• Journal of The Korean Dental Society of Anesthesiology
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• v.6 no.2 s.11
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• pp.121-126
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• 2006

Generalized anaphylaxis is a most dramatic and acutely life-threatening allergic reaction. Most fatalities from anaphylaxis occur within the first 30 minutes postantigenic exposure. The mechanism of generalized anaphylaxis is the reaction of IgE antibodies to an allergen that causes the release of histamine, bradykinin, and others. These chemical mediators cause the contraction of smooth muscles of the respiratory and intestinal tracts, as well as increased vascular permeability. Four major clinical symptoms are recognized: skin reactions, smooth muscle spasm (gastrointestinal and genitourinary tracts and respiratory smooth muscle), respiratory distress, and cardiovascular collapse. Epinephrine is the drug of choice for the management. Its syrnpathomimetic effects directly counteract most aspects of the attack. Respiration must be immediately supported by the establishment of a patent airway along with artificial ventilation. The circulation should be supported and the existing hypotension overcome by placing the victim in a position to allow gravity to aid venous return and by administering intravenous fluids, vasopressors, and corticosteroids. When an imperceptible pulse is evident, external cardiac compression must also be instituted. This is a case report of anaphylactic shock care during general anesthesia, possibly due to penicillin, pancuronium and others.

• Journal of Korean Academy of Nursing Administration
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• v.15 no.4
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• pp.527-538
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• 2009

Purpose: The purpose of this study was to reclassify the advanced nursing practices of critical care nurse practitioners(CCNPs) in intensive care unit and measure the time and frequency of CCNP's activities. Method: Practices of ICU nurses are divided into RN's and CCNP's practices by a panel of ICU nursing experts. Each practice of CCNP is defined and CCNP's working time and service frequencies are monitored in general hospitals. Result: Practices of CCNP were classified into 4 domains and 32 practices. Fourteen practices by CCNPs were completed in 10 minutes and the other 12 practices consumed 10-30 minutes. A priority of practice in respiratory therapy was given to artificial airway management, management of tracheostomy patient, lower respiratory care, and the priority of CRRT was management of anticoagulation. Conclusions: Advanced nursing practices of CCNPs were recognized from those of RNs. A further research of CCNPs practices should be extended to other advanced practices and it is required to evaluate economic value of advanced nursing practice in the national health insurance system.

• Korean Journal of Adult Nursing
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• v.20 no.2
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• pp.209-218
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• 2008

Purpose: Regarding the respiratory function of patients with an artificial airway, this study compared the effects between normal saline with chest vibration and normal saline with expectorant mixture, administered before endotracheal suction. Methods: The study was conducted in the ICUs of one university hospital located in Incheon. The experimental group I received normal saline with chest vibration administered before endotracheal suction while the experimental group II received normal saline with expectorant mixture administered before endotracheal suction. For respiratory function, $PaO_2$, $PaCO_2$, and $O_2$ saturation were measured by ABGA at 3 minutes after endotracheal suction for both pre-test and post-test. Results: The two groups were not different significantly regarding $PaO_2$ level and $O_2$ saturation after the treatments, while, the experimental group II had lower $PaCO_2$ level than the experimental group I after the treatments (t = 2.075, p = .042). For experimental group II, post-test score of $PaCO_2$ level was significantly lower than that of the pre-test score (t = 1.842, p = .075). Conclusion: The administration of normal saline with expectorant mixture before endotracheal suction reduced $PaCO_2$ level and improved the respiratory function.

• Journal of Yeungnam Medical Science
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• v.6 no.2
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• pp.47-55
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• 1989

High frequency ventilation (HFV) is a new ventilatory technique that uses very small tidal volume(less than the anatomic dead space) and high frequency, and classified 4 distinct types according to frequency and mode of gas delivery. The mechanism of gas transport of high frequency oscillation ventilation(HFOV) is somewhat different to other types of HFV. To evaluate the determinants of $PaCO_2$ in HFOV, a study was done with a HFOV on 9 cats, and the results are : 1) $PaCO_2$ was not correlated with frequency at the constant stroke volume(6 voltage) and bias flow (6L/minutes). 2) $PaCO_2$ was correlated with stroke volume but not with bias flow under the constant frequency(15Hz/min) and bias flow(3 to 6L/min). From above results, the main determinant of $PaCO_2$ on artificial ventilation with HFOV was stroke volume, but further study between flow, the site of delivery to the airway and humidification of bias flow and $CO_2$ elimination is required in future research.

