• Clinical and Experimental Pediatrics
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• 제63권1호
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• pp.3-7
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• 2020

High-flow nasal cannula (HFNC) is a relatively safe and effective noninvasive ventilation method that was recently accepted as a treatment option for acute respiratory support before endotracheal intubation or invasive ventilation. The action mechanism of HFNC includes a decrease in nasopharyngeal resistance, washout of dead space, reduction in inflow of ambient air, and an increase in airway pressure. In preterm infants, HFNC can be used to prevent reintubation and initial noninvasive respiratory support after birth. In children, flow level adjustments are crucial considering their maximal efficacy and complications. Randomized controlled studies suggest that HFNC can be used in cases of moderate to severe bronchiolitis upon initial low-flow oxygen failure. HFNC can also reduce intubation and mechanical ventilation in children with respiratory failure. Several observational studies have shown that HFNC can be beneficial in acute asthma and other respiratory distress. Multicenter randomized studies are warranted to determine the feasibility and adherence of HFNC and continuous positive airway pressure in pediatric intensive care units. The development of clinical guidelines for HFNC, including flow settings, indications, and contraindications, device management, efficacy identification, and safety issues are needed, particularly in children.

• Clinical and Experimental Pediatrics
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• 제59권10호
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• pp.389-394
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• 2016

The incidence of bronchopulmonary dysplasia (BPD) has not decreased over the last decade. The most important way to decrease BPD is by weaning the patient from the ventilator as soon as possible in order to reduce ventilator-induced lung injury that underlies BPD, and by using a noninvasive ventilator (NIV). Use of a heated, humidified, high flow nasal cannula (HHHFNC), which is the most recently introduced NIV mode for respiratory support in preterm infants, is rapidly increasing in many neonatal intensive care units due to the technical ease of use without sealing, and the attending physician's preference compared to other NIV modes. A number of studies have shown that nasal breakdown and neonatal complications were lower when using a HHHFNC than when using nasal continuous positive airway pressure (nCPAP), or nasal intermittent positive pressure ventilation. The rates of extubation failure during respiratory support were not different between patients who used HHHFNC and nCPAP. However, data from the use of HHHFNC as the initial respiratory support "after birth", particularly in extremely preterm infants, are lacking. Although the HHHFNC is efficacious and safe, large randomized controlled trials are needed before the HHHFNC can be considered an NIV standard, particularly for extremely preterm infants.

• Clinical and Experimental Pediatrics
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• 제65권3호
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• pp.136-141
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• 2022

Background: High-flow nasal cannula (HFNC) is a noninvasive respiratory support that provides the optimum flow of an air-oxygen mixture. Several studies demonstrated its usefulness and good safety profile for treating pediatric respiratory distress patients. However, the cost of the commercial HFNC is high; therefore, the modified high-flow nasal cannula was developed. Purpose: This study aimed to compare the effectiveness, safety, and nurses' satisfaction of the modified system versus the standard commercial HFNC. Methods: This prospective comparative study was performed in a tertiary care hospital. We recruited children aged 1 month to 5 years who developed acute respiratory distress and were admitted to the pediatric intensive care unit. Patients were assigned to 2 groups (modified vs. commercial). The effectiveness and safety assessments included vital signs, respiratory scores, intubation rate, adverse events, and nurses' satisfaction. Results: A total of 74 patients were treated with HFNC. Thirtynine patients were assigned to the modified group, while the remaining 35 patients were in the commercial group. Intubation rate and adverse events did not differ significantly between the 2 groups. However, the commercial group had higher nurses' satisfaction scores than the modified group. Conclusion: Our findings suggest that our low-cost modified HFNC could be a useful respiratory support option for younger children with acute respiratory distress, especially in hospital settings with financial constraints.

• Clinical and Experimental Pediatrics
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• 제60권9호
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• pp.273-281
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• 2017

To date, preterm infants with respiratory distress syndrome (RDS) after birth have been managed with a combination of endotracheal intubation, surfactant instillation, and mechanical ventilation. It is now recognized that noninvasive ventilation (NIV) such as nasal continuous positive airway pressure (CPAP) in preterm infants is a reasonable alternative to elective intubation after birth. Recently, a meta-analysis of large controlled trials comparing conventional methods and nasal CPAP suggested that CPAP decreased the risk of the combined outcome of bronchopulmonary dysplasia or death. Since then, the use of NIV as primary therapy for preterm infants has increased, but when and how to give exogenous surfactant remains unclear. Overcoming this problem, minimally invasive surfactant therapy (MIST) allows spontaneously breathing neonates to remain on CPAP in the first week after birth. MIST has included administration of exogenous surfactant by intrapharyngeal instillation, nebulization, a laryngeal mask, and a thin catheter. In recent clinical trials, surfactant delivery via a thin catheter was found to reduce the need for subsequent endotracheal intubation and mechanical ventilation, and improves short-term respiratory outcomes. There is also growing evidence for MIST as an alternative to the INSURE (intubation-surfactant-extubation) procedure in spontaneously breathing preterm infants with RDS. In conclusion, MIST is gentle, safe, feasible, and effective in preterm infants, and is widely used for surfactant administration with noninvasive respiratory support by neonatologists. However, further studies are needed to resolve uncertainties in the MIST method, including infant selection, optimal surfactant dosage and administration method, and need for sedation.

