• Tuberculosis and Respiratory Diseases
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• v.82 no.2
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• pp.166-172
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• 2019

Background: The purpose of this study was to determine whether components of the ProVent model can predict the high medical costs in Korean patients requiring at least 21 days of mechanical ventilation (prolonged mechanical ventilation [PMV]). Methods: Retrospective data from 302 patients (61.6% male; median age, 63.0 years) who had received PMV in the past 5 years were analyzed. To determine the relationship between medical cost per patient and components of the ProVent model, we collected the following data on day 21 of mechanical ventilation (MV): age, blood platelet count, requirement for hemodialysis, and requirement for vasopressors. Results: The mortality rate in the intensive care unit (ICU) was 31.5%. The average medical costs per patient during ICU and total hospital (ICU and general ward) stay were 35,105 and 41,110 US dollars (USD), respectively. The following components of the ProVent model were associated with higher medical costs during ICU stay: age <50 years (average 42,731 USD vs. 33,710 USD, p=0.001), thrombocytopenia on day 21 of MV (36,237 USD vs. 34,783 USD, p=0.009), and requirement for hemodialysis on day 21 of MV (57,864 USD vs. 33,509 USD, p<0.001). As the number of these three components increased, a positive correlation was found betweeen medical costs and ICU stay based on the Pearson's correlation coefficient (${\gamma}$) (${\gamma}=0.367$, p<0.001). Conclusion: The ProVent model can be used to predict high medical costs in PMV patients during ICU stay. The highest medical costs were for patients who required hemodialysis on day 21 of MV.

• Tuberculosis and Respiratory Diseases
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• v.62 no.5
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• pp.398-405
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• 2007

Background: There is little data on the 3 year prognosis and quality of life of patients on long-term (>72 hour) mechanical ventilation in a medical intensive care unit (MICU). Methods: Patients with long-term mechanical ventilation from May 2003 through July 2003 in MICU of Asan Medical Center, Seoul were enrolled in this studay. The survival rates were observed prospectively at 1, 3, 6, 12, 24, 36 months, and the quality of life of survivor was measured at 12 months by using Short Form 36 (SF-36). Results: The survival rate at 1, 3, 6, 12, 24 and 36 months was 54.8% (40/73), 39.7% (29/73), 30.1% (22/73), 20.5% (15/73), 18.3% (13/71) and 16.9% (12/71), respectively. There was a similar survival rate regardless of the diseases that required mechanical ventilation. A neoplasm or chronic liver disease had a worse survival rate than chronic lung or kidney disease (p<0.05). Each SF-36 domain except for the Role-emotional was inferior to the general population. Conclusions: The survival rate of patients with mechanical ventilation more than 72 hours is decreases continuously until 12 months but is relatively constant from 12 to 36 months. In these patients quality of life is also decrased.

• Journal of Chest Surgery
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• v.55 no.4
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• pp.293-300
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• 2022

Lung transplantation is the only treatment option for patients with end-stage lung disease. Although more than 4,000 lung transplants are performed every year worldwide, the standardized protocols contain no guidelines for monitoring during lung transplantation. Specific anesthetic concerns are associated with lung transplantation, especially during critical periods, including anesthesia induction, the initiation of positive pressure ventilation, the establishment and maintenance of one-lung ventilation, pulmonary artery clamping, pulmonary artery unclamping, and reperfusion of the transplanted lung. Anesthetic management according to the special risks associated with a patient's existing lung disease and surgical stage is the most important factor. Successful anesthesia in lung transplantation can improve hemodynamic stability, oxygenation, ventilation, and outcomes. Therefore, anesthesiologists must have expertise in transesophageal echocardiography, extracorporeal life support, and cardiopulmonary anesthesia and understand the pathophysiology of end-stage lung disease and the drugs administered. In addition, communication among anesthesiologists, surgeons, and perfusionists during surgery is important to achieve optimal patient results.

