• 대한수의학회지
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• 제45권2호
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• pp.279-285
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• 2005

One-lung ventilation (OLV) is the isolation and selective ventilation of one lung field. OLV allows the collapse of lung lobes on the side of the thoracic surgical approach to facilitate observation of intrathoracic structures and to achieve lung immobility. OLV be achieved by endotracheal intubation with double lumen tubes or bronchial blockers. In this study, cardiopulmonary consequences of two-lung ventilation (TLV), OLV and Re-TLV (TLV after OLV) were evaluated in 5 dogs. The dogs were anesthetized with mask induction and maintained with isoflurane in oxygen. Tidal volume and respiratory rates were set to maintain end-tidal $CO_2$ at $40{\pm}2mmHg$ during instrumentation. Following instrumentation, the dogs were placed in right lateral recumbency and induced spontaneously respiration state. Effect of TLV on hemodynamic and pulmonary variables were recorded. Then, the left bronchus was obstructed by endotracheal intubation with double lumen endotracheal tube to achieve OLV state and recording was continued. After OLV, double lumen endotracheal tube was extubated, and standard endotracheal tubes was intubated again. In this study, spontaneous OLV caused significant decrease in $PaO_2$, arterial oxygen saturation, mixed-venous oxygen saturation, and increase in $PaCO_2$. Especially, a significant elevation in $PaCO_2$ and respiratory acidosis were remarkable findings. So spontaneous ventilation in OLV affected gas exchange and hemodynamic function.

• Tuberculosis and Respiratory Diseases
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• 제72권6호
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• pp.481-485
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• 2012

Background: Tracheostomy is a common procedure for patients requiring prolonged mechanical ventilation. However, the timing of tracheostomy is quite variable. This study was performed to find out the factors determining the timing of tracheostomy in medical intensive care unit (ICU). Methods: Patients who were underwent tracheostomy between January 2008 and December 2009 in the medical ICU of Seoul National University Hospital were included in this retrospective study. Results: Among the 59 patients, 36 (61.0%) were male. Median Acute Physiology And Chronic Health Evaluation (APACHE) II scores and Sequential Organ Failure Assessment scores on the admission day were 28 and 7, respectively. The decision of tracheostomy was made on 13 days, and tracheostomy was performed on 15 days after endotracheal intubation. Of the 59 patients, 21 patients received tracheostomy before 2 weeks (group I) and 38 were underwent after 2 weeks (group II). In univariate analysis, days until the decision to perform tracheostomy (8 vs. 14.5, p<0.001), days before tracheostomy (10 vs. 18, p<0.001), time delay for tracheostomy (2.1 vs. 3.0, p<0.001), cardiopulmonary resuscitation (19.0% vs. 2.6%, p=0.049), existence of neurologic problem (38.1% vs. 7.9%, p=0.042), APACHE II scores (24 vs. 30, p=0.002), and $PaO_2/FiO_2$ <300 mm Hg (61.9% vs. 91.1%, p=0.011) were different between the two groups. In multivariate analysis, APACHE II scores${\geq}20$ (odds ratio [OR], 12.44; 95% confidence interval [CI], 1.14~136.19; p=0.039) and time delay for tracheostomy (OR, 1.97; 95% CI, 1.11~3.55; p=0.020) were significantly associated with tracheostomy after 2 weeks. Conclusion: APACHE II scores${\geq}20$ and time delay for tracheostomy were associated with tracheostomy after 2 weeks.

• Tuberculosis and Respiratory Diseases
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• 제82권3호
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• pp.251-260
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• 2019

Background: Beyond its current function as a rescue therapy in acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) may be applied in ARDS patients with less severe hypoxemia to facilitate lung protective ventilation. The purpose of this study was to evaluate the efficacy of extended ECMO use in ARDS patients. Methods: This study reviewed 223 adult patients who had been admitted to the intensive care units of 11 hospitals in Korea and subsequently treated using ECMO. Among them, the 62 who required ECMO for ARDS were analyzed. The patients were divided into two groups according to pre-ECMO arterial blood gas: an extended group (n=14) and a conventional group (n=48). Results: Baseline characteristics were not different between the groups. The median arterial carbon dioxide tension/fraction of inspired oxygen ($FiO_2$) ratio was higher (97 vs. 61, p<0.001) while the median $FiO_2$ was lower (0.8 vs. 1.0, p<0.001) in the extended compared to the conventional group. The 60-day mortality was 21% in the extended group and 54% in the conventional group (p=0.03). Multivariate analysis indicated that the extended use of ECMO was independently associated with reduced 60-day mortality (odds ratio, 0.10; 95% confidence interval, 0.02-0.64; p=0.02). Lower median peak inspiratory pressure and median dynamic driving pressure were observed in the extended group 24 hours after ECMO support. Conclusion: Extended indications of ECMO implementation coupled with protective ventilator settings may improve the clinical outcome of patients with ARDS.

