• Tuberculosis and Respiratory Diseases
• /
• v.70 no.3
• /
• pp.191-198
• /
• 2011

Ventilator-associated pneumonia (VAP) is the most frequent nosocomial infection in the intensive care unit (ICU), with an incidence ranging from 8% to 38%. Patients who acquire VAP have higher mortality rates and longer ICU and hospital stays. Because there are other potential causes of fever, leukocytosis, and pulmonary infiltrates, clinical diagnosis of VAP is overly sensitive. The only alternative approach to the clinical diagnosis of VAP is the Clinical Pulmonary Infection Score (CPIS). Employing quantitative cultures of respiratory secretions in the diagnosis of VAP leads to less antibiotic use and probably to lower mortality. With respect to microbiologic diagnosis, however, it is not clear that the use of invasive sampling using bronchoscopy is associated with better outcomes. Delayed administration of antibiotic therapy is associated with an increased mortality, and inadequate antibiotic therapy is also associated with higher mortality. Therefore, prompt initiation of adequate antibiotic therapy is a cornerstone of the treatment of VAP. The initial antibiotic therapy should be based on the most common organisms in each hospital and the most likely pathogens for that specific patient. When final cultures and susceptibilities are available, de-escalation to less broad spectrum antibiotics should be done. Since clinical improvement usually takes 2 to 3 days, clinical responses to the initial empirical therapy should be evaluated by day 3. A short course of antibiotic therapy appears to be equivalent to a traditional course of more than 14 days, except when treating non-fermenting gram-negative organisms. If patients receive initially adequate antibiotic therapy, efforts should be made to shorten the duration of therapy to as short as 7 days, provided that the etiologic pathogen is not a non-fermenting gram-negative organism.

• KIPS Transactions on Computer and Communication Systems
• /
• v.6 no.3
• /
• pp.113-120
• /
• 2017

In recent years, indoor localization has been researched for the improvement of its localization accuracy capability in Wi-Fi environment. The fingerprint and RF propagation models has been the main approach in determining indoor positioning. With the use of fingerprint, a low-cost, versatile localization system can be achieved without the use of external hardware. However, only a few research have been made on virtual access points (VAPs) among indoor localization models. In this paper, the idea of indoor localization system using fingerprint with the addition of VAP in Wi-Fi environment is discussed. The idea is to virtually add APs in the existing indoor Wi-Fi system, this would mean additional virtually APs in the network. The experiments of the proposed algorithm shows the positive results when 2VAPs are used compared with only APs. A combination of 3APs and 2VAPs in the 3rd case had the lowest average error of 3.99 among its 4 scenarios.

• Tuberculosis and Respiratory Diseases
• /
• v.84 no.4
• /
• pp.317-325
• /
• 2021

Background: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are significant public health issues in the world, but the epidemiological data pertaining to HAP/VAP is limited in Korea. The objective of this study was to investigate the characteristics, management, and clinical outcomes of HAP/VAP in Korea. Methods: This study is a multicenter retrospective cohort study. In total, 206,372 adult patients, who were hospitalized at one of the 13 participating tertiary hospitals in Korea, were screened for eligibility during the six-month study period. Among them, we included patients who were diagnosed with HAP/VAP based on the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) definition for HAP/VAP. Results: Using the IDSA/ATS diagnostic criteria, 526 patients were identified as HAP/VAP patients. Among them, 27.9% were diagnosed at the intensive care unit (ICU). The cohort of patients had a median age of 71.0 (range from 62.0 to 79.0) years. Most of the patients had a high risk of aspiration (63.3%). The pathogen involved was identified in 211 patients (40.1%). Furthermore, multidrug resistant (MDR) pathogens were isolated in 138 patients; the most common MDR pathogen was Acinetobacter baumannii. During hospitalization, 107 patients with HAP (28.2%) had to be admitted to the ICU for additional care. The hospital mortality rate was 28.1% in the cohort of this study. Among the 378 patients who survived, 54.2% were discharged and sent back home, while 45.8% were transferred to other hospitals or facilities. Conclusion: This study found that the prevalence of HAP/VAP in adult hospitalized patients in Korea was 2.54/1,000 patients. In tertiary hospitals in Korea, patients with HAP/VAP were elderly and had a risk of aspiration, so they were often referred to step-down centers.

