• Tuberculosis and Respiratory Diseases
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• v.69 no.2
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• pp.75-80
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• 2010

The year of 2009~2010 brought a number of concepts and new ideas were evaluated with promising results. However, some studies that challenged many beliefs. In acute respiratory distress syndrome (ARDS), recent clinical studies took into consideration of pathophysiologic changes of respiratory system compliance. Meta-analysis of positive end-expiratory pressure trials showed survival benefit of high positive end-expiratory pressure in ARDS. Until now, prone positioning did not show survival benefit in patients with ARDS. Extracorporeal membrane oxygenation (ECMO) based management improved survival in patients with severe ARDS. ECMO can be a management option in severe ARDS. Sedation is a standard practice in critically ill patients needing mechanical ventilation. However, Danish group reported less sedation of critically ill patients receiving mechanical ventilation was associated with an increase in days without ventilation. Although this single center study has some limitations, the overall results are promising. Use of maximal sterile barrier precautions (mask, sterile gown, sterile gloves, and large sterile drapes) with chlorhexidine-impregnated dressing reduced central venous catheter related infection. Selective oropharyngeal decontamination (application of topical antibiotics in the oropharynx) reduced the mortality rate of an intensive care unit (ICU) population. Normoglycemia in Intensive Care Evaluation and Survival Using Glucose Algorithm Regulation (NICE-SUGAR) trial reported intensive glucose control increased mortality among adults in the ICU. Some of the results of above papers are promising. However, some ideas may need for more frequent individual assessment and increase the workload of ICU staffs. Before implementation of new practice in ICU, we should take into consideration of individual hospital situation including human and material resources.

• Journal of Chest Surgery
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• v.51 no.2
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• pp.149-152
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• 2018

A 76-day-old infant weighing 3.4 kg was referred for surgical intervention for severe mitral valve stenoinsufficiency caused by leaflet fibrosis and calcification. He had ex perienced a cerebral infarction in the left middle cerebral artery territory, which was deemed attributable to an embolism of a calcified particle from the dysmorphic mitral valve. Because mitral valve replacement using a prosthetic valve was not feasible in this small baby, mitral valve replacement with a pulmonary autograft was performed. After a brief period of extracorporeal membrane oxygenation (ECMO) support, he was weaned from ECMO and was discharged home without further cardiovascular complications.

• Journal of Chest Surgery
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• v.54 no.5
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• pp.396-399
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• 2021

A 58-year-old man, incapable of maintaining oxygen saturation with mechanical ventilation, was admitted to our hospital for veno-venous extracorporeal membrane oxygenation (ECMO) treatment. He was diagnosed with acute respiratory distress syndrome (ARDS) due to influenza A pneumonia. His condition stabilized with antibiotics and steroid administration, but weaning from ECMO failed due to post-infectious pulmonary sequelae. On day 84 after admission, he underwent bilateral lung transplantation. In the postoperative phase, he did not regain consciousness even after discontinuation of sedatives for 3 days. However, spontaneous pupillary reflex and eye movements were preserved, while communication and upper and lower limb movements were affected. The nerve conduction study was diagnostic of Guillain-Barré syndrome. He was managed with intravenous immunoglobulins and plasmapheresis. Mild recovery of the facial muscles was seen, but he died 24 days post-surgery due to progressive ARDS and sepsis.

• Journal of Chest Surgery
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• v.54 no.1
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• pp.2-8
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• 2021

Since the first reported case of coronavirus disease 2019 (COVID-19) in December 2019, the numbers of confirmed cases and deaths have continued to increase exponentially despite multi-factorial efforts. Although various attempts have been made to improve the level of evidence for extracorporeal membrane oxygenation (ECMO) treatment over the past 10 years, most experts still hesitate to take an active position on whether to apply ECMO in COVID-19 patients. Several ECMO management guidelines have been published recently, but they reflect some important differences from the Korean medical system and aspects of real-world medical practice in Korea. We aimed to find evidence on the efficacy of ECMO for COVID-19 patients by reviewing the published literature and to propose expert recommendations by analyzing the Korean COVID-19 ECMO registry data.

• Childhood Kidney Diseases
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• v.18 no.1
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• pp.13-17
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• 2014

Continuous renal replacement therapy (CRRT) has become the preferred dialysis modality to support critically ill children with acute kidney injury. As CRRT technology and clinical practice advances, experiences using CRRT on small infants and neonates have increased. In neonates with hyperammonemia or acute kidney injury during extracorporeal membrane oxygenation (ECMO) therapy, CRRT can be a safe and effective technique. However, there are many limitations of CRRT in neonates, including vascular access, bleeding complications, and lack of neonatespecific devices. This review discusses the basic principles of CRRT and the special considerations when using this technique in neonates and infants.