• Tuberculosis and Respiratory Diseases
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• v.77 no.4
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• pp.193-196
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• 2014

Acute airway obstruction after hemoptysis occurs due to the presence of blood clots. These conditions may result in lifethreatening ventilation impairment. We report a case of obstruction of the large airway by endobronchial blood clots which were removed using bronchoscopic cryotherapy at the bedside of intensive care unit. A 66-year-old female with endometrial cancer who had undergone chemotherapy, was admitted to the intensive care unit due to neutropenic fever. During mechanical ventilation, the minute ventilation dropped to inadequately low levels and chest radiography showed complete opacification of the left hemithorax. Flexible bronchoscopy revealed large blood clots obstructing the proximal left main bronchus. After unsuccessful attempts to remove the clots with bronchial lavage and forceps extraction, blood clots were removed using bronchoscopic cryotherapy. This report shows that cryotherapy via flexible bronchoscopy at the bedside in the intensive of intensive care unit is a simple and effective alternative for the removal of endobronchial blood clots.

• The Korean Journal of Emergency Medical Services
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• v.17 no.3
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• pp.21-28
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• 2013

Purpose: The purpose of this study is to get basic user guidelines of safe and efficient bag-valve-mask application on patients having abnormal pathophysiological pulmonary conditions. Methods: This study was performed by pre-qualified 35 EMS junior and senior students. Participants were instructed to compress ambulatory bag randomly about half, one-third, one-fourth within different airway resistance and pulmonary compliance. Resultant tidal volume and pulmonary wedge pressures on RespiTranier monitor were analysed in relation to pulmonary physiologic index. Results: At least over half compression of bag guaranteed minimal tidal volume regardless of pulmonary conditions. There was no increase of pulmonary wedge pressure above the level of barotrauma on half compression at any pulmonary conditions. Conclusion: Assisted ventilation with ambulatory bag on patients with pathological pulmonary conditions should be over half compressed regardless of respiratory disease entity.

• Journal of The Korean Society of Integrative Medicine
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• v.9 no.1
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• pp.183-192
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• 2021

Purpose : The purpose of this study was to investigate the impact of postural correction training on pulmonary function on 28 college students suspected of turtle neck syndrome, and the following conclusions were obtained. Methods : Turtle neck syndrome suspicion 28 person were randomly divided into a posture training group (n = 14) and group that does not perform posture training (n = 14). Respiratory function was measured by SPIROVIT SP-1 and respiratory gas analyzer. The posture training group performed balloon blowing and stair climbing after 20 minutes of posture training, and the group without posture training carried out balloon blowing training and stair climbing. Five times a week and for two weeks. Results : 1. The comparison of the FVC before and after experiments caused by balloon blowing showed a higher level of effortful pulmonary function in the control group than in the experimental group. 2. Comparison of PEFs before and after the experiment by balloon blowing showed that the experimental group's peak flow rate was higher than that of the control group. 3. Comparison of the FIVC before and after experiments with balloon blowing showed that the comparison of the FIVC showed a higher level of effortless intake pulmonary function in the control group than in the experimental group. 4. The comparison of the maximum ventilation volume(VE) before and after the experimental gas measurement showed that the maximum ventilation rate of the experimental group was higher than that of the control group. 5. The comparison of pre-test and post-test heart rate(HR) by breath gas measurement showed that the heart rate of the control group was higher than that of the experimental group. Conclusion : the results of this study showed that postural correction training, balloon blowing training, and stair climbing could have a positive impact on improving pulmonary function. However, the two-week experiment conducted five times a week showed an increase in pulmonary function, but it was difficult to see the effect due to the short study period. Therefore, it is hoped that later studies will be conducted more systematically on the effects of breathing exercises on improving pulmonary function after post-postural correction training for patients with pulmonary function problems.

