• 대한간호학회지
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• 제33권1호
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• pp.42-50
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• 2003

Purpose: This study was conducted to investigate the effects of the suction-induced hypoxemia interventions. Method: 30 suction-induced hypoxemia interventions were reviewed for the purpose of meta-analysis. Result: The study showed that both preoxygenation and insufflation were the most frequently examined oxygenation time periods, and hyperoxygenation combined with hyperinflation was the most commonly applied oxygenation method in order to prevent suction-induced hypoxemia. The greatest effect was obtained by providing oxygenation before and after suctioning, whereas negative effect(the contrary results from the study hypotheses) was frequently obtained by applying insufflation only. Applying hyperoxygenation combined with hyperinflation had the greatest effect over that of applying hyperoxygenation only, even though the difference between effect sizes of both methods were statistically significant. Conclusion: The results of meta-analysis showed that the occurrence rate of hypoxemia after suctioning was significantly reduced with the overall interventions for hypoxemia (decreasing 40% of occurrence rate), independent with time periods or methods for providing oxygenation.

• Archives of Pharmacal Research
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• 제25권5호
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• pp.709-717
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• 2002

Hypoxemia is known to induce various physiological changes which can result in alteration in drug pharmacokinetics. To examine the effect of acute moderate hypoxemia on metoclopramide (MCP) pharmacokinetics, a continuous 14-hour infusion of MCP during a normoxemic, hypoxemic and subsequent normoxemic period was conducted in eight adult sheep. Arterial blood and urine samples were collected to examine the effects on the pharmacokinetics of MCP and its deethylated metabolites. MCP and its mono- and di-deethylated metabolites were quantitated using a GC/MS method. Steady-state concentrations of MCP were achieved in each of the three periods. During hypoxemia, MCP plasma steady-state concentration increased significantly from 50.72$\pm$1.06 to 63.62$\pm$1.79 ng/mL, and later decreased to 55.83$\pm$1.15 ng/mL during the post-hypoxemic recovery period. Total body clearance ($CL_{TB}$) of MCP was significantly decreased from 274.2$\pm$48.0 L/h to 205.40$\pm$28.2 L/h during hypoxemia, and later restored to 245.8$\pm$44.2 L/h during the post-hypoxemic period. Plasma mono-deethylated MCP concentration (32.78$\pm$1.73 ng/mL) also increased, compared to the control group (21.20$\\pm$1.39 ng/mL), during hypoxemia and subsequent normoxemic period. Renal excretion of MCP and its metabolites was also decreased during hypoxemia, while urine flow was increased with a concomitant decrease in urine osmolality. Thus, the results indicate that acute moderate hypoxemia affects MCP pharmacokinetics.

• Neonatal Medicine
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• 제25권4호
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• pp.137-143
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• 2018

Purpose: This study was performed to determine the clinical features of full-term infants with hypoxemia detected by pulse oximetry and to establish the diagnosis of critical congenital heart disease (CCHD). Methods: We retrospectively reviewed the medical records of neonates who had been admitted to the neonatal intensive care unit within 2 weeks of birth at Korea University Ansan Hospital between January 2013 and October 2017 (n=450). We classified these neonates based on the presence of hypoxemia at admission and investigated neonatal characteristics, initial symptoms, echocardiographic findings, and final diagnosis associated with hypoxemic diseases. Results: Of 450 term infants, 265 infants (58.9%) were identified hypoxemia by pulse oximetry at admission. The most common symptoms of them were cyanosis and tachypnea. Among them, 80.1% of infants (214/265) were diagnosed with respiratory tract disease and 8.3% of infants (22/265) had congenital heart disease. Thirteen infants (13/265, 4.9%) had CCHD and were treated with urgent surgery or transcatheter intervention within 28 days of birth. Majority of infants with respiratory tract disorder were transferred from hospital immediately after birth, but 46.1% of infants (6/13) with CCHD remained asymptomatic after birth and were admitted after 48 hours after birth. In addition, other hypoxemic illnesses were identified as neonatal infectious and neurological diseases. Conclusion: This study showed the importance of assessment in neonates with hypoxemia, including those diagnosed with CCHD. The possibility of CCHD should be considered in the differential diagnosis in neonates demonstrating hypoxemia after 48 hours of birth. A larger prospective study is needed to assess the effectiveness and outcomes of pulse oximetry for neonatal screening in Korea.

• Tuberculosis and Respiratory Diseases
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• 제62권3호
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• pp.217-222
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• 2007

저자들은 악성흉수 환자에서 가장 많은 치료법으로 선택되고 있는 talc 늑막유착술 이후에 급성 저산소증으로 사망한 환자 2예를 경험하였다. Talc 늑막유착술은 안전하고 효과적인 치료이지만, talc를 5 g 이상 사용하거나, 전신상태가 불량하거나, 반복적인 늑막유착술을 시행한 경우나, 양측에 흉수가 있거나, 늑막유착술 전 2주 이내에 항암요법이나 방사선치료를 한 경우나 폐실질에 전이성병변이 있을 때 예후가 불량하므로 talc 늑막유착술 환자를 선정할 때 주의하여야 하겠다.