• Tuberculosis and Respiratory Diseases
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• 제66권1호
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• pp.6-12
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• 2009

연구배경: 폐혈전색전증 환자에서 혈전용해제의 효과는 차이가 없는 것으로 보고되어 있으나 출혈 등의 부작용에 대해서는 잘 알려져 있지 않다. 본 연구는 한 병원에서 중증 폐혈전색전증환자들에 사용한 alteplase와 urokinase의 치료효과 및 출혈 유발 정도를 비교하였다. 방법: 2000년 1월부터 2008년 7월까지 대상 환자 40명을 urokinase군(16명)과 alteplase군(24명)으로 나누어 의무기록을 후향적으로 분석하였다. 결과: 혈전용해제 사용한 이유는 혈역학적 불안정 23명, 중증 우심실부전 7명 그리고 헤파린 사용에도 불구하고 진행하는 저산소증 10명이었다. 두 군간 나이, APACHE II, SOFA score, 혈전용해제에서 유의한 차이는 없었다. 혈전용해제를 사용 후 승압제의 사용기간에서 aletplase군이 urokinase군보다 더 짧았으나, 인공호흡기 사용 기간과 중환자실 입원기간에서는 양 군간 유의한 차이가 없었다. 입원기간 동안 사망한 환자수는 13명(30%)으로 urokinase와 alteplase군 5명, 8명으로 유의한 차이는 없었고, 폐혈전색전증과 연관된 사망한 환자수에서도 urokinase와 alteplase군에서 1명, 4명으로 유의한 차이는 없었다. 혈전용해제 사용 후 수술적 치료가 필요한 환자 수도 urokinase군 2명, alteplase군 1명으로 차이가 없었다. 혈전용해제 사용 후 발생한 출혈은 14명(35%)에서 관찰되었고 urokinase군 3명(7.5%), alteplase군 11명(27.5%)으로 urokinase군에서 적은 경향을 보였다. 중증 출혈은 2명으로 모두 alteplase군에서 발생하였으며 1명은 뇌출혈로 사망하였다. 결론: 중증 폐색전혈전증환자에서 urokinase 사용은 alteplase에 비하여 치료효과는 차이가 없으면서 출혈의 위험은 낮을 것으로 사료된다.

• Journal of Chest Surgery
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• 제32권8호
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• pp.732-738
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• 1999

배경: 비디오 기술의 발전과 내시경의 향상으로 비디오 흉강경수술은 기흉, 다한증 및 종격동 종양 같은 몇 몇 질환에서는 표준 수술로서 인정받고 있다. 이러한 비디오 흉강경수술은 전신마취하에 이중기도관에 의한 일측 폐환기가 필요하였다. 그러나 폐질환이 동반된 환자나 전신상태가 나쁜 고령의 환자와 같은 고위험군 의 경우는 일측 폐환기나 전신마취 자체에 대한 위험성이 높다. 대상 및 방법: 1997년 12월부터 1998년 7월 까지, 전신상태가 나빠서 전신마취가 위험한 8례의 환자를 대상으로(농흉 6례, 난치성 흉수 1례, 간질성 폐섬 유증 1례) 경막외마취하에 자가호흡을 유지한 상태에서 비디오 흉강경을 이용하여 흉강내 질환의 진단 및 치료를 시행하였다. 결과: 7례에서 성공적으로 비디오 흉강경수술이 시행되었다. 수술 도중 호흡기능이 저하 되어 전신마취로 전환한 경우가 1례 있었으나 개흉술로 전환한 경우는 없었다. 만성 농흉 환자 2례의 경우 에서, 1례는 재발하여 다시 비디오 흉강경 배농술을 시행하였으며 1례는 수술 후 7일째 흉곽성형술을 시행 하였다. 수술시간은 평균 31.8$\pm$15.2분이었으며 수술 후 호흡합병증이 발생한 경우는 없었다. 결론: 경막외마 취하에 비디오 흉강경을 통한 진단 및 치료는 고위험군에서 안전하게 시행될 수 있는 기법이라고 사료된다.

• Journal of Trauma and Injury
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• 제26권3호
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• pp.170-174
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• 2013

Purpose: A flail chest is one of most challenging problems for trauma surgeons. It is usually accompanied by significant underlying pulmonary parenchymal injuries and mayled to a life-threatening thoracic injury. In this study, we evaluated the treatment result for a flail chest to determine the effect of trauma localization on morbidity and mortality. Methods: Between 2004 and 2011, 46 patients(29 males/17 females) were treated for a flail chest. The patients were divided into two group based on the location of the trauma in the chest wall; Group I contained patients with an anterior flail chest due to a bilateral costochondral separation (n=27) and Group II contained patients with a single-side posterolateral flail chest due to a segmental rib fracture (n=19). The location of the trauma in the chest wall, other injuries, mechanical ventilation support, prognosis and ISS (injury severity score) were retrospectively examined in the two groups. Results: Mechanical ventilation support was given in 38 patients(82.6%), and 7 of these 38 patients required a subsequent tracheostomy. The mean ISS for all 46 patients was $19.08{\pm}10.57$. Between the two groups, there was a significant difference in mean ventilator time (p<0.048), but no significant difference in either trauma-related morbidity (p=0.369) or mortality (p=0.189). Conclusion: An anterior flail chest frequently affects the two underlying lung parenchyma and can cause a bilateral lung contusion, a hemopneumothorax and lung hemorrhage. Thus, it needs longer ventilator care than a lateral flail chest does and is more frequently associated with pulmonary complications with poor outcome than a lateral flail chest is. In a severe trauma patient with a flail chest, especially an anterior flail chest, we must pay more attention to the pulmonary care strategy and the bronchial toilet.

