• 대한임상독성학회지
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• 제18권2호
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• pp.116-122
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• 2020

Acute respiratory failure is an important risk factor for mortality in patients with acute pesticide poisoning. Therefore, it is necessary to investigate the risk factors to predict respiratory failure in these patients. This study retrospectively investigated the clinical features of respiratory failure among patients with acute pesticide poisoning requiring mechanical ventilation. This study included patients who were admitted with intentional poisoning by pesticide ingestion from January 2017 to December 2019. Paraquat intoxication was excluded. Among 469 patients with acute pesticide poisoning, 398 patients were enrolled in this study. The respiratory failure rate was 30.4%. The rate of respiratory failure according to the type of pesticide was carbamate (75.0%), organophosphate (52.6%), glufosinate (52.1%), glyphosate (23%), pyrethroid (8.9%), and others (17%). The mortality was 25.6% in the respiratory failure group. The risk factors for respiratory failure were old age, low body mass index, and ingestion of more than 300 mL. In conclusion, respiratory failure is a risk factor for mortality in pesticide poisoning. Old age, low body mass index, and ingestion of more than 300 mL are the risk factors for predicting respiratory failure.

• The Korean Journal of Pain
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• 제4권2호
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• pp.200-204
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• 1991

Neurolytic splanchnic nerve block is a relatively safe and effective method for the relief of intractable pain caused by upper abdominal cancer. We have experienced a case of severe acute respiratory failure during splanchnic nerve block under control of X-ray fluoroscopy. We think that the most likely cause of the acute respiratory failure was an asthmatic attack due to anxiety and dyspnea from the injury or stimulation of the diaphragm and pleura in this case.

• Journal of Chest Surgery
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• 제17권3호
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• pp.409-417
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• 1984

In the early days of open heart surgery, acute respiratory failure following extracorporeal circulation was a significant deterrent to an uncomplicated recovery. Although a marked improvement in prevention and treatment of postoperative respiratory failure has been achieved, the problem has not been completely eliminated and continues to be a causative factor in morbidity and mortality Fates following open heart surgery. We have attempted to evaluate postoperative respiratory failure in patients undergoing cardiac operation with the aid of extracorporeal circulation. Our series comprised 92 patients who underwent elective open heart surgery at the Department of Thoracic and Cariodvascular Surgery, School of Medicine, Kyungpook National University, from January, 1980 to December, 1982. In our study, the overall incidence of acute respiratory failure following open heart surgery was 18.8 percent. The duration of extracorporeal circulation in a series of 18 patients who developed postoperative respiratory failure [Group B] was longer in the mean value [120.3 minutes] than the uncomplicated 74 patients [Group A] [85.8 minutes]. The duration of artificial ventilation after open heart surgery in Group A averaged 13.4 hours as contrasted with 76.5 hours in Group B. In Group B, the inspired oxygen concentration [FiO2] in artificial ventilation was continued in the higher level than Group A until 18 hours after operation. Upon pulmonary function test performed pre-and postoperatively, residual volume[RV], RV/TLC and FEV 1.0/FVC were remained essentially unchanged following extracorporeal circulation, whereas forced vital capacity [FVC], FEV 1.0 and FEF 25-75% were significantly decreased in the early postoperative days. The incidence of acute respiratory failure was significantly higher in a series of patients who developed postoperative complications, such as re- exploration due to massive bleeding, low cardiac output, acute renal failure and arrhythmias. A total of 9 patients died, giving an overall mortality was 33.3 percent whereas the mortality was only 1.1 percent for patients without respiratory failure.

• Journal of Chest Surgery
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• 제9권2호
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• pp.148-156
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• 1976

Acute respiratory failure has become an increasingly frequent cause of death following shock or trauma. Interstitial or diffuse alveolar edema, as chief pathophysiologic change of acute respiratory insufficiency, can be the result of sepsis, fat embolism, cardiac failure, lung congestion, and oxygen toxicity. These pulmonary problems are extremely difficult to treat without early recognition of their development and aggressive management. If the treatment is delayed, the progressive respiratory failure is almost uniformly fatal. Authors have experienced two cases of acute respiratory insufficiency following the blunt chest trauma, which were healed uneventfully. Literatures were briefly reviewed.

