• 한국응급구조학회지
• /
• 제16권2호
• /
• pp.67-74
• /
• 2012

Purpose : The purpose of this study is to get basal user guidelines of safer bag-valve-mask application on patient with normal pulmonary patho-physiologic condition. Methods : This study was accomplished by pre-qualified 25 EMS junior grade students. Participants were instructed randomly compress bag to one-third, half and total and also with differesnt compression speed. Resultant tidal volumes and mean airway pressures obtained in RespiTrainer were analysed in relation to the each compression depth and rate. Results : Demographic difference does not affect tidal volume with any compression depth and rate change. Increasing compression depth is correlated with tidal volume increasement at any compression rate and also with mean airway pressure. If the compression depth is same, compression rate change did not affect significantly the resultant tidal volume or mean airway pressure. Conclusion : Hand size, Experience, BMI dose not affect tidal volume. Compress the 1600 ml bag half to total amount is safe way to offer sufficient tidal volume without risky high airway pressure delivery to patient airway who with normal lung patho-physiologic condition.

• 대한의용생체공학회:의공학회지
• /
• 제11권2호
• /
• pp.203-208
• /
• 1990

A possible asymmetry in airway inertance was modeled based on previously reported radiographic visualization data of the airway wall fluctuation in intact dogs. Effects of asymmetric Inertance on mean lung volume during high frequency ventilation (HFV) were evaluated in terms of mean inertive pressure drop across the airways. It was found that a negligible inertlve pressure drop was expected ($<1{\;}cmH_20$) in normal subjects, while a sig- nificant rise in mean alveolar pressure compared to mean mouth pressure by approximately $3{\;}cmH_20$ was resulted for about 40% airway fluctuation representing bronchoconstriction state by Histamine induction. These results demonstrate that asymmetric Inertance could lead patients with airway diseases to a significant lung hyperinflation (LHI), and bronchodilation treatment is recommended prior to applying HFV to prevent those patients from a possible barotrauma.

• Tuberculosis and Respiratory Diseases
• /
• 제45권5호
• /
• pp.1022-1030
• /
• 1998

연구배경: Volume controlled ventilation(VCV)시 inspiratory pause의 사용은 흡기시간을 연장하여 평균기도압을 상승시키고 가스교환을 호전시키는 것으로 알려져 있다. 그러나 같은 흡기시간을 유지하더라도 inspiratory pause를 사용하였을 경우 평균기도압과 가스교환의 변화에 대하여는 잘 알려지지 않았다. 방 법: 저자들은 VCV으로 기계호흡을 받는 12명의 환자를 대상으로 흡기산소농도, 상시호흡량, 호흡수 및 I : E ratio(1 : 3)는 변화시키지 않고 5%의 pause를 사용한 경우와 사용하지 않은 경우의 기도압 및 가스교환의 변화를 관찰하여 비교하였다. 결 과: 동맥혈 이산화탄소분압은 pause를 사용한 경우 $38.6{\pm}7.4$ mmHg로 시용하지 않은 경우의 $41.0{\pm}7.7$ mmHg보다 유의하게 낮았다 (p<0.01). 동맥혈 산소분압은 pause를 사용한 경우 $94.4{\pm}23.2$ mmHg로 사용하지 않은 경우의 $91.8{\pm}19.7$ mmHg보다 높은 경향이 있었으나 (p=0.054), 폐포-동맥혈 산소분압차$(P(A-a)O_2)$는 pause 유무에 따른 차이가 없었다 ($185.3{\pm}86.5$ mmHg vs. $184.9{\pm}84.9$ mmHg, P=0.766). 평균기도압은 pause를 사용한 경우 $9.7{\pm}4.0\;cmH_2O$로 사용하지 않은 경우의 $8.8{\pm}4.0\;cmH_2O$보다 유의하게 높았다 (p<0.01). Pause를 사용했을 때의 pause pressure와 pause를 사용하지 않을 때의 최고흡기압의 차이는 호흡기계의 저항과 역상관관계를 보였으나 (r=-0.777, p<0.01), pause가 없을 때의 최고흡기압에서 pause를 사용했을 때의 최고흡기압으로의 증가는 호흡기계의 저항과 정상관관계를 보여 (r=0.811, p<0.01), 평균기도압의 차이는 호흡기계의 저항과 유의한 정상관관계를 보였다(r=0.681, p<0.05). 평균기도압의 변화는 $PaCO_2$의 변화와 상관관계를 보이지 않았다. 결 론: Volume control ventilation시 동일한 1:3 의 I:E ratio하에서라도 5%의 inspiratory pause를 사용하는 것이 평균기도압을 더 높게 유지할 수 있으며 폐환기를 호전시킬 수 있는 것으로 사료되었다. 또한 호흡기계의 저항이 증가되어 있을수록 평균기도압의 상승이 많았으나 평균기도압의 상승 정도는 폐환기의 변화와 상관관계를 보이지 않았다.