• Journal of Chest Surgery
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• v.30 no.8
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• pp.739-746
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• 1997

A variety of experiments concerning the development of ideal prosthetic grafts for correcting circumferential tracheal defects have been performed. The requirements for an ideal tracheal prosthesis are impermeability to air, consistency to prevent collapse, and acceptance by the host tissue causing a minimum inflammatory reaction, allowing fibroblastic infiltration and epithelialization. The synthetic material, polyurethane(PU), is known as a biocompatible polymer with an inert component. In this study, the tracheal prosthesis was made from microporous PU(30 micrometer in diameter) coated with gelatin and reinforced with isoplastic rings. This procedure provides the prosthesis with a compression strength. The out side diame er of the prosthesis was 20 mm with a length of 30 mm. The gelatin used in the study was obtained from pig skin and immobilized and cross-linked by irradiation(60 Co gamma ray) to promote host tissue incorporation and render the prosthesis epithelization after implantation. Animal experiments using 10 mongrel dogs were performed to compare three kinds of prosthesis; gelatin coated polyurethane graft, uncoated polyurethane graft, and prosthesisf pericadium complex graft. After 6 weeks of implantation, the epithelialization of implants was seen on the gelatin-coated and prosthesisfpericadium complex grafts. Implanted prosthesis were complicated by airway obstruction due to anastomosis granuloma. Early tracheal stenosis was found in the uncoated graft group. Two kind of anastomosis techniques were tested on the gelatin-coated prosthesis. Everted anastomosis resulted severe granuloma than the inverted anastomosis. In the prosthesislpericadium complex graft, bacteria and inflammation at a anastomotic site was found. Based on these results, gelatin coated porous polyurethane trachea prosthesis is biocompatible and may be useful in clinical application with further investigation.

• Journal of the Korea Academia-Industrial cooperation Society
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• v.10 no.11
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• pp.3418-3426
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• 2009

The purpose of this study was to investigate the feasibility of field operation protocol for cardiopulmonary resuscitation(CPR) in person with non-traumatic arrest. This study was performed from May 1 through June 27, 2008, and subjects were 150 students who are attending the department of Emergency Medical Service in J and K universities which located in Jeollabuk-do and Jeollanam-do areas. Practical conformance was verified using by nonequivalent control group pretest-posttest design. This study divided into two groups; experimental group that employed field operation protocol and control group that applied conventional CPR protocol, and comparative analyzed statistically the necessary time of the items of each protocol. The results indicated that each performance time of 18 items was reduced over 3 seconds except 5 items(assessment of consciousness, airway control, two times of artificial respiration, check of circulation, and five cycles of CPR). And time of 6 items(intubation, peripheral intravenous line, reassessment of consciousness, pupil reaction, carotid artery pulse, and vital sign) was minimized more than 60 seconds, and total performing time was shortened 110.85 seconds. The results suggested that total performing time in pre and post test where the protocol was applied for two groups showed a statistically significant decrease(t=-6.580, p=.000). Consequently, field operation protocol for cardiopulmonary resuscitation(CPR) in person with non-traumatic arrest will be a available manual which support prompt and accurate decision making, and improve emergency medical service.

• Tuberculosis and Respiratory Diseases
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• v.78 no.4
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• pp.336-340
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• 2015

Background: Potentially harmful unplanned extubation (UE) may occur in patients on mechanical ventilation (MV) in an intensive care unit (ICU) setting. This study aimed to evaluate the clinical characteristics of UE and its impact on clinical outcomes in patients with MV in a medical ICU (MICU). Methods: We retrospectively evaluated MICU data prospectively collected between December 2011 and May 2014. Results: A total of 468 patients were admitted to the MICU, of whom 450 were on MV. Of the patients on MV, 30 (6.7%) experienced UE; 13 (43.3%) required reintubation after UE, whereas 17 (56.7%) did not require reintubation. Patients who required reintubation had a significantly longer MV duration and ICU stay than did those not requiring reintubation ($19.4{\pm}15.1days$ vs. $5.9{\pm}5.9days$ days and $18.1{\pm}14.2days$ vs. $7.1{\pm}6.5days$, respectively; p<0.05). In addition, mortality rate was significantly higher among patients requiring reintubation than among those not requiring reintubation (54.5% vs. 5.9%; p=0.007). These two groups of patients exhibited no significant differences, within 2 hours after UE, in the fraction of inspired oxygen, blood pressure, heart rate, respiratory rate, and pH. Conclusion: Although reintubation may not always be required in patients with UE, it is associated with a poor outcome after UE.

• The Korean Journal of Emergency Medical Services
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• v.12 no.3
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• pp.17-26
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• 2008

