with heat stroke in the bath facility were characterized by old age, past medical history of hypertension and diabetes mellitus, and high incidence of hypotension compared with those in the non-bath facility but also low incidence of acute renal failure, seizure, and multiple major complications. In the multivariate analysis, predictive factors of multiple major complications in heat stroke patients were non-bath facility (odds ratio [OR], 5.4; 95% confidence interval [CI], 1.2-29.9), Glasgow Coma Scale (GCS)${\leq}8$ (OR, 8.2; 95% CI, 1.3-49.4), and mean arterial pressure (MAP), body temperature above $40.5^{\circ}C$ (OR, 8.1; 95% CI, 1.1-58.8) <60 mmHg (OR, 14.8; 95% CI, 1.8-122.9). Conclusion: Heat stroke in the bath facility resulted in less major complications, and high body temperature, GCS ${\leq}8$, and MAP <60 mmHg were independent predictive factors of multiple major complications in heat stroke patients.

• Pediatric Infection and Vaccine
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• 제28권2호
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• pp.66-81
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• 2021

코로나바이러스감염증-19는 전 세계적으로 유행하고 있으며, 2021년 7월 15일 기준으로 1.88억명 이상의 확진자와 406만명 이상의 사망자가 발생하였다. 소아청소년에서는 성인에 비해 비교적 중증 감염 발생이 낮으나, 일부에서는 SARS-CoV-2 감염 약 2-6주후소아다기관염증증후군(multisystem inflammatory syndrome in children, MIS-C)라는 합병증이 발생할 수 있다. MIS-C는 어린영아부터 청소년까지 다양한 연령에서 발생할 수 있으며, 발열을 포함하여 다양한 장기와 관련된 증상을 보일 수 있다. 소화기 및 신경계 증상이 흔하며, 많은 경우 가와사키병과 유사한 피부점막증상 등이 나타난다. 특히 심장관련 증상으로 좌심실 기능저하, 심근염 등이 나타날 수 있으며, 관상동맥확장 및 관상동맥류가 나타날 수 있다. 경우에 따라 저혈압, 쇼크를 동반하며, 중환자실 치료 및 기계환기요법을 요하나, 적절한 치료 후 대체로 회복을 보이는 것으로 보고된다. 이와 같이 MIS-C는 소아청소년에서 SARS-CoV-2 이후 드물게 발생하는 중요한 합병증으로, 임상증상을 잘 인지하고 조기에 적절한 치료를 하는 것이 중요하다. 이에 본 종설에서는 MIS-C의 역학 및 임상 증상, 추정되는 병태생리, 진단적 접근 및 치료에 대해 다루고자 한다.

• Tuberculosis and Respiratory Diseases
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• 제43권2호
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• pp.201-209
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• 1996

연구배경: Auto-PEEP 혹은 intrinsic PEEP은 호기말에 폐용적이 전체 호흡기계의 이완 용적으로 돌아오지 않음으로써, 증가된 호흡기계의 탄성반도압만큼 호기말 폐포내압(alveolar pressure) 이양의 값을 보이는 것을 말한다. Auto-PEEP 이 존재하는 만성폐쇄성폐질환 환자에게 externa1 PEEP을 적용하면 환자의 호흡 일을 줄일 수 있어서, 질환의 급성악화시 혹은 기계호흡으로부터의 이탈시 환자의 자발호흡을 보조하기 위한 요법으로 제시되고 있다. 이에 기계호흡중인 환자에서 auto-PEEP의 존재가 호흡 일에 미치는 영향을 알아보고, externa1 PEEP의 사용이 auto- PEEP에 의해 증가된 호흡 일을 줄이는지를 알아보기 위해 본 연구를 시행하였다. 방법: 호흡부전으로 기계호흡을 하고 있는 환자 15명을 대상으로 연구가 이루어 졌으며, 이들 7명에서 auto-PEEP이 관찰되었고(auto-PPEP군) 8명에서 auto-PEEP이 auto-PEEP군). 양군 간의 환자의 호흡역학적 지표의 차이를 조사하였으며, auto-PEEP이 존재하는 환자들에 대해 3cm $H_2O$의 external PEEP을 적용한 뒤 호흡역학적 지표들의 변화를 조사하였다. 호흡역학적 지표는 상시호흡량(tidal volume, 이하 $V_T$), 분당 호흡수, 분당환기량 (minute ventilation 이하 $V_E$), 최고흡기유량(peak inspiratory flow rate, 이하 PIFR), 최고호기유행peak expiratory flow rate, 이하 PEFR), 최고흡기압(peak inspiratory pressure, 이하 PIP), $T_I/T_{TOT}$, auto-PEEP, 폐 동적탄성 (dynamic compliance of lung, 이하 Cdyn), 호기 기도저항(expiratory airway resistance, 이하 RAWe), 평균 기도저항(mean airway resistance, 이하 RAWm), $P_{0.1}$, 환자에 의해 수행되는 호흡 일 (work of breathing performed by patient, 이하 호흡 일), pressure-time product(이하 PTP)등이었다.