• Journal of Chest Surgery
• /
• v.50 no.5
• /
• pp.346-354
• /
• 2017

Background: Ventilator-associated pneumonia (VAP) is a common disease that may contribute to morbidity and mortality among trauma patients in the intensive care unit (ICU). This study evaluated the associations between trauma factors and the development of VAP in ventilated patients with multiple rib fractures. Methods: We retrospectively and consecutively evaluated 101 patients with multiple rib fractures who were ventilated and managed at our hospital between January 2010 and December 2015, analyzing the associations between VAP and trauma factors in these patients. Trauma factors included sternal fracture, flail chest, diaphragm injury, traumatic aortic dissection, combined cardiac injury, pulmonary contusion, pneumothorax, hemothorax, hemopneumothorax, abbreviated injury scale score, thoracic trauma severity score, and injury severity score. Results: Forty-six patients (45.5%) had at least 1 episode of VAP, 10 (21.7%) of whom died in the ICU. Of the 55 (54.5%) patients who did not have pneumonia, 9 (16.4%) died in the ICU. Using logistic regression analysis, we found that VAP was associated with severe lung contusion (odds ratio, 3.07; 95% confidence interval, 1.12 to 8.39; p=0.029). Conclusion: Severe pulmonary contusion (pulmonary lung contusion score 6-12) is an independent risk factor for VAP in ventilated trauma patients with multiple rib fractures.

• Tuberculosis and Respiratory Diseases
• /
• v.47 no.3
• /
• pp.321-330
• /
• 1999

Background : Early diagnosis and proper antibiotic treatment are very important in the management of ventilator-associated pneumonia (VAP) because of its high mortality. Bronchoscopy with a protected specimen brush (PSB) has been considered the standard method to isolate the causative organisms of VAP. However, this method burdens consumer economically to purchase a PSB. Another useful method for the diagnosis of VAP is quantitative cultures of aspirated specimens through bronchoscopic bronchoalveolar lavage (BAL), for which the infusion of more than 120 m1 of saline has been recommended for adequate sampling of a pulmonary segment. However, occasionally it leads to deterioration of the patient's condition. We studied the diagnostic efficacy of minibronchoalveolar lavage (miniBAL), which retrieves only 25 ml of BAL fluid, in the isolation of causative organisms of VAP. Methods: We included 38 consecutive patients (41 cases) suspected of having VAP on the basis of clinical evidence, who had received antibiotics before the bronchoscopy. The two diagnostic techniques of PSB and miniBAL, which were performed one after another at the same pulmonary segment, 'were compared prospectively. The cut-off values for quantitative cultures to define causative bacteria of VAP were more than $10^3$ colony-forming units (cfu)/ml for PSB and more than $10^4$ cfu/ml for BAL. Results: The amount of instilled normal saline required to retrieve 25 ml of BAL fluid was $93{\pm}32 ml$ (mean${\pm}$SD). The detection rate of causative agents was 46.3% (19/41) with PSB and 43.9% (18/41) with miniBAL. The concordance rate of PSB and miniBAL in the bacterial culture was 85.4% (35/41). Although arterial blood oxygen saturation dropped significantly (p<0.05) during ($92{\pm}10%$) and 10 min after ($95{\pm}3%$) miniBAL compared with the baseline ($97{\pm}3%$), all except 3 cases were within normal ranges. The significantly elevated heart rate during ($l25{\pm}24$/min, p<0.05) miniBAL compared with the baseline ($1l1{\pm}22$/min) recovered again in 10 min after ($111{\pm}26$/min) miniBAL. Transient hypotension was developed during the procedure in two cases. The procedure was stopped in one case due to atrial flutter. Conclusion: MiniBAL is a safe and effective technique to detect the causative organisms of VAP.

• Pediatric Infection and Vaccine
• /
• v.12 no.1
• /
• pp.67-74
• /
• 2005

Purpose : The incidence of mortality associated with respiratory difficulties is decreasing nowadays contributed to the development of neonatology. However, complications associated with mechanical ventilator are increasing. This study is to determine clinical manifestations, diagnositc availability of the endotracheal tip culture in patients with Ventilator-Associated Pneumonia(VAP) in neonatal intensive care unit(NICU). Methods : A retrospective analysis of 50 neonates who were admitted to the NICU of Kangnam Sacred Heart Hospital and had given mechanical ventilator from 1 January 2000 to 30 June 2003. VAP group defined as neonates who had pneumonia with mechanical ventilation longer than 48 hours. They were classified into VAP group(n=13) and control group (n=37) and the prevalence, microorganisms cultured from the endotracheal tube tip and risk factors were investigated. Results : The prevalence of VAP was 26.0%(n=13) and the most dominant microorganism cultured in our NICU was methicillin-resistant coagulase negative staphylococcus(MR-CNS) in 4 cases. Other microorganisms were Pseudomonas, Enterobacter, methicillin-resistant Staphylococcus aureus(MRSA) and Klebsiella. Gestational age, birth weight, Apgar score, respiratory distress syndrome, retinopathy of prematurity, bronchopulmonary dysplasia, sepsis, renal failure, pulmonary hemorrhage, pneumothorax were not different significantly between two groups except intraventricular hemorrhage(P<0.001) and patent ductus arteriosus(P<0.05). Duration of hospital stay and mortality rate were also not different significantly. Conclusion : VAP occurred at a significant rate among mechanically ventilated NICU patients. Despite of limitation of encotracheal tip culture, the most common microorganism was MR-CNS. We should be aware of occurrence of VAP in NICU neonate who were with mechanical ventilator and should treat with great care.

