• Tuberculosis and Respiratory Diseases
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• 제85권4호
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• pp.332-340
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• 2022

Background: Cardiac dysfunction patients have long been considered at high risk of reintubation. However, it is based on past studies in which only conventional oxygen therapy was applied after extubation. We investigated association between cardiac dysfunction and reintubation rate in situation where high-flow nasal cannula (HFNC) was widely used during post-extubation period. Methods: We conducted a retrospective observational cohort study of patients treated with HFNC after planned extubation in medical intensive care unit of single tertiary center. Patients were divided into normal function group (ejection fraction [EF] ≥45%) and cardiac dysfunction group (EF <45%). The primary outcome was reintubation rate within 72 hours following extubation. Results: Of 270 patients, 35 (13%) had cardiac dysfunction. Baseline characteristics were similar in both groups. There were no differences in the changes in vital signs between the two groups during the first 12 hours after extubation except diastolic blood pressure. The reintubation rates were 20% and 17% for cardiac dysfunction group and normal function group, respectively (p=0.637). In a multivariate Cox regression analysis, cardiac dysfunction was not associated with an increased risk of reintubation within 72 hours following extubation (hazard ratio, 1.56; p=0.292). Conclusion: Cardiac dysfunction was not associated with increased reintubation rate within 72 hours when HFNC is immediately applied after planned extubation.

• Neonatal Medicine
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• 제18권2호
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• pp.293-300
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• 2011

목적: 본 연구의 목적은 미숙아에서 HHFNC를 이용한 보조환기요법의 사용 빈도와 예후에 미치는 영향을 알아보고자 하였다. 방법: 2008년 1월부터 2011년 3월까지 서울 한양대학교 신생아 중환자실에 입원한 재태주령 32주 미만의 환아들을 대상으로 의무기록을 후향적으로 분석하였다. 첫 번째 2008년 1월부터 2009년 2월까지를 Era 1, 2009년 3월부터 2011년 3월까지를 Era 2으로 구분하여 두 기간 동안 HHFNC 사용 빈도의 변화에 대해 조사하였다. 두 번째로 재태주령 25-30주 미만 환아들 중 출생 14일 이내 보조환기요법으로 NCPAP 또는 HHFNC를 적용 받았던 두 그룹의 임상경과를 비교하였다. 결과: Era 1과 비교해서 HHFNC의 사용은 10에서 55%으로 증가하였고, NCPAP의 사용은 40에서 5%으로 Era 2에서 감소하였다. 재삽관률과 BPD 그리고 산소나 인공환기기를 적용 받은 기간에서는 두 그룹에서 차이가 없었고, 기타 미숙아 합병증에서도 유의한 차이를 보이지 않았다. 그러나 완전 장관 수유까지 걸린 시간과 출생체중으로 회복되는데 걸린 시간이 HHFNC를 적용한 그룹에서 감소하였다. 고찰: HHFNC이 미숙아에서 잘 적용되었고, NCPAP과 비교하여 임상 경과에 유의한 차이를 보이지 않았으나 완전 장관 수유까지 걸린 시간과 출생체중으로 회복되는데 걸린 시간을 줄였다. 향후 전향적인 다기관 연구를 통하여 HHFNC의 안정성과 효과에 대한 연구가 필요하다.

• Tuberculosis and Respiratory Diseases
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• 제86권1호
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• pp.65-66
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• 2023

• Clinical Endoscopy
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• 제57권2호
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• pp.196-202
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• 2024

Background/Aims: Hypoxemia is a common side effect of propofol sedation during endoscopy. Applying mild positive airway pressure (PAP) using a nasal mask may offer a simple way to reduce such events and optimize the conditions for diagnostic and therapeutic upper gastrointestinal endoscopies. Methods: We compared overweight patients (body mass index >25 kg/m²) with a nasal PAP mask or standard nasal cannula undergoing upper gastrointestinal endoscopies by non-anesthesiologists who provided propofol sedation. Outcome parameters included the frequency and severity of hypoxemic episodes. Results: We analyzed 102 procedures in 51 patients with nasal PAP masks and 51 controls. Episodes of hypoxemia (oxygen saturation [SpO₂] <90% at any time during sedation) occurred in 25 (49.0%) controls compared to 8 (15.7%) patients with nasal PAP masks (p<0.001). Severe hypoxemia (SpO₂ <80%) occurred in three individuals (5.9%) in both groups. The mean delta between baseline SpO₂ and the lowest SpO₂ recorded was significantly decreased among patients with nasal PAP mask compared to controls (3.7 and 8.2 percentage points difference, respectively). There were significantly fewer airway interventions performed in the nasal PAP mask group (15.7% vs. 41.2%, p=0.008). Conclusions: Using a nasal PAP mask may be a simple means of increasing patient safety and ease of examination.