• 대한의용생체공학회:의공학회지
• /
• 제14권1호
• /
• pp.89-96
• /
• 1993

During high frequency ventilation (HFV), mean alveolar pressure has been measured to increase with mean airway opening pressure controlled at a constant level in both humans and experimental animals. Since this phenomenon could potentiate barotrauma limiting advantages of HFV, the present study theoretically predicted the difference between menu alveolar and airway opening pressures ($MP_{alv}$). In a Weibel's trumpet airway model, approximated formula for $MP_{alv}$ was derived based on momentum conservation assuming a uniform velocity profile. The prediction, equation was a func pion of gas density($\rho$), mean flow rate(Q), and diameter of the airway opening where the pressure measurement was made($D_0$) : $MP_{alv}=4{\rho}(Q/D_0^{2})^2$. This was a result of the difference in crosssectional area between the alveoli and the airway opening. A simple aireway model experiment was performed and the results well fitted to the prediction, which demonstrated the validity of the present analysis. Previously reported $MP_{alv}$ data from anesthetized dogs in supine position were comparable to the predicted values, indicating that the observed dissociation between mean alveolar and airway opening pressures during HFV can be explained by this innate geometric (or cross-sectional area) asymmetry of the airways. In lateral position, however, the prediction substantially underestimated the measurements suggesting involvement of other important physiological mechanisms.

• 한국임상수의학회지
• /
• 제22권3호
• /
• pp.214-219
• /
• 2005

This experiment was conducted in order to identify the effect of the laryngeal mask airway and it's clinical utility on cardiovascular system, intraocular pressure and stress reaction at the time of anesthesia care. The heart rate, systolic arterial pressure, diastolic arterial pressure and intraocular pressure were significantly reduced in the experimental group to be compared with the control group. But, there were no significant differences in mean arterial pressure, central venous pressure and blood cortisol concentration between both groups. In view of the above results, it is thought that the airway management using the laryngeal mask airway will be useful to reduce the stress condition in the induction of anesthesia.

• 대한의용생체공학회:의공학회지
• /
• 제40권4호
• /
• pp.132-136
• /
• 2019

This study proposes an auto-titrating algorithm for auto-titrating positive airway pressure (APAP). The process of the proposed algorithm is as follows. First, sleep apnea-hypopnea and snoring events were detected using nasal pressure. Second, APAP base pressure and SDB events were used for automatic titration of optimal pressure. And, auto-titrating algorithm is built into M3 (MEK-ICS CO. Ltd., Republic of Korea) for evaluation. The detection results of SDB showed mean sensitivity (Sen.) and positive predictive value (PPV.) of 85.7% and 87.8%, respectively. The mean pressure and apnea-hypopnea index (AHI) of auto-titrating algorithm showed $13.0{\pm}5.2cmH_2O$ and $3.0{\pm}2.4$ events/h, respectively. And, paired t-test was conducted to verify whether the performance of our algorithm has no significant difference with AutoSet S9 (p>0.05). These results represent better or comparable outcomes compared to those of previous APAP devices.

• 수면정신생리
• /
• 제7권1호
• /
• pp.27-33
• /
• 2000

수면 중 나타나는 호흡장애를 좀 더 정확하게 측정하기 위해 고안된 비강 공기압 측정기의 민감도를 온도감지 센서와 비교하기 위해 30명의 수면무호흡 증후군 환자와 6명의 상기도 저항증후군 환자에서 저호흡-무호흡 지수와 각성지수를 비교하였다. 그리고 상기도 저항 증후군에서 각성을 일으키는 상기도 압력변화에 대해 알아보기 위하여 온도감지 센서에서 발견되지 않은 저호흡-무호흡과 관련된 각성에서 상기도의 압력을 측정하였다. 비강 공기압 측정기가 기존의 온도감지 센서보다 훨씬 더 민감한 방법임을 알 수 있었다(p<0.05). 비강 공기압 측정기로 검사하여 저호흡-무호흡지수가 평균 41%가 증가되었고 호흡장애가 심하지 않은 경증의 수면무호흡 증후군이나 상기도 저항 증후군에서 더 많이 증가하였다. 비강 공기압 측정기로 검사한 저호흡-무호흡지수를 비교하면 상기도 저항 증후군이 수면무호흡 증후군의 가장 경미한 형태라는 것을 알 수 있었다. 상기도 저항 증후군에서 나타나는 각성에서 상기도의 압력 변화는 일정한 범위에서 나타나지 않았고 다양한 압력 분포를 보였으며 수면 중 호흡장애의 정도가 심해질수록 압력변화의 폭이 더 커지는 양상을 보였다. 비강 공기압 측정기가 기존의 온도감지 센서보다 더 민감하지만 아직까지 해결해야 할 문제가 일부 남아 있어서 온도 감지 센서를 완전히 대체하기는 어려울 것으로 보인다. 그러나 경증의 수면무호흡 증후군이나 상기도 저항 증후군을 진단하는 데에는 많은 도움이 될 것이다. 특히 상기도 저항 증후군의 진단에 기존에는 상기도 압력 측정이 필요하다고 하였으나 비강 공기압 측정기를 이용하면 불편한 상기도 압력 측정은 필요 없을 것으로 생각된다.

