• Title/Summary/Keyword: Ventilation method

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The Comparison of Clinical Outcomes of Off-Pump versus On-Pump Coronary Artery Bypass Grafting in High Risk Patients (고위험군 환자에서 시행한 On-Pump CABG와 Off-Pump CABG의 비교연구)

  • 윤영남;이교준;김치영;안지영;오영준;유경종
    • Journal of Chest Surgery
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    • v.37 no.9
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    • pp.749-754
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    • 2004
  • Off-pump coronary artery bypass grafting (Off-Pump CABG) has been proven to have less morbidity and to facilitate early recovery. High-risk surgical patients may have benefitted by avoiding the adverse effects of the cardiopulmonary bypass. We compared the effectiveness of Off-Pump CABG with that of coronary artery bypass using cardiopulmonary bypass (On-Pump CABG) in high-risk patients. Material and Method: 682 patients (424 Off-Pump CABG and 258 On-Pump CABG) underwent isolated coronary artery bypass grafting between January 2001 and June 2003. Patients who were considered high risk were selected High risk is defined as the presence of one or more of nine adverse prognostic factors. Data were collected from 492 patients in Off-Pump CABG and 100 in On-Pump CABG for risk factors, extent of coronary disease, and in-hospital outcomes. Result: Off-Pump CABG group and On-Pump CABG group did not show differences in their preoperative risk factors. We used more arterial grafts in Off-Pump CABG group (p < 0.05). Postoperative results showed that operative mortality (0.5% in Off-Pump CABG versus 2.0% in On-Pump CABG), renal failure (2.6% in Off-Pump CABG versus 7.0% in On-Pump CABG), and perioperative myocardial infarction (1.5% in Off-Pump CABG versus 1.0% in On-Pump CABG) did not differ significantly. However, Off-Pump CABG had shorter mean operation time (p<0.05), lower mean CK-MB level (p <0.05), lower rate of usage of inotropics (p < 0.05), shorter mean ventilation time (p <0.05), lower perioperative stroke (0% versus 2.0%), and shorter length of stay (p < 0.05) than On-Pump CABG. On-Pump CABG had more distal grafts (p<0.05) than Off-Pump CABG. Although Off-Pump CABG and On-Pump CABG did not show statistical differences in mortality and morbidity was more frequent in CABG. Conclusion: Off-Pump CABG reduces morbidity and favors hospital outcomes. Therefore, Off-Pump CABG is safe, reasonable and may be a preferable operative strategy for high-risk patients.

The In-hospital Analysis of Outcome of Off-pump CABG and On-pump CABG (비체외순환 및 체외순환하에서의 관상동맥우회로술의 임상 고찰)

  • 안재범;김인섭;정성철;배윤숙;유환국;김병열;김우식
    • Journal of Chest Surgery
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    • v.37 no.9
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    • pp.762-767
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    • 2004
  • With the developement of non-invasive surgical techeniques, coronary artery bypass graft without cardiopulmonary bypass has become popular. We compared the preoperative risk factors and in-hospital outcomes of patients having off-pump CABG with these having on-pump CABG. Material and Method: From January 2001 to June 2003, 87 patients underwent CABG. Thirty-sin patients underwent on-pump CABG, fifty-one patients under-went off-pump CABG. Preoperative risk factors, extent of coronary disease, operative time, postoperative endotracheal intubation time, duration of ICU stay & hospital stay, the amount of bleeding and postoperative levels of cardiac enzymes were compared in both groups, Result: The were no differences in their sex ratios, ages, preoperative risk factors, preoperative Ml, Canadian classes, extent of coronary artery diseases and, echocardio-graphic ejection fraction between Off-pump CABG and On-pump CABG groups. Off-pump CABG group had significantly lower mean operative time (270$\pm$79.3 min vs 372$\pm$142.2 min, p<0.001), mean ventilation time (17.1$\pm$13.4 hr vs 24.3$\pm$17.8 hr) and CK-MB level (8,9$\pm$18.7 IU/L vs 25.7$\pm$8.4 IU/L) than on-pump CABG groups, On-pump CABG group had more distal grafts (2.2$\pm$0.5 vs 1.7$\pm$0.71 than Off-pump CABG groups did. There were no differences in their postoperative complications and outcomes including amount of postoperative bleeding for 24 hrs, reoperation for bleeding control, mean in-hospital days, postoperative infection, renal failure and neurologic complications between Off-pump CABG and On-pump CABG groups. Conclusion: This study showed that patients who underwent Off-pump CABG had less operation time & intubation time and lower CK-MB level; however, they also have less distal graft. Even though CABG without CPB provided satisfactory results, more clinical experience & longer follow-up is required.