• Tuberculosis and Respiratory Diseases
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• 제82권3호
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• pp.242-250
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• 2019

Background: Data on noninvasive ventilation (NIV) use in intensive care units (ICUs) are very limited in South Korea. Methods: A prospective observational study was performed in 20 ICUs of university-affiliated hospitals from June 2017 to February 2018. Adult patients (age>18 years) who were admitted to the ICU and received NIV treatment for acute respiratory failure were included. Results: A total of 156 patients treated with NIV were enrolled (mean age, $71.9{\pm}11.6years$). The most common indications for NIV were acute hypercapnic respiratory failure (AHRF, n=89) and post-extubation respiratory failure (n=44). The main device for NIV was an invasive mechanical ventilator with an NIV module (61.5%), and the majority of patients (87.2%) used an oronasal mask. After the exclusion of 32 do-not-resuscitate patients, NIV success rate was 68.5% (85/124); ICU and hospital mortality rates were 8.9% and 15.3%, respectively. However, the success rate was lower in patients with de novo respiratory failure (27.3%) compared to that of patients with AHRF (72.8%) or post-extubation respiratory failure (75.0%). In multivariate analysis, immunocompromised state, de novo respiratory failure, post-NIV (2 hours) respiratory rate, NIV mode (i.e., non-pressure support ventilation mode), and the change of NIV device were significantly associated with a lower success rate of NIV. Conclusion: AHRF and post-extubation respiratory failure were the most common indications for NIV in Korean ICUs. Overall NIV success was achieved in 68.5% of patients, with the lowest rate in patients with de novo respiratory failure.

• Tuberculosis and Respiratory Diseases
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• 제42권5호
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• pp.723-730
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• 1995

Background: Noninvasive ventilation has been used extensively for the treatment of patients with neuromuscular weakness or restrictive chest wall disorders complicated by hypoventilatory respiratory failure. Recently, noninvasive positive pressure ventilation has been used in patients with alveolar hypoventilation, chronic obstructive pulmonary disease(COPD), and adult respiratory distress syndrome. Sanders and Kern reported treatment of obstructive sleep apnea with a modification of the standard nasal CPAP device to deliver seperate inspiratory positive airway pressure(IPAP) and expiratory positive airway pressure(EPAP). Bi-level positive airway pressure(BiPAP) unlike nasal CPAP, the unit delivers a different pressure during inspiration from that during expiration. The device is similar to the positive pressure ventilator or pressure support ventilation. Method and purpose: Bi-level positive airway pressure(BiPAP) system(Respironics, USA) was applied to seven patients with acute respiratory failure and three patients on conventional mechanical ventilation. Results: 1) Two of three patients after extubation were successfully achieved weaning from conventional mechanical ventilation by the use of BiPAP ventilation with nasal mask. Five of seven patients with acute respiratory failure successfully recovered without use of conventional mechanical ventilation. 2) $PaO_2$ 1hour after BiPAP ventilation in acute respiratory failure patients significantly improved more than baseline values(p<0.01). $PaCO_2$ 1hour after BiPAP ventilation in acute respiratory failure patients did not change significantly more than baseline values. Conclusion: Nasal mask BiPAP ventilation can be one of the possible alternatives of conventional mechanical ventilation in acute respiratory failure and supportive method for weaning from mechanical ventilation.