• Korean Journal of Adult Nursing
• /
• v.15 no.3
• /
• pp.463-471
• /
• 2003

Purpose: This study was aimed at providing scientific evidence for minimizing ventilator-associated pneumonia(VAP) by identifying appropriate timing of exchange of circuit for mechanical ventilator that is well suitable for the medical environment of intensive care units of hospitals in Korea. Method: This was a quasi-experimental study with a convenience sample of 19 adult subjects aged over 18 years who were admitted to the NS ICU of C university hospital, and placed on mechanical ventilator. The subjects were placed in two groups, compared on the incidence rate of VAP after they received exchange of circuit either at 1-week interval (N =10) or 2-week interval (N = 9). Result: 1) When considering 1000 days as the standard unit of analysis for incidence, the incidence rate of VAP was 7.19 cases at the 1-week cycle exchange group and 15.23 at the 2-week cycle exchange group, showing no statistically significant difference between the two groups. 2) There were a total of 3 types of bacteria isolated from the patients with VAP, including 2 cases with P. aeruginosa, 1 case with Streptococcus group F and A. baumannii. Conclusion: With thorough hand washing and strict management of tracheal tube of mechanical ventilator as well as use of tracheal intubation techniques, exchange cycle of circuit of mechanical ventilator by nurses may be changed from 1-week to 2-week interval.

• Journal of Astronomy and Space Sciences
• /
• v.34 no.2
• /
• pp.111-118
• /
• 2017

A ultra low frequency (ULF) wave, Pi2, has been reported to occur during periods of extremely quiet magnetospheric and solar wind conditions. And no statistical study on the Pi2 has been performed during extremely quiet conditions, using satellite observations to the author's knowledge. Also Pi2 pulsations in the space fluxgate magnetometers near perigee failed to attract scientist's attention previously. In this paper, Pi2 pulsations detected by the Van Allen probe satellites (VAP-A & VAP-B) were investigated statistically. During the period from October 2012 to December 2014, ninety six Pi2 events were identified using VAP when Kp = 0 while using Kakioka (KAK, L = 1.23) as a reference ground station. Seventy five events had high coherence between VAP-Bz and H components at KAK station. As a result, it was found that 77 % of the events had power spectra between 5 and 12 mHz, which differs from the regular Pi2 band range of from 6.7 to 25 mHz. In addition, it was shown that it is possible to observe Pi2 pulsations from space fluxgate magnetometers near perigee. Twenty two clean Pi2 pulsations were found where L < 4 and four examples of Pi2 oscillations at different L shells are presented in this paper.

• Composites Research
• /
• v.31 no.6
• /
• pp.304-310
• /
• 2018

Autoclave process has been remaining as one of the most robust and stable process in fabricating structural composite part of aerospace industry. It has lots of advantages, however exhibits some disadvantages or limitations in capital investment and operation. Recently, there have been various Out-of-Autoclave process being researched and developed to overcome those limitations. In this study, laminate specimens were fabricated using LCM (Liquid Composite Molding) process, regarded as one of potential OoA process. DB (Double bagging), CAPRI (Controlled Atmospheric Pressure Resin Infusion), VAP (Vacuum Assisted Process) and Autoclave process were used for laminate specimens. Void content, Thickness, Tg (Glass Transition Temperature), ILSS (Interlaminar Shear Strength) and Flexural strength properties were evaluated for comparison. It is verified that Autoclave based specimen has uniform thickness distribution, the lowest void content and outstanding mechanical properties. And, CAPRI based specimen exhibits relatively good physical and mechanical properties over DB and VAP based specimen and comparable mechanical properties with autoclave based specimen.

• Food Science and Preservation
• /
• v.20 no.6
• /
• pp.775-783
• /
• 2013

Changes in the various quality characteristics of hamburg steak depending on the packaging methods were investigated during storage at $5{\pm}1^{\circ}C$ for up to 15 days. Three packaging treatments including vacuum packaging (VAP), air-containing packaging (AC), and oxygen scavenger packaging (OS) were applied in this experiment. The initial total aerobe bacteria counts were identical at 2.3 log CFU/g in all treatments, but the growth rate of total aerobe bacteria in the AC samples was significantly faster than the VAP and OS samples during storage. The changes in the TBA and VBN values over the storage time showed that lipid oxidation and protein spoilage developed fastest in the AC sample, followed by OS and then VAP samples. The instrumental color and texture profiles were not significantly differ between treatments during storage (p>0.05). After 12 days of storage at $5^{\circ}C$, evaluation of the samples' sensory attributes showed that the AC samples had become unmarketable with a score of less than 5.0 points for all sensory properties, whereas the VAP and OS samples were still marketable.