• Journal of Chest Surgery
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• 제54권5호
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• pp.348-355
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• 2021

Background: Congenital diaphragmatic hernia (CDH) is a rare disease often requiring mechanical ventilation after birth. In severe cases, extracorporeal membrane oxygenation (ECMO) may be needed. This study analyzed the outcomes of patients with CDH treated with ECMO and investigated factors related to in-hospital mortality. Methods: Among 254 newborns diagnosed with CDH between 2008 and 2020, 51 patients needed ECMO support. At Asan Medical Center, a multidisciplinary team approach has been applied for managing newborns with CDH since 2018. Outcomes were compared between hospital survivors and nonsurvivors. Results: ECMO was established at a median of 17 hours after birth. The mean birth weight was 3.1±0.5 kg. Twenty-three patients (23/51, 45.1%) were weaned from ECMO, and 16 patients (16/51, 31.4%) survived to discharge. The ECMO mode was veno-venous in 24 patients (47.1%) and veno-arterial in 27 patients (52.9%). Most cannulations (50/51, 98%) were accomplished through a transverse cervical incision. No significant between-group differences in baseline characteristics and prenatal indices were observed. The oxygenation index (1 hour before: 90.0 vs. 51.0, p=0.005) and blood lactate level (peak: 7.9 vs. 5.2 mmol/L, p=0.023) before ECMO were higher in nonsurvivors. Major bleeding during ECMO more frequently occurred in nonsurvivors (57.1% vs. 12.5%, p=0.007). In the multivariate analysis, the oxygenation index measured at 1 hour before ECMO initiation was identified as a significant risk factor for in-hospital mortality (odds ratio, 1.02; 95% confidence interval, 1.01-1.04; p=0.05). Conclusion: The survival of neonates after ECMO for CDH is suboptimal. Timely application of ECMO is crucial for better survival outcomes.

• Clinical and Experimental Pediatrics
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• 제46권12호
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• pp.1207-1211
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• 2003

목 적 : RDS가 있는 미숙아에서 질병의 심한 정도와 폐동맥압 및 혈중 L-arginine 농도와는 어떤 연관이 있는지 알아보고자 하였다. 방 법 : RDS로 인공 환기요법을 시행 받은 재태기간 37주 미만 미숙아 21명을 대상으로 하여 제 1병일, 제 3병일, 제 7병일에 혈액을 채취하여 혈중 L-arginine 농도를 측정하였다. 혈액채취와 동일한 시기에 호흡곤란 증후군의 중등도를 나타내는 지수로서 OI를 산출하였고, 도플러 심초음파를 이용하여 RVSTI를 측정하여 폐동맥압의 지표로 삼았다. OI와 혈중 L-arginine 농도 및 RVSTI 간의 상관관계를 알아보았다. 결 과 : 1) OI가 클수록 RDS 미숙아의 혈중 L-arginine 농도는 낮았다(r=-0.346, P<0.01). 2) OI가 클수록 RVSTI도 증가되었다(r=0.772, P<0.01). 3) RVSTI가 커지면 RDS 증후군 미숙아의 혈중 L-arginine 농도는 낮았다(r=-0.416, P<0.01). 결 론 : RDS가 있는 미숙아에서 질병이 심할수록 혈중 L-arginine 농도는 낮고, 폐동맥압은 높았으며, 폐동맥압이 높을수록 혈중 L-arginine 농도는 낮은 관계를 보였다.

• Journal of Chest Surgery
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• 제28권1호
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• pp.7-10
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• 1995

Mixed Venous oxygenation saturation[SvO2 is a variable determined in part by the externally controlled factors and in part by the patient during CPB. I monitored the SvO2 and tested it as a parameter for the regulation of pump output and as a criteria for the need of inotropics after CPB. With the help of SvO2, I increased the pump flow especially during rewarming for more optimal oxygenation of cells. After CPB, the calculated cardiac index was used as an indicator for the need of inotropic support with greater accuracy and without any clinical problems. I conclude that the SvO2 is an easily checkable variable and a good indicator for optimal oxygenation at cell level, and can be used as an objective criteria for the need of postoperative inotropic support.

• Acute and Critical Care
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• 제33권4호
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• pp.222-229
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• 2018

Background: The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS. Methods: Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality. Results: PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001). Conclusions: Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.