• Tuberculosis and Respiratory Diseases
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• 제46권3호
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• pp.350-362
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• 1999

연구배경: 침습적 기계 호흡 이탈에 성공하여 기관내 관을 제거하였으나 48시간 이내에 급성 호흡 부전이 경우 또는 환자 스스로 기관내 관을 제거한 후 발생된 급성 호흡 부전은 이탈 실패의 중요한 원인이며, 발생시 기관내 관의 재삽관을 통한 호흡 보조가 표준적 치료이다. 비침습적 양압 환기법(noninvasive positive pressure ventilation이하 NIPPV)은 비 혹은 안면마스크를 통해 양압 환기를 시행하므로 기관내 삽관을 회피할 수 있다. 본 연구는 기계 호흡 이탈 후 기관내 관을 제거한 환자들에게 발생된 급성 호흡 부전 시 NIPPV 적용이 기관내 삽관을 통한 양압 환기 치료를 대체할 수 있는지를 알아보고자 하였다. 방 법: 대상은 아산 재단 서울 중앙병원 내과계 중환자실에 입원하여 기계적 환기 치료를 받고 이탈 과정에서 기관내 관 제거 후 48시간 이내에 급성 호흡 부전이 발생한 환자 21명 및 스스로 기관내 관을 제거한 후 급성 호흡 부전이 발생한 환자 7명과 기관내 관이 기도내 분비물로 막혀 기관내 관을 제거한 환자 2명등 총 31명에게 NIPPV를 적용하였다. NIPPV는 환자 상태에 따라 기계 환기 양식, 압력 보조 수준 및 흡입 산소의 양이 조절 되어졌으며, 압력 보조 8cm $H_2O$미만에서 임상적으로 안정된 상태를 유지하는 경우 완전히 NIPPV에서 이탈하였다. 성공군은 NIPPV 이탈후 48 시간 이상 자발 호흡을 유지한 경우로 정의하였고, 실패군은 NIPPV 시행 후 호흡 부전 소견이나 동맥혈 가스검사의 호전이 없어 다시 기관내 삽관을 시행하여 기계호흡을 시행한 환자로 정의하였다. 각 군에서 NIPPV적용 직전, 적용 후 30분, 6시간, 24시간, NIPPV 이탈 작전 또는 실패하여 기관내 재삽관으로 전환 직전의 심박동수, 분당 호흡수, 동맥혈 가스검사, 압력 보조 수준 및 호기말 양압등을 비교하였다. 결 과: 총 31명에서 NIPPV를 적용하였고, 이 중 성공군은 14명(45%)이었다. 성공군과 실패군을 비교 시 나이, 중환자실 입원 당시의 APACHE III 점수, 기관 내 삽관 기간, 기관내 관 제거 후 NIPPV적용시까지의 시간 및 NIPPV 시행 직전의 분당 호흡수, 심박동수, 동맥혈 가스검사, $PaO_2/FiO_2$ 등은 양군간에 유의한 차이가 없었다. 모든 환자에서 NIPPV적용 30분후부터 분당 호흡수 및 심박동수는 감소하였고 동맥혈 산소 포화도는 증가하였다.(p<0.05) 그러나, 실패군에서는 NIPPV 시행중에 상태가 악화되어 기관내 재삽관을 시행하였고, 재삽관 작전의 분당 호흡수 및 심박동수는 다시 증가하였으며 동맥혈 산소포화도는 감소하였다(p<0.05). 기저 질환이 COPD 이면서 기관내 관 제거 후 급성 호흡부전이 발생한 환자 8명에게 NIPPV 적용 시 COPD가 아닌 다른 환자들에 비해 NIPPV의 성공률이 의미 있게 높았다(62% 대 39%)(p=0.007). NIPPV를 이용한 이탈 시 실패의 원인으로는 기저 질환의 악화 없이 동맥혈 가스 소견이 악화되었던 예가 9예, 그 외 기저 질환 악화 5예, 마스크 부적응이 2예, 기도내 분비물 축적이 1예였다. 결 론: NIPPV는 침습적 기계 호흡이탈과정에서 특히 기저질환이 COPD인 환자들의 경우 기관내 관 제거 후 발생한 급성 호흡 부전 시 기관내 관의 재삽관을 피할 수 있는 유용한 치료적인 방법으로 사료된다.

• Tuberculosis and Respiratory Diseases
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• 제46권4호
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• pp.500-511
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• 1999