The Systemic Effects of Hypothermic and Normothermic Cardiopulmonary Bypass in Cardiac Surgery (심장수술시 저체온 체외순환과 정상체온 체외순환의 전신 효과에 관한 연구)

  • Park Jae Min;Cho Yong Gil;Hwang Yoon Ho;Lee Yang Haeng;Yoon Young Chul;Junng Hee Jae;Han Il Yong;Choi Seok Cheol;Cho Kwang Hyun
    • Journal of Chest Surgery
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    • v.38 no.1 s.246
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    • pp.29-37
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    • 2005
  • This study was prospectively designed to determine the physiologic effects of normothermic CPB and to compare its influences with hypothermic CPB. Material and Method: Thirty-six adult patients scheduled for el­ective cardiac surgery were randomly assigned to moderate hypothermic (hypothermic group nasopharyngeal tem­perature $26\~28^{\circ}C,\;n=18)$ ornormothermic (normothermic group, nasopharyngeal temperature > $35.5^{\circ}C\;n=18)$ CPB. Arterial blood samples were taken before CPB (Pre-CPB), 10 minutes after the start of CPB (CPB-10), and imme­diately after CPB stop (CPB-off) for determining total leukocyte counts, neuron-specific enolase (NSE), interleukin-6 (IL-6), endothelin-1 (ET-1), cortisol, troponin I (TNI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, blood urea nitrogen (BUN), and the pulmonary index $(Pi,\;PaO_{2}/FiO_{2}),$Other parameters such as urine output, mechanical ventilating period, ICU-staying period, postoperative complications and hospitalized days were also evaluated. Result: Total leukocyte counts, increased rate in NSE, in IL-6 and in cortisol at CPB-10 and CPB-off were significantly higher in normothermic group than in hyphothermic group. Urine output during CPB was lower in normothermic group than in hyphothermic group. The duration of mechanical ventilation, ICU-stay, and hospitalization were longer in normothermic group than in hyphothermic group. Conclusion: These findings sug­gested that normothermic CPB caused higher inflammatory and stress responses than hypothermic CPB during car­diac surgery using cold crystalloid cardioplegia. However, further studies with large number of cases should be carried out to validate this hypothesis.

Study on the Environmental Factors and Symptoms of VDT Syndrome (VDT 증후군의 환경적 요인과 증상에 대한 연구)

  • Jeong, Seunghui;Lee, Seon Young;Eu, Sun Mi;Kim, Douk-Hoon;Lee, Eun-Hee
    • Journal of Korean Ophthalmic Optics Society
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    • v.14 no.4
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    • pp.65-69
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    • 2009
  • Purpose: Recently incidence of VDT syndrome has gradually increased as extensive use of computers. VDT syndrome reported by VDT workers include musculoskeletal disorder, neuropsychiatric disoders and eye symptoms such as eye strain, tired eyes, irritation and blurred vision. The environmental factors of VDT syndrome include electromagnetic waves, size, brightness and lighting of computer screen, height of a monitor and a worktable, working hours, kind of task, distance between screen and workers, indoor humidity and temperature, indoor air contamination and ventilation. In this study, we investigated the environmental factors related to body symptoms and health effects included in VDT syndrome. Methods: Study subjects were total 120 persons (54 male, 66 female) with age from 19 to 28. We surveyed the body symptoms and physical discomfort when doing an activity in a short distance such as reading book or paper, computer work. The questionnaire included main body symptoms, self-consciousness symptoms of eye, satisfaction of working environment, pain of the wrist when using keyboard and mouse. Results: Most of people (70%) felt physical pain from long time work of computer, paper, electrical apparatus. They mainly complained pain of neck and low back (57.1%), eye (45.2%) and head (31%). With the environmental factors, 78.3% of the subjects complaint pain of eye from inappropriate illumination. Most of the symptoms included 'eye fatigue'(38.3%), 'dryness of eye'(31.9%) and 'blurred vision'(23.7%). Subjects in this study complained discomfort of their chairs and most of them experienced pain in the wrist when using keyboard or mouse. Conclusions: When people use electrical apparatus or work with paper, people would get their eye fatigue and feeling of physical fatigue because of not harmonizing various environmental factors such as light, space, posture, worktable with theirselves. Therefore, workers should develop preventive method such as self-control of adequate break time to avoid fatigue while VDT work. Work environment should be changed to ergonomic design for optimal visual environment to prevent musculoskeletal disorder through constant research.