• Tuberculosis and Respiratory Diseases
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• 제81권4호
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• pp.319-329
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• 2018

Background: Bronchoalveolar lavage (BAL) is a necessary procedure for diagnosis of various lung diseases. High-flow nasal cannula (HFNC) oxygen delivery was recently introduced. This study aimed to investigate the safety and effectiveness of HFNC oxygen supply during BAL procedure in patients with acute respiratory failure (ARF). Methods: Patients who underwent BAL while using HFNC at a partial pressure of oxygen in arterial blood/fraction of inspired oxygen ($PaO_2/FiO_2$; PF) ratio of 300 or below among patients who had been admitted from March 2013 to May 2017 were retrospectively investigated. Results: Thirty-three BAL procedures were confirmed. Their baseline PF ratio was $166.1{\pm}46.7$. $FiO_2$ values before, during, and after BAL were $0.45{\pm}0.12$, $0.74{\pm}0.19$, and $0.57{\pm}0.14$, respectively. Flow (L/min) values before, during, and after BAL were $26.5{\pm}20.3$, $49.0{\pm}7.2$, and $40.8{\pm}14.2$, respectively. Both $FiO_2$ and flow during and after the procedure were significantly different from those before the procedure (both p<0.001). Oxygen saturation levels before, during, and after BAL measured by pulse oximeter were $94.8{\pm}2.9$, $94.6{\pm}3.5$, and $95.2{\pm}2.8%$, respectively. There were no significant differences in oxygen saturation among the three groups. Complications of BAL procedure included transient hypoxemia, hypotension, and fever. However, there was no endotracheal intubation within 24 hours. Baseline PF ratio in "without HFNC" group was significantly higher than that in "with HFNC" group. There were no differences in complications between the two groups. Conclusion: The use of HFNC during BAL procedure in ARF patients was effective and safe. However, there were no significant differences in oxygen saturation level and complications comparing "without HFNC" group in mild ARF. More studies are needed for moderate to severe ARF patients.

• 대한임상독성학회지
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• 제17권2호
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• pp.102-107
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• 2019

Purpose: Acute carbon monoxide (CO) poisoning is one of the most common types of poisoning and a major health problem worldwide. Treatment options are limited to normobaric oxygen therapy, administered using a non-rebreather face mask or hyperbaric oxygen. Compared to conventional oxygen therapy, high-flow nasal cannula oxygen (HFNC) creates a positive pressure effect through high-flow rates. The purpose of this human pilot study is to determine the effects of HFNC on the rate of CO clearance from the blood, in patients with mild to moderate CO poisoning. Methods: CO-poisoned patients were administered 100% oxygen from HFNC (flow of 60 L/min). The fraction of COHb (fCOHb) was measured at 30-min intervals until it decreased to under 10%, and the half-life time of fCOHb (fCOHb t_1/2) was subsequently determined. Results: At the time of ED arrival, a total of 10 patients had fCOHb levels ≥10%, with 4 patients ranging between 10% and 50%. The mean rate of fCOHb elimination patterns exhibits logarithmic growth curves that initially increase quickly with time (HFNC equation, Y=0.3388*X+11.67). The mean fCOHbt_1/2 in the HFNC group was determined to be 48.5±12.4 minutes. Conclusion: In patients with mild to moderate CO poisoning, oxygen delivered via high flow nasal cannula is a safe and comfortable method to treat acute CO toxicity, and is effective in reducing the COHb half-life. Our results indicate HFNC to be a promising alternative method of delivering oxygen for CO toxicity. Validating the effectiveness of this method will require larger studies with clinical outcomes.

• The Korean Journal of Pain
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• 제12권2호
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• pp.227-230
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• 1999

The sphenopalatine ganglion lies behind the middle nasal concha in the sphenopalatine foramen which connects the fossa to the nasal cavity. It has sympathetic and parasympathetic fibers as well as sensory fibers which innervate the nasal cavity, palate and nasopharynx. Current indications for blockade of the sphenopalatine ganglion include the management of migraine, cluster headache and a variety of facial neuralgias. Blockage of this ganglion can be attempted when more conservative treatments have failed. If the pain relief gained through the procedure is of short duration and the blockage needs to be repeated frequently, then radiofrequency thermocoagulation should be considered. Since the sphenopalatine ganglion lies close to the maxillary nerve, neurolytics can cause facial dysesthesia, radiofrequency thermocoagulation is the preferred method for ganglionotomy. Radiofrequency thermocoagulation of the sphenopalatine ganglion was done for 3 patients who suffered from postherpetic neuralgia, cluster headache, atypical facial pain respectively. Good results were obtained with the exception of the patient suffering from atypical facial pain. Although we were concerned about complications such as epistaxis, none were encountered. However it should be noted that caution must be exercised when repeatedly redirecting the cannula in the sphenopalatine fossa as serious bleeding and pronounced facial swelling may result.