• Journal of Chest Surgery
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• v.54 no.6
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• pp.543-546
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• 2021

A 55-year-old woman who had received an implantable left ventricular assist device 3 months earlier presented with dyspnea and a low-flow alarm of the device. Computed tomography and log-file analysis of the device system suggested inflow cannula obstruction. Since the patient had cardiogenic shock due to pump failure, venoarterial extracorporeal membrane oxygenation (ECMO) was initiated. With ECMO, surgical exchange of the pump was considered. However, the obstruction spontaneously resolved without surgical intervention. It turned out that an obstructive thrombus was washed out by rebooting the pump. Moreover, the thrombus was embolized in the patient's left subclavian artery. The patient underwent heart transplantation 4 months after the pump obstruction accident and continued to do well.

• Clinical and Experimental Pediatrics
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• v.59 no.3
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• pp.105-113
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• 2016

Diffuse alveolar hemorrhage (DAH) is a life-threatening pulmonary complication in patients with hematologic malignancies or autoimmune disorders. The current treatment options, which include corticosteroids, transfusions, extracorporeal membrane oxygenation (ECMO), and immunosuppressants, have been limited and largely unsuccessful. Recombinant activated factor VII (rFVIIa) has been successfully administered, either systemically or bronchoscopically, to adults for the treatment of DAH, but there are few data on its use in pediatric patients. The current literature in the PubMed database was reviewed to evaluate the efficacy and risk of rFVIIa treatment for DAH in pediatric patients. This review discusses the diagnosis and treatment of DAH, as well as a new treatment paradigm that includes rFVIIa. Additionally, the risks and benefits of off-label use of rFVIIa in pediatric patients are discussed.

• International Journal of Fluid Machinery and Systems
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• v.7 no.4
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• pp.142-150
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• 2014

In the cardiopulmonary support system with an ECMO (extracorporeal membrane oxygenation), a higher pump head is demanded for a blood pump. In order to realize a blood pump with higher pump head, higher anti-hemolysis and thrombosis performances, a study on the development of unprecedented multistage blood pump was conducted. In consideration of the application of the blood pump for pediatric patients, a miniature two-stage centrifugal blood pump with the impeller's diameter of 40mm was designed and the performance was examined in experiments and computations. Some useful knowledge for a design of the blood pump with higher anti-hemolysis and thrombosis performances was obtained.

• Journal of Biomedical Engineering Research
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• v.42 no.4
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• pp.193-200
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• 2021

Flowmeter and oxygen sensors are listed in COVID-19 essential medical devices. This article reports a Teensy microcontroller-based Oxygen mass flow controller (MFC), core part of the oxygen respirator or extracorporeal membrane oxygenation (ECMO). The developed MFC consisting of the microcontroller, MEMS flow sensor, and solenoid valve was able to accurately control 0 to 100 sccm of oxygen flow rate. The pressure of vacuum chamber increased proportionally to the flow rate (0.998 of Pearson correlation coefficient). The experimental results proved that the developed MFC exhibits comparable performance to a commercial MFC in accuracy, settling time, linearity with pressure, and repeatability of oxygen mass flow control. It is expected that this simple and cheap MFC is utilized for oxygen therapy against the severe acute respiratory syndrome coronavirus 2.

• Journal of computational fluids engineering
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• v.20 no.2
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• pp.88-95
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• 2015

Blood pump analysis process includes both mechanical and bio-mechanical aspects. Since a blood pump is a mechanical device, it has to be mechanically efficient. On the other hand, blood pumps function is sensitively related to the blood recirculation; hence, bio-factors such as hemolysis and thrombosis become important. This paper numerically investigates the mechanical and bio-mechanical performances of the Rotaflow in the extracorporeal membrane oxygenation(ECMO), Ventricular Assist Device(VAD), and full-load conditions. The operational conditions are defined as(400[mmHg], 5[L/min.]), (100[mmHg], 3[L/min.]), and (600[mmHg], 10[L/min.]) for ECMO, VAD, and full-load conditions, respectively. The results are presented and analyzed from the mechanical aspect via performance curves, and from bio-mechanical aspect via focusing on hemolytic characteristics. Regions of top and bottom cavities show recirculation in both ECMO and VAD condtions. In addition, Eulerian-based calculation of modified index of hemolysis(MIH) has been investigated. The results demonstrate that the VAD condition has the least risk of hemolysis among the others, while the full-load condition has the highest risk.