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A Study on Environmental Standards of School Building (교사환경기준에 관한 연구)

  • Hong, Seok-Pyo;Park, Young-Soo
    • The Journal of Korean Society for School & Community Health Education
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    • v.1 no.1
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    • pp.11-43
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    • 2000
  • The purpose of this study was, through analyzing the previous researches, to grasp the present status of environment of school building(ESB), research the sundry records of each element and, through comparative analysis of the standard of ESB in Korea, the United States, and Japan, select the normative standard of ESB, to clarify the point at issue presented in Regulation of Construction & facility Management for Elementary and and Secondary School in Korea, and to suggest an alternative preliminary standard of ESB. To carry out a research for this purpose, these were required: 1. to investigate the existing present status of ESB, 2. to make a comparative analysis of the standard of ESB in each country, 3. to suggest the normative standard of preliminary standard of ESB, 4. to analyze the controversial points of the standard of ESB in Korea, 5. to suggest an alternative preliminary standard of ESB. The conclusions were as follows: 1. Putting, through analyzing the previous researches, the existing present status of ESB together, it seemed that lighting environment, indoor air environment and noise environment were all in poor conditions. 2. In the result of a comparative analysis of the standard of ESB in Korea, Japan and the United States, in Korea the factors of each lighting and indoor air environment were not presented properly, in Japan, in lighting environment aspect, the standard on natural lighting and the factors on brightness were not presented., and in the USA the essential factors of each environment were throughly presented. In the comparison of the standards on each factor, Korea showed that the standard level presented was less properly prescribed than those of the USA and Japan but it also showed that the standard levels prescribed in the USA and in Japan were mostly similar to the standard levels in records investigated. 3. With the result of the normative standard selection on School Builiding environment factor of prescribed in this study, the controversial points of the standard of ESB in Korea were analyzed and the result was utilized to suggest new preliminary standard of ESB. 4. As the result of the analysis of the controversial points of the standard of ESB in Korea, it was found that the standard of ESB in Korea should be established on a basis of School Health Act and be concretely presented in School Health Regulation and School Health Rule. The factors of each environment was improperly presented in the existing standard of ESB in Korea. Moreover the standard of them was inferior to that of the records investigated and those of in the USA and in Japan and it also showed that the standard of it in Korea was improper to maintain Comfortable Learning Environment. 5. A suggested preliminary standard of ESB acquired through above study as follows: 1) In this study a new kind of preliminary standard of ESB is divided into lighting environment, indoor air environment, noise environment, odor environment and for above classification, reasonable factor and standard should be established and the controling way on each standard and countermeasures against it should be considered. 2) In lighting environment, the factors of natural lighting are divided into daylight rate, brightness, glare. In the standard on each factor, daylight rate should secure 5% of a mean daylight rate and 2% of a minimum daylight rate, brightness ratio of maximum illumination to minimum illumination should be under 10:1, and in glare there should not be an occurrence factor from a reflector outside of the classroom. And the factors of unnatural lighting are illumination, brightness, and glare. In the standard on each factor, illumination should be 750 lux or more, brightness ratio should be under 3 to 1, and glare should not occur. And Optimal reflection rate(%) of Colors and Facilities of Classroom which influences lighting environment should be considered. 3) In indoor air environment factors, thermal factors are divided into (1) room temperature, (2) relative humidity, (3) room air movement, (4) radiation heat, and harmful gases (5) CO, (6) $CO_2$ that are proceeded from using the heating fuel such as oval briquettes, firewood, charcoal being used in most of the classroom, and finally (7) dust. In the standard on each factor, the next are necessary; room temperature: $16^{\circ}C{\sim}26^{\circ}C$(summer : $E.T18.9{\sim}23.8^{\circ}C$, winter: $E.T16.7{\sim}21.7^{\circ}C$), relative humidity: $30{\sim}80%$, room air movement: under 0.5m/sec, radiation heat: under $5^{\circ}C$ gap between dry-bulb temperature and wet-bulb temperature, below 1000 ppm of ca and below 10ppm of $CO_2$, dust: below 0.10 $mg/m^3$ of Volume of dust in indoor air, and ventilation standard($CO_2$) for purification of indoor air : once/6 min.(about 7 times/40 min.) in an airtight classroom. 4) In the standard on noise environment, noise level should be under 40 dB(A) and the noise measuring way and the countermeasures against it should be considered. 5) In the standard on odor environment, odor level under Physical Method should be under 2 degrees, and the inspecting way and the countermeasures against it should be considered.