• Journal of the korean academy of Pediatric Dentistry
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• v.42 no.1
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• pp.75-79
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• 2015

Pulmonary arterial hypertension (PAH) is a common complication of Congenital heart defects (CHD) with left-to-right shunts, and PAH with increased pulmonary vascular resistance (PVR) is associated with considerable morbidity and mortality. General anesthesia (GA) can be life-threatening in patients with PAH, because the positive pressure ventilation during GA increases pulmonary arterial pressure and decreases pulmonary blood flow. This may also lead to hypoxia. Therefore, spontaneous ventilation may be safer than positive pressure ventilation in patients with PAH. A five-year-old male child, weighing 11 kg, with medical history showing a total correction of Tetralogy of Fallot (TOF) in 2009 and ongoing treatment with hypertension (HTN) medicine since 2007, visited the Dankook University Dental Hospital. He had multiple dental caries, and the treatment was completed under sevoflurane insufflation sedation via nasal cannula. The patient remained sedated throughout the operation while maintaining normal vital signs and spontaneous respiration. In conclusion, sevoflurane insufflation sedation may be a safer alternative to GA for the dental treatment of patients with PAH.

• Tuberculosis and Respiratory Diseases
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• v.73 no.3
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• pp.151-161
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• 2012

Background: Adequate assessment and control of sedation play crucial roles in the proper performance of mechanical ventilation. Methods: A total of 30 patients with various pulmonary diseases were prospectively enrolled. The study population was randomized into two groups. The sedation assessment group (SAG) received active protocol-based control of sedation, and in the empiric control group (ECG), the sedation levels were empirically adjusted. Subsequently, daily interruption of sedation (DIS) was conducted in the SAG. Results: In the SAG, the dose of midazolam was significantly reduced by control of sedation (day 1, $1.3{\pm}0.5{\mu}g/kg/min$; day 2, $0.9{\pm}0.4{\mu}g/kg/min$; p<0.01), and was significantly lower than the ECG on day 2 (p<0.01). Likewise, on day 2, sedation levels were significantly lower in the SAG than in the ECG. Significant relationship was found between Ramsay sedation scale and Richmond agitation-sedation scale (RASS; $r_s$=-0.57), Ramsay Sedation Scale and Bispectral Index (BIS; $r_s$=0.77), and RASS and BIS ($r_s$=-0.79). In 10 patients, who didn't require re-sedation after DIS, BIS showed the earliest and most significant changes among the sedation scales. Ventilatory parameters showed significant but less prominent changes, and hemodynamic parameters didn't show significant changes. No seriously adverse events ensued after the implementation of DIS. Conclusion: Active assessment and control of sedation significantly reduced the dosage of sedatives in patients receiving mechanical ventilation. DIS, conducted in limited cases, suggested its potential efficacy and tolerability.

• Journal of the Korea Convergence Society
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• v.12 no.9
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• pp.121-126
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• 2021

The purpose of this study is to investigate the effect of balloon blowing exercise on multiple pulmonary function and maximum voluntary ventilation in patients with mild intellectual disabilities in their 20s. 10 people in the experimental group and 10 people in the control group participated in the experiment. The experimental group performed the balloon blowing exercise for 30 minutes a day, and the control group performed the diaphragm breathing exercise for 30 minutes each. The subjects measured voluntary capacity and maximal voluntary ventilation using Fitmate before and after the experiment. Subjects were assessed with Vital capacity(VC) and Maximal voluntary ventilation(MVV) before and after the test and the results were compared with the paired t test. Data analysis was performed with SPSS win 18.0. After the experiment, the experimental group showed higher lung capacity and maximum ventilation than the control group. Through this study, the experimental group increased voluntary capacity and maximum voluntary ventilation more than the control group. It is thought that the quality of life can be improved if we continuously manage the health of intellectuals by developing various breathing exercise programs.

• Tuberculosis and Respiratory Diseases
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• v.81 no.2
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• pp.99-105
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• 2018

Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.