• 대한장애인치과학회지
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• 제15권1호
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• pp.60-64
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• 2019

Swyer James 증후군은 영아기 및 소아기의 호흡기 감염으로 인한 폐쇄성 기관지염의 형태로, 단순 흉부 촬영에서 한쪽 폐의 과투과성을 특징으로 한다. 특별한 증상이 없어 우연히 발견되기도 하나, 반복적인 호흡기 감염 등을 유발할 수 있다. 아산화질소가 폐포 파열을 유발할 수 있고, 기흉을 악화시킬 수 있기 때문에 협조도가 필요한 환자의 경우 전신마취가 권장된다. 전신 마취시에 폐 환기의 저하로 인한 저산소증이 보고된 바 있기 때문에, 면밀한 호흡과 관련한 환자감시가 필요하다.

• 대한임상검사과학회지
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• 제55권3호
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• pp.143-150
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• 2023

2019년 12월에 발생한 COVID-19는 세계적으로 대유행하였고, 이로 인해 폐기능검사실의 안전한 감염관리가 절실히 요구되었다. 그러나 국내 유관 기관에서 제공하는 지침과 규제는 이 심각한 공중보건 위기에 대응하기에는 부족한 실정이었다. 이에 본 연구에서는 2021년 10월 1일부터 2021년 11월 2일까지 국내 2차 이상 의료기관 51개를 대상으로 감염관리 기본규정, 일회용품 사용, 환기 시설, 공간 분리, 출입문의 형태 등에 대해 조사하였다. 그 결과, 공기 주의, 비말 주의, 접촉 주의를 위한 인식과 보호용구착용은 상당 부분 적절히 이루어지고 있었으나, 1인 검사 후 환경소독을 항상 시행하는 기관이 39.22%로 낮은 수준으로 조사되었다. 또한, 일회용품 사용(81.05%), 환기 시설(45.75%), 검사 전용 공간(80.39%), 사무 공간 분리(15.69%), 자동문 설치(19.61%)의 경우 조사 항목에 따라 큰 차이가 있는 것으로 나타났다. 본 연구는 국내 폐기능검사실의 감염관리의 일반적 사항과 시설의 실태조사를 통해 폐기능검사실의 감염관리의 중요성을 재고하고, 국내 의료기관의 감염병 위기 대응을 위한 후속 연구에 기초 정보를 제공함으로써, 폐기능검사실의 감염관리 표준 지침서 개발 및 개선에 기여할 것으로 판단된다.

• Journal of Chest Surgery
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• 제18권1호
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• pp.79-85
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• 1985

The effect of graded increments in positive end-expiratory pressure [PEEP] on hemodynamics required to ventilate 8 critically ill patients is reported. Acute respiratory insufficiency was a cause of death in only one patient of drug inoxication among the 8 patients studied. The cardiac output was not changed significantly after the increment of PEEP to the level of 20 cm H2O. The heart rate was increased significantly from 15 cm H2O PEEP [P<0.01] as compared to 0 cm H2O PEEP; and the stroke volume was decreased significantly from 15 cm H2O PEEP [P<0.05]. The blood pressure was not affected at any level of PEEP, but the pulmonary artery pressure was elevated significantly at 10 cm H2O PEEP [P<0.01]. The right ventricular transmural filling pressure was not affected at the level of 10 cm H2O PEEP, but from 15 cm H2O PEEP it was increased significantly. With the increment of PEEP, the left ventricular stroke work index was decreased slightly; and at 20 cm H2O PEEP, it was decreased significantly. The right ventricular stroke work index was increased only at 10 cm H2O PEEP. The systemic vascular resistance was decreased significantly from 15 cm H2O PEEP [P<0.01].

• Journal of Chest Surgery
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• 제17권4호
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• pp.703-708
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• 1984

Fibrothorax is the end stage of chronic pathologic processes of pleura such as hemothorax, empyema, or tuberculous effusion. The pleural space become adherent and obliterated, and the lung parenchyma is covered by a thick, fibrous, unexpandable "peel", so the lung function is diminished markedly with impaired ventilation and oxygenation. Constrictive pericarditis is often accompanied fibrothorax, also cardiac and hemodynamic function is deteriorated. Surgical relief of these fibrous peels causes remarkable improvement in pulmonary function, cardiac and hemodynamic function, and subjective symptoms. We experienced a case of bilateral fibrothorax combined with constrictive pericarditis which occured 3 years after bilateral tuberculous effusion. Decortication and percardiectomy were done at the same time through bilateral submammary thoracotomy with sternal transection. Comparing postoperative Peripheral venous pressure, Circulation time, Pulmonary function test, Arterial blood gas analysis, Subjective symptoms with preoperative conditions showed noticeable improvement.provement.