연구배경: 비 혹은 안면마스크를 이용한 비침습적 양압호흡법(NPPV)은 안정된 만성호흡부전환자를 대상으로 사용되었으며, 최근 급성호흡부전환자를 대상으로도 시도되고 있다. 일부 연구에서 기계호흡이탈후 발생한 호흡부전에서 NPPV를 시도하여 기관내삽관을 피할 수 있음을 보고한바 있으나, 기계호흡이탈의 한 방법으로 시도된 예는 거의 없다. 본 연구자는 장기간 침습적 기계호흡중인 환자에서 의도적으로 ET를 제거한 후 NPPV틀 적용하여 새운 이탈방법으로서 효용성이 있는지를 알아보고자 하였다. 대상 및 방법: 1회이상 이탈시도가 실패하였고, 압력보조 요구량이 8-15cm $H_2O$, PEEP 요구량이 5-10cm $H_2O$ 사이이며, 기계환기 시작 후 10일 이상 경과되어 기관절개술 시행을 고려중인 환자로서 NPPV 적응증을 만족시키는 12명(14회)을 대상으로 하였다. 기관내관 제거 후 안면마스크를 이용하여 NPPV를 시작하였다. NPPV 적용 직전, 적용후 30분, 1-6시간, 6-12시간, 12-24시간, 2일째, 3일째, 그리고 NPPV 이탈 직전에 분당호흡수, 동맥혈가스검사, 압력보조수준, 그리고 호기말양압 수준을 측정하였다. 이탈후 기계호흡없이 48시간 이상 자가호흡을 유지한 예를 성공군으로 정의하였다. 결 과: 의도적 ET 제거후 NPPV에 의한 기계호흡 이탈을 시도한 14예중 7예(50%)에서 이탈에 성공하여 기관절개를 피할 수 있었다. 양군에서 나이, 입원당일의 APACHE III 점수, 기관내삽관 기간, NPPV 시행직전의 분당호흡수, 동맥혈가스검사, $PaO_2/FiO_2$, 압력보조수준, 호기말양압 수준에 차이가 없었다. 성공군에서 NPPV 전후의 분당호흡수, 압력보조수준, 흡기말양압, 동맥혈가스소견 및 $PaO_2/FiO_2$가 차이 없었으나 실패군은 NPPV 후 30분에 동맥혈 pH가 유의하게 감소하였다($7.40\pm0.08$ vs. $7.34\pm0.06$, p<0.05). 이탈실패의 원인은 동맥혈가스검사소견 악화 3예, 기도내 분비물 축적 2예, 마스크 부적응 1예, 그리고 늑골골절에 의한 flail chest 1예이었다. 결 론: 비침습적 양압호흡법은 급성호흡부전에 의한 장기적 기계호흡 환자에서 새로운 기계호흡이탈 방법으로 기대된다.

• Child Health Nursing Research
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• 제6권1호
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• pp.32-50
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• 2000

A descriptive exploratory design was used in this study to evaluate the effects of sponge bathing on physiological(heart rate, heart period, vagal tone, oxygen saturation, respiration) and behavioral responses in newly born 40 preterm infants from intensive care unit of S University Hospital in Seoul. Data has been collected from October, 1997 to March, 1999. The infants were between 27-33 weeks gestational age at birth, and were free of congenital defects. The subjects entered the protocol when they were medically stable (determined by initiation of feeding and discontinuation of all respiratory support) but still receiving neonatal intensive care. The infants' physiologic parameters were recorded a 10 - minute before, during, and after bathing. Continuous heart rate data were recorded on a notebook computer from the infant's EKG monitor. The data were digitized off-line on software(developed by Lee and Chang in Wavelet program) which detected the peak of the R wave for each heart beat and quantified sequential R-R intervals in msec(i.e. heart periods). Heart period data were edited to remove movement artifact. Heart period data were quantified as : 1) mean heart period; 2) vagal tone. Vagal tone was quantitfied with a noninvasive measure developed by Porges(1985) in Mxedit software. To determine behavioral status, tools were developed by Scafidi et al(1990) were used. Collected data were analyzed with the SPSS program using paried t-test, ANOVA, and Pearson correlation. The result were as follow. 1. The results of the ANOVAs indicated that vagal tone were signifcantly lower during bathing than baseline and post-bathing. There were significant differences in heart period and heart rate levels across the bathing. But the mean oxygen saturations and respirations were no differences. Also, there were no significant differences on behavioral sign, motor activity, behavioral distress, weight changes, morbidity, and hospitalization period. 2. To evaluate the relation between vagal tone and subsequent parameters, the two groups (the high group had 19 subjects and low group had 21subjects) were divided by the mean baseline vagal tone. Vagal tone measured prior to bathing were significantly associated with respiration before bathing, vagal tone during bathing, and the magnitude of change in both vagal tone. But, other subsequent reactivities were no differences in two groups. 3. Correlations were also calculated between vagal tone and the subsequent physiological reactivities from baseline through after- bathing. Correlations were significant between baseline vagal tone and baseline heart rate, between baseline vagal tone and baseline heart period, between baseline vagal tone and oxygen saturation after bathing. In summary, the bathing in this study showed a stressful stimulus on premature infants through there was significance in the physiological parameters. In addition, our study represents the documentation that vagal tone reactivity in response to clearly defined external stimulation provides an index of infant's status.