Purpose : This study aimed to make comparison before and after CPR training for health college students (departments of visual optics, occupational therapy, and health welfare administration). The questionnaire consisted of self-efficacy, knowledge, and attitudes toward CPR affect performance ability. Through this study, the researchers tried to provide basic data in developing of cardiopulmonary resuscitation training programs and training methods for health college students. Methods : This study was applied to 83 health college students (departments of visual optics, occupational therapy, and health welfare administration) in G Province. Data were collected from September 22 to October 9, 2008. Analysis was performed by using SPSS WIN 12.0 Version program. Frequency analysis, t-test, ANOVA, and Pearson's correlation coefficients were used. Statistical significance was based on p < .05. Results : 1. There was an increase with(${\rightarrow}$ in) 1.69 point before education and 3.01 after education of artificial ventilation(p < .001). There was an increase in 1.46 point before education and 3.24 after education of airway(p < .001). There was an increase in 1.54 point before education and 2.84 after education of chest compression location(p < .001). There was an increase in 1.97 point before education and 3.13 after education of chest compression(p < .001). 2. The difference between self-efficacy, knowledge, and attitude before and after CPR education, the self-efficacy increased from 2.08 point before education(p < .001 to 3.18 point after education. Knowledge increased from 2.09 point before education(p < .001) to 3.28 point after education. Attitude increased from 1.75 point before education(p < .001 to 3.05 point after education. 3. The correlation between self-efficacy, knowledge, and attitude toward CPR), was not changed before education. After education, knowledge showed quantitative correlation(r = .219, p < .05) with attitude. 4. In regression analysis with the aim of examining influence of self-efficacy, knowledge, and attitude upon performance ability, the effect wasn't given to performance ability before education. After education, the self-efficacy was indicated to have significant effect on performance ability(p < .05).

• Journal of Korean Neurosurgical Society
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• v.66 no.6
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• pp.716-725
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• 2023

Objective : Anterior cervical spine surgery (ACSS) is a common surgical procedure used to treat cervical spinal degenerative diseases. One of the complications associated with ACSS is prevertebral soft tissue swelling (PSTS), which can result in airway obstruction, dysphagia, and other adverse outcomes. This study aims to investigate the correlation between various cervical sagittal parameters and PSTS following single-level ACSS, as well as to identify independent risk factors for PSTS. Methods : A retrospective study conducted at a single institution. The study population included all patients who underwent single-level ACSS between January 2014 and December 2022. Patients with a history of cervical spine surgery or trauma were excluded from the study. The presence and severity of PSTS was assessed by reviewing pre- and postoperative imaging studies. The potential risk factors for PSTS that were examined include patient age, sex, body mass index, tobacco use, comorbidities, serum albumin levels, operative time, implant type, implanted level, and various cervical spine sagittal parameters. Multivariate linear regression analysis was performed to identify the independent risk factors for PSTS. Results : A total of 62 consecutive patients who underwent single-level ACSS over a 8-year period at a single institution were enrolled in this study. Only preoperative segmental angle showed positive correlation with PSTS among various cervical spine sagittal parameters (r=0.36, p=0.005). Artificial disc replacement showed a negative correlation with PSTS (β=-0.38, p=0.002), whereas the use of demineralized bone matrix (DBM) had a positive impact on PSTS (β=0.33, p=0.009). We found that male sex, lower preoperative serum albumin, and implantation of upper cervical level (above C5) were independent predictors for PSTS after single-level ACSS (β=1.21; 95% confidence interval [CI], 0.27 to 2.15; p=0.012; β=-1.63; 95% CI, -2.91 to -0.34; p=0.014; β=1.44; 95% CI, 0.38 to 2.49; p=0.008, respectively). Conclusion : Our study identified male sex, lower preoperative serum albumin levels, and upper cervical level involvement as independent risk factors for PSTS after single-level ACSS. These findings can help clinicians monitor high-risk patients and take preventive measures to reduce complications. Further research with larger sample sizes and prospective designs is needed to validate these findings.

• Tuberculosis and Respiratory Diseases
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• v.48 no.4
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• pp.500-512
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• 2000

Background : To evaluate the efficacy of two methods of obtaining lung recruitment to reduce ventilator-induced lung injury(VILI). Methods : Fifteen New-Zealand white rabbits were ventilated in the pressure-controlled mode while maintaining constant tidal volume(10 ml/kg) and fixed respiration rate. Lung injury was induced by repeated saline lavage (PaO2<100 mmHg), and the pressure-volume curve was drawn to obtain Pflex. The animals were then randomly assigned to three groups and ventilated for 4 hours. In the control group(n=5), positive end-expiratory pressure(PEEP) less than that of Pflex by 3 mmHg was applied throughout the study. In the recruitment maneuver(RM) group(n=5), RM(CPAP of 22.5 mmHg, for 45 seconds) was performed every 15 minutes in addition to PEEP level less than Pflex by 3 mmHg This phrase is unclear. In the Pflex group, PEEP of Pflex was given without RM. Gas exchange, lung mechanics, and hemodynamics parameters as well as pathology were examined. Results : 1) Both the control and RM groups showed decreasing tendency in PaO2 with time. There was significantly decreased PaO2 at 4 hr compared to Ihr(p<0.05). But in the Pflex group, PaO2 did not decrease with time(p<0.05 vs other groups at 3, 4 hr). PaCO2 did not show significant difference among the three groups. 2) There was no significant difference in static compliance and plateau pressure. Mean blood pressure and heart rate also did not show any significant difference among the three groups. 3) The pathologic exam showed significantly less neutrophil infiltration in the Pflex group than in the control group(p<0.05). There was borderline significant difference in hyaline membrane score among the groups (p= 0.0532). Conclusion : Although recruitment maneuver of the injured lung may be important in decreasing VILI, it alone may not be sufficient to minimize VILI.