• Tuberculosis and Respiratory Diseases
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• 제46권3호
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• pp.363-371
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• 1999

연구배경: 유기인제는 국내에서 1950년대부터 농업용 살충제로 널리 사용되고 있으며, 최근 공업용 화공약품으로 사용이 증가하면서 이로 인한 중독 환자가 증가하고 있다. 아트로핀, PAM 또한 호흡부전 발생시 인공호흡기를 이용한 적극적인 치료로 사망률은 과거보다 감소하였으나, 호흡부전으로 인한 사망은 유기인제 중독의 주요한 사망 원인이다. 저자들은 유기인제 중독시 호흡부전의 발생 빈도 및 그 유발 인자를 관찰 분석하여 유기인제 중독으로 인한 사망률을 줄여 보고자 하였다. 방 법: 영남대학교 의과대학 부속병원에서 유기인제 중독증으로 진단 받은 111례를 대상으로 하였으며, 특히 호흡부전이 발생한 31례의 임상 소견 및 치료 방법, 혈중 cholinesterase 활성도 등을 조사하여 호흡부전 발생과 관계가 있는 요인들을 알아보았다. 결 과: 유기인제 중독환자 111례 중 자살 목적인 경우가 81례로 가장 많았고, 중독 정도도 가장 심하였다. 환자 중 15례에서 사망하였으며, 사망률은 14%였다. 호흡부전이 발생한 31례 중 23예가 중독 후 24시간이내, 8례는 25시간에서 96시간이내 발생하였으며, 중독 정도가 심할수록 호흡부전 발생 빈도가 높았다. 호흡부전이 발생한 31례 중 15례에서 사망하였고, 호흡부전이 발생하지 않은 경우에서는 사망한 예가 없었다. 16예의 환자에서 폐렴이 발생하였으며 이중 14례에서 호흡부전이 생겨, 폐렴이 생긴 대부분의 환자에서 호흡부전이 발생하였다. 심혈관 허탈은 5례에서 발생하였으며 이중 2례에서 호흡부전이 생겼으나 통계적으로 유의하지 않았다. 첫 24시간동안 아트로핀의 평균 요구량은 $56{\pm}65mg/dl$이고, 급성 호흡부전인 경우 아급성 호흡부전이나 호흡부전이 발생하지 않았을 때보다 아트로핀 요구량이 더 많아 중독 정도가 심할수록 아트로핀 요구량이 더 많았다. PAM으로 치료하였던 95례 중 26예와, 치료하지 않았던 16예 중 5례에서 호흡부전이 발생하여 PAM 치료 여부와 호흡부전 발생간의 유의한 차이를 보이지 않았다. 혈중 cholinesterase 활성도는 호흡부전이 발생하였을 때보다 인공호흡기 이탈시 7배정도 높았으며, 인공호흡기로 치료한 기간은 급성 호흡부전이 생겼을 때 유의하게 길었다. 결 론: 급성 유기인제 중독에 의한 호흡부전은 중독 후 첫 96시간 이내 주로 발생하며, 중독 정도와 폐렴 발생이 호흡부전 발생의 중요한 유발 인자로 생각된다. 따라서 중독 후 첫 96시간 동안 세심한 관찰이 필요하고 적극적인 아트로핀 투여와 기도 확보 및 흡인성 폐렴 방지로 호흡부전 발생 빈도를 줄일 수 있을 것으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제68권2호
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• pp.62-66
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• 2010