• 대한불안의학회지
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• 제2권2호
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• pp.122-127
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• 2006

Objective : We examined the putative association between the psychological symptoms and hypoxemia in hospitalized pneumoconiosis patients. Methods : One hundred and nine hospitalized pneumoconiosis patients were divided into two groups according to their level of hypoxemia (PaO2); hypoxemic group consisted of 47 patients with PaO2 lower than 80 mmHg, and comparative group consisted of 62 patients with higher than 80 mmHg. All of them were interviewed with the Hamilton Depression Rating Scale (HAM-D), and completed the Symptom Checklist-90items-Revised (SCL-90-R) and the State-Trait Anxiety Inventory (STAI). The medical data (PaO2, PaCO2, Hb, and Hct), number of hospital days and socio-demographic data as well as scores of the three psychological measurements were compared between the two groups. Results : Hypoxemic patients with lower PaO2 showed higher scores in the HAM-D (p=0.01) and stateanxiety subscale of the STAI (p<0.05). Values of hemoglobin and hematocrit were negatively correlated with levels of trait-anxiety (p<0.05). Thirty patients (27.5%) of total subjects suffered from depression (higher than 18 in the HAM-D), and 46.8% of hypoxemic patients were depressed, whereas 12.9% of comparative group patients were depressed (p=0.01). Conclusion : These results suggest that depression and anxiety might be associated with the hypoxemic mechanism in pneumoconiosis patients.

• 대한간호학회지
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• 제44권2호
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• pp.149-158
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• 2014

Purpose: This study was conducted to compare effects of open and closed suctioning methods on lung dynamics (dynamic compliance, tidal volume, and airway resistance) and hypoxemia (oxygen saturation and heart rate) in mechanically ventilated patients. Methods: This study was a cross-over repeated design. Participants were 21 adult patients being treated with endotracheal intubation using a pressure-controlled ventilator below Fraction of Inspired Oxygen ($FiO_2$) 60% and PEEP $8cmH_2O$. Data were collected at baseline and 1, 2, 3, 4, 5, and 10 minutes after suctioning. Data were analyzed using two-factor ANOVA with repeated measures on time and suctioning type. Results: Effects of the interaction between suction type and time were significant for oxygen saturation and heart rate but not significant for dynamic compliance, tidal volume, or airway resistance. Prior to performance of suctioning, tidal volume and oxygen saturation were significantly lower, but airway pressure and heart rate were significantly higher using the closed suctioning method as compared with the open suctioning method. Conclusion: For patients on ventilator therapy below $FiO_2$ 60% and PEEP $8cmH_2O$, open suctioning performed after delivery of 100% $FiO_2$ using a mechanical ventilator may not have as much negative impact on lung dynamics and hypoxemia as closed suctioning.

• Tuberculosis and Respiratory Diseases
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• 제41권5호
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• pp.504-512
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• 1994