• 한국화재소방학회논문지
• /
• 제28권6호
• /
• pp.76-81
• /
• 2014

이 연구는 RespiTrainer를 활용한 백밸브마스크 환기에서 1인 백밸브마스크, 2인 백밸브마스크, 전문기도삽관 별 호흡량과 기도압을 비교 분석하였다. 실험기간은 2014년 6월 2일부터 6월 10일까지이며, 수집된 자료는 SPSS 18.0을 이용하여 분석하였다. 그 결과 기관내삽관을 통한 환기 $497{\pm}78mL$, 2인 BVM 환기 $479{\pm}91mL$를 보였고, 1인 BVM 환기와 킹후두관기도기, 후두마스크 환기에서 각각 $386{\pm}59mL$, $365{\pm}05mL$, $351{\pm}35mL$를 보였다. 기도압에서도 기관내삽관을 통한 BVM 환기에서 가장 높은 기도압(11.67 cm $H_2O$)을 보였다. 결과적으로 기관내삽관을 통한 BVM 환기와 2인 BVM 환기에서 1/3 백 압착법은 적절하였다.

• 한국응급구조학회지
• /
• 제24권1호
• /
• pp.67-76
• /
• 2020

Purpose: Effective time management, as well as life-saving care, are important in maximizing the prognosis of patients who have sustained major traumas. This study evaluated the appropriateness of emergency medical system (EMS) provider's essential care and how this care impacted on-scene time in patients with major traumas. Methods: This retrospective observational study analyzed the EMS major trauma documents, classified according to the physiological criteria (Glasgow coma scale <14, systolic blood pressure <90mmHg, Respiration rate <10 or >29) in Daejeon, from January, 2015 to December, 2018. Results: Of the 707 major trauma cases, the mean on-scene time was 7.75±4.64 minutes. According to EMS guidelines, essential care accuracy was 67.5% for basic airway, 36.4% for advanced airway, 91.2% for cervical collar, 81.5% for supplemental oxygen, 47.0% for positive pressure ventilation, 19.9% for intravenous access and fluid administration, and 96.0% for external hemorrhage control. Factors affecting on-scene time were positive pressure ventilation (p<.004), and intravenous access and fluid administration (p<.002). Conclusion: Adherence to guidelines was low during advanced airway procedures, positive pressure ventilation, intravenous access, and fluid administration. In addition, the on-scene time was prolonged when the practitioner provided positive pressure ventilation, intravenous access, and fluid administration; however, these durations did not exceed the recommended 10 minutes.

• Journal of Sleep Medicine
• /
• 제15권2호
• /
• pp.48-54
• /
• 2018

Objectives: The aim of this study was to develop a predicting model for the optimal continuous positive airway pressure (CPAP) for obstructive sleep apnea (OSA) patient with obesity by using a machine learning. Methods: We retrospectively investigated the medical records of 162 OSA patients who had obesity [body mass index (BMI) ≥ 25] and undertaken successful CPAP titration study. We divided the data to a training set (90%) and a test set (10%), randomly. We made a random forest model and a least absolute shrinkage and selection operator (lasso) regression model to predict the optimal pressure by using the training set, and then applied our models and previous reported equations to the test set. To compare the fitness of each models, we used a correlation coefficient (CC) and a mean absolute error (MAE). Results: The random forest model showed the best performance {CC 0.78 [95% confidence interval (CI) 0.43-0.93], MAE 1.20}. The lasso regression model also showed the improved result [CC 0.78 (95% CI 0.42-0.93), MAE 1.26] compared to the Hoffstein equation [CC 0.68 (95% CI 0.23-0.89), MAE 1.34] and the Choi's equation [CC 0.72 (95% CI 0.30-0.90), MAE 1.40]. Conclusions: Our random forest model and lasso model ($26.213+0.084{\times}BMI+0.004{\times}$apnea-hypopnea index+$0.004{\times}oxygen$ desaturation index-$0.215{\times}mean$ oxygen saturation) showed the improved performance compared to the previous reported equations. The further study for other subgroup or phenotype of OSA is required.