Background: Extracorporeal membrane oxygenation (ECMO) during severe acute respiratory failure helps to recover the pulmonary function. This study evaluated our experience with veno-venous ECMO in adult patients with acute respiratory failure. Methods: From January 2007 to July 2009, ECMO was used on 54 patients. Of these 54 patients, 7 were placed on veno-venous ECMO for acute respiratory failure. The indications of ECMO were based on the lung dysfunction measured as a $PaO_2/FiO_2$ ratio <100 mm Hg on $FiO_2$ of 1.0, or an arterial blood gas pH <7.25 due to hypercapnia despite the optimal treatment. $EBS^{(R)}$, $Bio-pump^{(R)}$, and Centrifugal Rotaflow $pump^{(R)}$ were used and all cannulations were performed percutaneously via both femoral veins. When the lung function was improved, an attempt was made to wean on ECMO at moderate ventilator settings followed by decannulation. Results: Five of the 7 patients were male and the mean age was $46.3{\pm}18.3$. The causes of acute respiratory failure were 3 cases of pneumonia, 2 near-drownings, 1 pulmonary hemorrhage due to acute hepatic failure and 1 mercury vapor poisoning. The mean support time of ECMO was $17.3{\pm}13.7$ days. Of the 7 patients implanted with ECMO, 5 patients (71%) were weaned off ECMO and 3 patients (43%) survived to hospital discharge after a mean 89.6 hospital days. Conclusion: The early use of ECMO for acute respiratory failure in adults due to any cause is a good therapeutic option for those unresponsive to the optimal conventional treatments.

• Tuberculosis and Respiratory Diseases
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• 제78권2호
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• pp.85-91
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• 2015

Background: In sepsis patients, target mean arterial pressures (MAPs) greater than 65 mm Hg are recommended. However, there is no such recommendation for patients receiving mechanical ventilation. We aimed to evaluate the influence of MAP over the first 24 hours after intensive care unit (ICU) admission on the mortality rate at 60 days post-admission in patients showing acute hypoxemic respiratory failure under mechanical ventilation. Methods: This prospective, multicenter study included 22 ICUs and compared the mortality and clinical outcomes in patients showing acute hypoxemic respiratory failure with high (75-90 mm Hg) and low (65-74.9 mm Hg) MAPs over the first 24 hours of admission to the ICU. Results: Of the 844 patients with acute hypoxemic respiratory failure, 338 had a sustained MAP of 65-90 mm Hg over the first 24 hours of admission to the ICU. At 60 days, the mortality rates in the low (26.2%) and high (24.5%) MAP groups were not significantly different. The ICU days, hospital days, and 60-day mortality rate did not differ between the groups. Conclusion: In the first 24 hours of ICU admission, MAP range between 65 and 90 mm Hg in patients with acute hypoxemic respiratory failure under mechanical ventilation may not cause significantly differences in 60-day mortality.

• 대한임상독성학회지
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• 제3권1호
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• pp.63-66
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• 2005

Toluene is an aromatic hydrocarbon found in glues, cements, and solvents. It is known to be toxic to the nervous system, hematopoietic system, and causes acid-base and electrolyte disorders. Acute respiratory failure with hypokalemia and rhabdomyolysis with acute renal failure should be considered as potential events in protracted glue sniffing. We reported the case of 26-year-old woman was admitted to the emergency department with the development of respiratory failure and altered mentality due to hypokalemia after chronic glue sniffing. She was weaned from the ventilator 3 days later after potassium and sodium bicarbonate replacement and was discharged without respiratory symptoms and other complications.

• Tuberculosis and Respiratory Diseases
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• 제81권2호
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• pp.99-105
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• 2018

Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.

• Tuberculosis and Respiratory Diseases
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• 제40권3호
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• pp.314-318
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• 1993

Chronic eosinophilic pneumonia is an idiopathic condition characterized by chronic infiltration of the lung with eosinophils, weight loss, dyspnea, and pulmonary infiltration. Recently, we have experienced one case of chronic eosinophilic pneumonia presenting as the acute respiratory failure. A 34-year-old man was admitted to the hospital with one month's history of coughing, dyspnea, mucoid sputum, weight loss and one day's history of subcutaneous emphysema. The radiographic lung lesion and dyspnea rapidly progressed to a critical condition of acute respiratory failure. The combination of blood eosinophilia, lung infiltration on the chest x-ray, sign of acute rapiratory failure, rapid response to steroid therapy, and the finding of the transbronchial lung biopsy permit the diagnosis of chronic eosinophilic pneumonia.