연구배경 : 간경화 환자에서 심질환 또는 폐질환이 동반되지 않으면서 심각한 저산소혈증이 발생할 수 있다는 사실은 이미 오래전부터 알려져 있는 사실이다. 그 원인으로서 폐혈관 장애를 초래하는 것이 주된 역할을 하는 것으로 알려져 있는데 그 중에서도 특히 폐혈관 확정에 의한 폐내단락이 가장 중요한 기전으로 제시되고 있다. 폐내단락은 전모세혈관 수준에서 폐내혈관확장이 발생하거나 직접적인 동정맥 교통에 의해서 발생하는데 간경화 환자에서 흔히 관찰되는 피부 소견인 거미상 혈관종과 관련성이 있다. 이러한 폐내 모세혈관의 확장으로 인해 중심 혈류 속도가 빨라지고 모세혈관 통과 속도가 증가하여 결국은 폐확산 장애가 초래되는데 이러한 효과는 심박출량이 증가하는 과운동성 순환을 나타내는 간경화의 혈류학적 특성과 상승작용을 유발하여 저산소혈증이 발생한다. 또한 앙아위에서 기립자세로 체위변화를 하면 폐기저부위에서 중력에 의한 혈류량이 증가하여 폐내단락 효과가 배가되어 저산소혈증이 더욱 악화되므로 기립성 탈산소증과 편평호흡이 발생할 수도 있다. 그러나 이러한 소견들은 주정성 간경화와 원발성 담즙성 간경화를 주로하는 구미에서의 결과이고, B형간염과 이로 인한 간경화 및 간암의 유병율과 사망률이 세계적으로 가장 높은 우리나라에서는 이에 대한 연구가 거의 없는 실정이다. 이에 저자들은 후괴사성 간경화가 대종을 이루는 국내 간경화 환자에서의 저산소혈증과 기립성 탈산소증의 빈도를 조사하고 그 기전으로서 폐내단락의 중요성을 확인하기 위해 본 연구를 시행하였다. 방법 : 간경화 환자 중에서 심폐질환의 증거가 없고 복수, 상부위장관 출혈, 간성 혼수등과 같은 심한 합병증의 현증이 없는 비교적 안정상태에 있는 48명을 대상으로 하여 앙아위와 기립시 동맥혈분석검사를 시행하여 저산소혈증과 기립성 탈산소증의 빈도를 조사하고, 그 결과에 따라 저산소혈증군과 정상산서혈증군으로 분류하여 각각 폐기능검사 및 폐내단락율을 측정하기 위한 Tc-99m-MAA 주사를 실시하였다. 폐내단락율 계산은 뇌와 좌우신장의 혈류량은 전신 혈류량의 32%인 점을 기준하여 뇌와 좌우신장에서 측정된 방사성 계수를 전신 방사성 계수로 환산하고 이 값을 좌우폐의 방사성 계수와 합산한 후 이에 대한 전신 방사성 계수의 비율을 계산함으로써 결정하였다. 결과 : 동맥혈산소분압 80 mmHg 미만의 저산소혈증은 9명에서 관찰되어 18.8%의 빈도를 보였고 10 mmHg 이상의 기립성 탈산소증은 8명에서 관찰되어 16.7%의 빈도를 보였으나 동맥혈산소분양 60 mmHg 미만의 심각한 저산소혈증은 관찰되지 않았다. 동맥혈 산소분압은 거미상 혈관종이 관찰되는 환자군에서 유의하게 낮았으며 혈청학적 표지자와 간경화의 심한 정도를 반영하는 간기능검사 수치와는 유의한 상관관계는 없었다. 저산소혈증군과 정상산소혈증군으로 분류하여 시행한 폐기능검사 소견상 양군간에 유의한 차이는 없었으며 Tc-99m-MAA 전신주사를 이용한 폐내단락율은 저산소혈증군에서 $11.4{\pm}4.1%$로서 정상산소혈증군의 $4.1{\pm}2.0%$보다 유의하게(p<0.05) 높은 결과를 나타내었다. 결론 : 간경화 환자에서 저산소혈증은 적지 않은 빈도로 관찰되는 소견으로 그 기전으로는 폐내단락이 중요한 역할을 하는 것으로 생각되지만 후괴사성 간경화가 대종을 이루는 국내의 간경화 환자에서는 임상적으로 호흡곤란 및 청색증을 유발할 정도의 심각한 저산소혈증은 매우 드물다고 생각된다.

• 수면정신생리
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• 제16권1호
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• pp.22-27
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• 2009

Regulation of respiration differs significantly between wakefulness and sleep. Respiration during wakefulness is influenced by not only automatic control but also voluntary and behavioral control. Sleep is associated with definite changes in respiratory function. With the onset of sleep, voluntary control of ventilation that overrides automatic control during wakefulness becomes terminated. Also ventilatory response to various stimuli including hypoxemia and hypercapnia is decreased. With these reasons respiration during sleep becomes fragile and unstable so that marked hypoxemia can be happened in patients with lung disease especially during REM sleep. Obstructive sleep apnea may also be developed if upper airway resistance is increased in addition to these blunted ventilatory responses.

• 대한치과마취과학회지
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• 제13권2호
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• pp.51-54
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• 2013

A 30-year-old man with morbid obesity (height: 176 cm, body weight: 100 kg, body mass index: 32.28) was scheduled for reconstruction of the mandibular fracture. During induction of general anesthesia and nasotracheal intubation, we experienced massive epistaxis, hypoxemia and difficult airway management. Fortunately, we performed oro-tracheal intubation with direct laryngoscopy and it barely succeeded. He recovered without any residual complications and rescheduled seven days later and we successfully performed awake fiberoptic nasotracheal intubation. The patient discharged on the fourth postoperative day.

• Journal of Chest Surgery
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• 제26권9호
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• pp.718-721
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• 1993

Reexpansion pulmonary edema[ RPE ] with hypoxemia and hypotension is a very rare complication of the treatment of lung collapse secondary to pneumothorax and pleural effusion. We experienced two cases of RPE. One is a 29 year old male with complete right pneumothorax and the other is a 20 year old female with massive right pleural effusion. Life threatening pulmonary edema was developed soon after insertion of chest tube in both. Fortunately, RPE was detected early and intensive treatment was performed. They were discharged without complication. Although RPE with hypoxemia and hypotension is rare , it is very serious and occasionally life-threatening. So, chest surgeon treating lung collapse must be aware of the possibility of RPE and make an effort to prevent the occurence of this condition.