• Tuberculosis and Respiratory Diseases
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• v.46 no.3
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• pp.350-362
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• 1999

Background: Acute Respiratory failure which is developed after extubation in the weaning process from mechanical ventilation is an important cause of weaning failure. Once it was developed, endotracheal reintubation has been done for respiratory support. Noninvasive Positive Pressure Ventilation (NIPPV) has been used in the management of acute or chronic respiratory failure, as an alternative to endotracheal intubation, using via nasal or facial mask. In this study, we evaluated the usefulness of NIPPV as an alternative method of reintubation in patients who developed acute respiratory failure after extubation. Method: We retrospectively analyzed thirty one patients(eighteen males and thirteen females, mean ages $63\pm13.2$ years) who were developed acute respiratory failure within forty eight hours after extubation, or were extubated unintentionally at medical intensive care unit(MICU) of Asan Medical Center. NIPPV was applied to the patients. Ventilatory mode of NIPPV, level of ventilatory support and inspiratory oxygen concentration were adjusted according to the patient condition and results of blood gas analysis by the attending doctors at MICU. NIPPV was completely weaned when the patients maintained stable clinical condition under 8 $cmH_2O$ of pressure support level. Weaning success was defined as maintenance of stable spontaneous breathing more than forty eight hours after discontinuation of NIPPV. Respiratory rate, heart rate, arterial blood gas analysis, level of pressure support, and level of PEEP were monitored just before extubation, at thirty minutes, six hours, twenty four hours after initiation of NIPPV. They were also measured at just before weaning from NIPPV in success group, and just before reintubation in failure group. Results: NIPPV was successfully applied to thirty-one patients of thirty-two trials and one patient could not tolerated NIPPV longer than thirty minutes. Endotracheal reintubation was successfully obviated in fourteen patients (45%) among them. There was no difference in age, sex, APACHE III score on admission at MICU, duration of intubation, interval from extubation to initiation of NIPPV, baseline heart rate, respiratory rate, arterial blood gas, and $PaO_2/FiO_2$ between the success and the failure group. Heart rate and respiration rate were significantly decreased with increase $SaO_2$ after thirty minutes of NIPPV in both groups(p<0.05). However, in the patients of failure group, heart rate and respiratory rate were increased again with decrease in $SaO_2$ leading to endotracheal reintubation. The success rate of NIPPV treatment was significantly higher in the patients with COPD compared to other diseases(62% vs 39%) (p=0.007). The causes of failure were deterioration of arterial blood gas without aggravation of underlying disease(n=9), aggravation of undelying disease(n=5), mask intolerance(n=2), and retained airway secretion(n=l). Conclusion: NIPPV would be a useful therapeutic alternative which can avoid reintubation in patient who developed acute respiratory failure after extubation.

• Applied Biological Chemistry
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• v.16 no.2
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• pp.99-111
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• 1973

Percentage recovery or fertilizer nitrogen, phosphorus and potassium by rice plant(Oriza sativa L.) were investigated at 8, 10, 12, 14 kg/10a of N, 6 kg of $P_2O_5$ and 8 kg of $K_2O$ application level in 1967 (51 places) and 1968 (32 places). Two types of nutrient contribution for the yield, that is, P type in which phosphorus firstly increases silicate uptake and secondly silicate increases nitrogen uptake, and K type in which potassium firstly increases P uptake and secondly P increases nitrogen uptake were postulated according to the following results from the correlation analyses (linear) between percentage recovery of fertilizer nutrient and grain or dry matter yields and nutrient uptake. 1. Percentage frequency of minus or zero recovery occurrence was 4% in nitrogen, 48% in phosphorus and 38% in potassium. The frequency distribution of percentage recovery appeared as a normal distribution curve with maximum at 30 to 40 recovery class in nitrogen, but appeared as a show distribution with maximum at below zero class in phosphorus and potassium. 2. Percentage recovery (including only above zero) was 33 in N (above 10kg/10a), 27 in P, 40 in K in 1967 and 40 in N, 20 in P, 46 in Kin 1968. Mean percentage recovery of two years including zero for zero or below zero was 33 in N, 13 in P and 27 in K. 3. Standard deviation of percentage recovery was greater than percentage recovery in P and K and annual variation of CV (coefficient of variation) was greatest in P. 4. The frequency of significant correlation between percentage recovery and grain or dry matter yield was highest in N and lowest in P. Percentage recovery of nitrogen at 10 kg level has significant correlation only with percentage recovery of P in 1967 and only with that of potassium in 1968. 5. The correlation between percentage recovery and dry matter yield of all treatments showed only significant in P in 1967, and only significant in K in 1968, Negative correlation coefficients between percentage recovery and grain or dry matter yield of no or minus fertilizer plots were shown only in K in 1967 and only in P in 1968 indicating that phosphorus fertilizer gave a distinct positive role in 1967 but somewhat' negative role in 1968 while potassium fertilizer worked positively in 1968 but somewhat negatively in 1967. 6. The correlation between percentage recovery of nutrient and grain yield showed similar tendency as with dry matter yield but lower coefficients. Thus the role of nutrients was more precisely expressed through dry matter yield. 7. Percentage recovery of N very frequently had significant correlation with nitrogen uptake of nitrogen applied plot, and significant negative correlation with nitrogen uptake of minus nitrogen plot, and less frequently had significant correlation with P, K and Si uptake of nitrogen applied plot. 8. Percentage recovery of P had significant correlation with Si uptake of all treatments and with N uptake of all treatments except minus phosphorus plot in 1967 indicating that phosphorus application firstly increases Si uptake and secondly silicate increases nitrogen uptake. Percentage recovery of P also frequently had significant correlation with P or K uptake of nitrogen applied plot. 9. Percentage recovery of K had significant correlation with P uptake of all treatments, N uptake of all treatments except minus phosphorus plot, and significant negative correlation with K uptake of minus K plot and with Si uptake of no fertilizer plot or the highest N applied plot in 1968, and negative correlation coefficient with P uptake of no fertilizer or minus nutrient plot in 1967. Percentage recovery of K had higher correlation coefficients with dry matter yield or grain yield than with K uptake. The above facts suggest that K application firstly increases P uptake and secondly phosphorus increases nitrogen uptake for dry matter yied. 10. Percentage recovery of N had significant higher correlation coefficient with grain yield or dry matter yield of minus K plot than with those of minus phosphorus plot, and had higher with those of fertilizer plot than with those of minus K plot. Similar tendency was observed between N uptake and percentage recovery of N among the above treatments. Percentage recovery of K had negative correlation coefficient with grain or-dry matter yield of no fertilizer plot or minus nutrient plot. These facts reveal that phosphorus increases nitrogen uptake and when phosphorus or nitrogen is insufficient potassium competatively inhibits nitrogen uptake. 11. Percentage recovery of N, Pand K had significant negative correlation with relative dry matter yield of minus phosphorus plot (yield of minus plot x 100/yield of complete plot; in 1967 and with relative grain yield of minus K plot in 1968. These results suggest that phosphorus affects tillering or vegetative phase more while potassium affects grain formation or Reproductive phase more, and that clearly show the annual difference of P and K fertilizer effect according to the weather. 12. The correlation between percentage recovery of fertilizer and the relative yield of minus nutrient plat or that of no fertilizer plot to that of minus nutrient plot indicated that nitrogen is the most effective factor for the production even in the minus P or K plot. 13. From the above facts it could be concluded that about 40 to 50 percen of paddy fields do rot require P or K fertilizer and even in the case of need the application amount should be greatly different according to field and weather of the year, especially in phosphorus.