• Journal of Preventive Medicine and Public Health
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• 제25권1호
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• pp.34-43
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• 1992

To investigate the effect of hyperoxia on EKG findings and to evaluate the applicability of EKG as noninvasive monitoring index of oxygen toxicity, 38 rabbits were continuously exposed to 6 different conditions-3 hyperbaric oxygenations (HBO-2.5, 3.5 and 5ATA, 100% $O_2$), normobaric oxygenation (NBO,100% $O_2$), hyperbaric aeration (HBA-5ATA, 21% $O_2$) and normobaric aeration (NBA, 21% $O_2$)-for 120 minutes and their EKG and time to dyspnea and convulsion were recorded. Dyspnea and death were observed in exposure conditions of HBO-3.5 and HBO-5 (Positive rate of dyspnea 10%, 100%, death : 10%, 25%, respectively) only, and convulsion in 4 oxygenation groups (NBO;20%, HBO-2.5;20%, HBO-3.5;20%, HBO-5;88%). Abnormal EKG findings included arrhythmia and ST-T changes and the incidences was increasing with doses(partial pressure of oxygen). In addition to EKG change, findings observed during exposure were dyspnea and convulsion in the order of appearance and when non specific ST-T change was accepted as positive(abnormal) finding, the frequency of abnormal EKG was statistically significant(p<0.01), but when it was excluded from positive results, the frequency of EKG change was not significant(p>0.05). These results suggest that the effect of hyperoxia on heart is myocardial ischemia and arrhythmia, that oxygenation more than 3.5ATA causes myocardial damage in 120 minutes exposure, and that EKG is valuable as monitoring index of oxygen toxicity.

• 기본간호학회지
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• 제17권1호
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• pp.45-54
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• 2010

Purpose: The purpose of this study was to develop and test an explanatory model of dyspnea in patients with chronic lung disease (CLD). Methods: Participants were 181 patients with CLD, recruited from the outpatient pulmonary clinic of one university hospital in Korea. Data were collected using questionnaires, as well as measurement of 6-minute walking distance (6MWD), oxygen saturation ($SpO_2$), FEV1% predicted, and Body Mass Index (BMI). Results: The results indicated a good fit between the proposed dyspnea model and the collected data [$x^2$=91.27, p= .13, $x^2$/d.f.=1.17, Normal Fit Index= .934]. Oxygenation ($SpO_2$, = -.530), self-efficacy (= -.429), anxiety (= .253), depression (= .224), exercise endurance (6MWD, = -.211), and pulmonary function (FEV1% predicted, = -.178) had a direct effect on dyspnea (all p< .05) and these variables explained 74% of variance in dyspnea. BMI, smoking history, and social support had an indirect effect on dyspnea. Conclusion: The findings of this study suggest that comprehensive nursing interventions should focus on recovery of respiratory health and improvement of emotions, exercise ability, and nutritional status. From this perspective, pulmonary rehabilitation would be an effective strategy for managing dyspnea in patients with CLD.

• Journal of Preventive Medicine and Public Health
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• 제20권2호
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• pp.221-227
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• 1987

In vivo ethane production in rats was used as an index of oxygen toxicity. The rats were allocated to four exposure conditions; hyperbaric oxygenation (HBO=5 ATA, 100% $O_2$), normobaric oxygenation (NBO=1 ATA,100% $O_2$), hyperbaric aeration (HBA=5 ATA, 21% $O_2$) and normobaric aeration (NBA=1 ATA, 21% $O_2$). After 120 minutes of exposure, the rats exposed to high concentration and/or high pressure oxygen exhaled significantly larger amounts of ethane than those exposed to NBA, and the differences in ethane production between any two groups were statistically significant (p<.01). This finding supports the hypothesis that hyperoxia increases oxygen free-radicals and the radicals produce ethane as a result of lipid peroxidation. It is notable that the ethane exhalation level of the HBA group was significantly higher than that of the NBO group. This difference could not be accounted for by the alveolar oxygen partial presure difference between the two groups.

• Clinical and Experimental Pediatrics
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• 제51권2호
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• pp.145-149
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• 2008