• Tuberculosis and Respiratory Diseases
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• 제82권1호
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• pp.81-85
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• 2019

Background: Bronchoscopy is a useful diagnostic and therapeutic tool. However, the clinical use of high-flow nasal cannula (HFNC) in adults with acute respiratory failure for diagnostic and invasive procedures has not been well evaluated. We present our experiences of well-tolerated diagnostic bronchoscopy as well as cases of improved saturation in hypoxaemic patients after a therapeutic bronchoscopic procedure. Methods: We retrospectively reviewed data of hypoxaemic patients who had undergone bronchoscopy for diagnostic or therapeutic purposes from October 2015 to February 2017. Results: Ten patients (44-75 years of age) were enrolled. The clinical purposes of bronchoscopy were for diagnosis in seven patients and for intervention in three patients. For the diagnoses, we performed bronchoalveolar lavage in six patients. One patient underwent endobronchial ultrasonography with transbronchial needle aspiration of a lymph node to investigate tumour involvement. Patients who underwent bronchoscopy for therapeutic interventions had endobronchial mass or blood clot removal with cryotherapy for bleeding control. The mean saturation ($SpO_2$) of pre-bronchoscopy in room air was 84.1%. The lowest and highest mean saturation with HFNC during the procedure was 95% and 99.4, respectively. The mean saturation in room air post-bronchoscopy was 87.4%, which was 3.3% higher than the mean room air $SpO_2$ pre-bronchoscopy. Seven patients with diagnostic bronchoscopy had no hypoxic event. Three patients with interventional bronchoscopy showed improvement in saturation after the procedure. Bronchoscopy was well tolerated in all 10 cases. Conclusion: This study suggests that the use of HFNC in hypoxaemic patients during diagnostic and therapeutic bronchoscopy procedures has clinical effectiveness.

• 대한간호학회지
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• 제53권4호
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• pp.468-479
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• 2023

Purpose: This study aimed to evaluate the use of the respiratory rate oxygenation (ROX) index, ROX-heart rate (ROX-HR) index, and saturation of percutaneous oxygen/fraction of inspired oxygen ratio (SF ratio) to predict weaning from high-flow nasal cannula (HFNC) in patients with respiratory distress in a pediatric intensive care unit. Methods: A total of 107 children admitted to the pediatric intensive care unit were enrolled in the study between January 1, 2017, and December 31, 2021. Data on clinical and personal information, ROX index, ROX-HR index, and SF ratio were collected from nursing records. The data were analyzed using an independent t-test, χ² test, Mann-Whitney U test, and area under the curve (AUC). Results: Seventy-five (70.1%) patients were successfully weaned from HFNC, while 32 (29.9%) failed. Considering specificity and sensitivity, the optimal cut off points for predicting treatment success and failure of HFNC oxygen therapy were 6.88 and 10.16 (ROX index), 5.23 and 8.61 (ROX-HR index), and 198.75 and 353.15 (SF ratio), respectively. The measurement of time showed that the most significant AUC was 1 hour before HFNC interruption. Conclusion: The ROX index, ROX-HR index, and SF ratio appear to be promising tools for the early prediction of treatment success or failure in patients initiated on HFNC for acute hypoxemic respiratory failure. Nurses caring for critically ill pediatric patients should closely observe and periodically check their breathing patterns. It is important to continuously monitor three indexes to ensure that ventilation assistance therapy is started at the right time.

• 대한소아치과학회지
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• 제42권1호
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• pp.75-79
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• 2015

폐동맥 고혈압은 좌우단락을 가진 선천성 심장질환의 흔한 합병증으로 폐동맥 고혈압 환자에서 높아진 폐혈관 저항은 생명에 위협을 초래한다. 전신마취시의 양압환기는 폐동맥압을 높이고, 폐혈류량은 감소시키므로 저산소증을 유발할 수 있으며, 이는 폐동맥 고혈압 환자에게서 불리하게 작용할 수 있다. 따라서 폐동맥 고혈압 환자에서는 양압환기보다는 자발호흡이 보다 안전할 것으로 생각된다. 만 5세 남환이 심한 저체중으로 본원으로 의뢰되었으며, 내원 당시 환아의 몸무게는 11 kg이었고, 209년 팔로사징후로 완전 교정 수술을 받은 의과적 병력이 있었으며, 2007년부터 현재까지 고혈압 약을 복용하고 있다고 하였다. 환아는 다발성 우식을 가지고 있었으며, 치료는 경비캐눌라를 사용한 세보플루란 흡입 진정 하에 진행하엿다. 치료 내내 환아는 정상적인 생징후와 자발호흡을 유지하였으며, 이후에도 폐동맥 고혈압과 연관된 다른 합병증은 보이지 않았다. 폐동맥 고혈압 환자에서의 세보플루란 흡입 진정의 안전한 사용 증례를 통해서, 세보플루란 흡입 진정이 심혈관계 질환을 가진 환자들에서 전신마취의 대안으로 사용될 수 있는 가능성을 보여주었다.