목 적 : OI가 폐의 중증도를 반영한다는 가정 하에 미숙아 호흡 곤란 증후군에서 표면활성제 투여 횟수 및 생존, 사망에 따라 OI가 어떠한 차이가 있는지 연구하고자 하였다. 방 법 : 2005년 1월부터 2006년 6월까지 세브란스 어린이병원 신생아 중환자실에 내원한 미숙아 84명을 대상으로 출생 시, 생후 24시간째, 48시간째, 72시간째 OI를 구하였다. 환아 들을 표면활성제 1회 투여 군을 Group I, 표면활성제 2회 투여 군을 Group II로 분류하였고, 각 군에서 생존, 사망으로 아 분류하여 비교 분석하였다. 결 과 : Group I(n=54)과 Group II(n=30)은 재태주령($30.1{\pm}2.6wk\;vs\;28.4{\pm}3.4wk$)과 출생체중($1,478{\pm}442g\;vs\;1,199{\pm}495g$)이 유의한 차이를 보였고(P=0.027 vs 0.013), Group I의 사망이 2명, Group II의 사망이 9명으로 유의한 차이를 보였다(P=0.001). 생후 나이에 따른 OI 변화는 군 간의 차이를 보였고(P=0.001), 시간의 변화에 따라 유의한 감소를 보였다(P<0.001). Group I에서 생존군(n=52)과 사망군(n=2)의 OI 변화는 차이가 없었으며, 시간의 변화에 따른 차이도 없었다. Group II에서도 생존 군(n=21)과 사망 군(n=9)간의 OI 변화와 생후 나이에 따른 OI 변화는 유의한 차이가 없었다. 결 론 : 미숙아 RDS 환아에 있어서, OI는 표면활성제 1회 및 2회투여 군 간에 유의한 차이를 보였고, 생후 나이에 따라 유의한 감소가 있었다. Group II에서 사망 군의 OI는 감소하지 않았다. OI는 RDS 환아의 폐 중증도를 파악하는데, 유용한 지표로 생각되며, 추 후 더 많은 환자군을 대상으로한 연구가 필요할 것으로 사료된다.

• 성인간호학회지
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• 제12권1호
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• pp.122-133
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• 2000

The purpose of this study was to identify the effect of body positioning on $PaO_2$, $SpO_2$, systolic blood pressure, diastolic blood pressure, pulse, and respiration(above all defined physiologic index), of patients with unilateral lung disease. The subjects for this study were eleven patients admitted to I.C.U. of K.H.M.C. with a diagnosis of unilateral lung disease confirmed by chest X-ray and the attending doctor, from January 30th. to April 20th. 1999. A quasi-experimental repeated-measures cross-over design was used to compare three body positions(semi-Fowler's, lateral decubitus with good lung dependent, and lateral decubitus with diseased lung dependent). Each subject spent 30 minutes in semi-Fowler's position and 2 hours in good lung dependent position and diseased lung dependent position. Starting in the semi-Fowler's position, then in the lateral position with the good lung dependent or the diseased lung dependent as assigned in random order. Thirty minutes after each positioning, arterial blood sample was analyzed. Measurements of all physiologic index were recorded at the specified intervals(0, 30, 60 90, and 120 minutes) in good lung dependent and diseased lung dependent position. Statistical comparison of $PaO_2$ value was done using the Wilcoxon Signed Rank Test, and Multivariate repeated-measures analysis of variance was performed to analyse the within-subject effect of two dependent position for 2 hours on the five dependent variables: (1) $PaO_2$ (2) $SpO_2$ (3) systolic blood pressure (4) diastolic blood pressure (5) pulse. The results obtained were as follows: 1. The $PaO_2$ value in the good lung dependent position was significantly higher than the $PaO_2$ value in the diseased lung dependent position(Z=-2.8451, p=.002). 2. The $PaO_2$ value in the good lung dependent position was significantly higher than the $PaO_2$ value in the semi-Fowler's position (Z=-2.6673, p=.003). 3. The difference between the $PaO_2$ value in the semi-Fowler's position and the $PaO_2$ value in the diseased lung dependent position was not significant(Z=-1.2448, p=.10). 4. There were no statistically significance in the trends of physiologic index in the good lung dependent position and the diseased lung dependent position. From the results, it may be concluded that the good lung dependent position is the most effective position for patients with unilateral lung disease that improve oxygenation. Identification of positioning over time may be need further studies.

• 한국의학물리학회지:의학물리
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• 제7권1호
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• pp.25-35
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• 1996

혼탁한 물질인 생체조직에서 신진대사, 혈액확산, 혈중산소의 비침습적 측정에 관한 연구를 광을 이용한 방법으로 제시하였다. 생체조직내의 산소포화도와 혈액분량을 측정하기 위하여 660nm와 880nm 의 광파장을 이용하여 측정하였으며, 생체조직에서 얻은 광 세기의 데이터는 조직내의 깊은 곳에서 생리적인 변화를 나타낸다. 데이터의 평가는 혈액분량과 산소포화도의 변화에 대한 지수의 기울기로서 조사하여 평가하였다. 여기서 곡선으로 나타낸 지수는 각각의 파장에서 기준파장의 세기와 측정부위에서의 반사광의 세기를 비율에 의한 자연대수로 나타냈다. 장단지 근육에 대한 실험 결과에 따르면 산소의 지수는 운동중에 현저하게 변화를 보여 주었다.