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Clinical Results of 100 Cases of Coronary Artery Bypass Grafting without Cardiopulmonary Bypass (심폐바이패스 없이 시행한 관상동맥 우회술 100예의 임상적 고찰)

  • 방정희;우종수
    • Journal of Chest Surgery
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    • v.37 no.4
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    • pp.322-327
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    • 2004
  • Coronary artery bypass grafting on the beating heart is no longer a new methods for any cardiac surgeon. We evaluated the application of the off-pump coronary artery bypass procedure relative to safety and efficiency as measured by postoperative complication and operative mortality. Material and Method: We used our retrospective database to compare the patients having off-pump coronary surgery (n=100) with those having on-pump coronary surgery (n=100) between June, 1999 and August, 2002. Patients whom underwent associated valvular or aortic aneurysmal operation were excluded. Result: Neither groups showed any differences in the patient's risk factors and extent of coronary disease. Off-pump CABG group did not have significantly less mean operation time (295$\pm$73 min vs 323$\pm$83 min, p=ns) and mean hospital day (15.34$\pm$6.02 day vs 13.80$\pm$4.95 day, p=ns). However, off-pump CABG group had significantly shorter mean ventilation time (17.3$\pm$11.27 hour vs 24.98$\pm$16.1 hour, p<0.05). No patients were converted to on-pump CABG in off-pump CABG. Intraoperative hemodynamic instability in off-pump CABG were 6 cases, of whom 2 cases were in lateral wall approach and 4 cases in right coronary anastomosis. Postoperative mortality was 1 case in off-pump CABG and 2 cases in on-pump CABG. Intra-aortic ballon pump (IABP) was applied in 1 case with off-pump CABG and in 2 cases with on-pump CABG. No patients presented postoperative cerebral infarction & stroke in off-pump CABG but 2 patients in on-pump CABG. Postoperative arrhythmia presented in 4 cases with off-pump CABG and in 6 cases with on-pump CABG. Acute renal failure (ARF) was complicated in 3 cases with off-pump CABG and in 2 cases with on-pump CABG. Conclusion: This study documented the immediate safety and efficiency of the off-pump CABG procedure.

Implication of Quantitative Culture of Bronchoalveolar Lavage Fluid in the Diagnosis of Ventilator Associated Pneumonia in Patients with Antimicrobial Therapy (항생제 사용 중 발생한 기계 호흡기 관련 폐렴에서 기관지 세포 세척술의 진단적 의미)

  • Chang, Yoon-Soo;Ahn, Chul-Min;Chung, Byung-Chun;Kim, Hyung-Jung;Kim, Seong-Kyu;Lee, Won-Yong;Shin, Jeung-Su
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.1
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    • pp.72-81
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    • 2000
  • Backgrounds : Authors evaluated the quantitative culture of bronchoalveolar lavage fluid(BALF) in patients who were being treated with antimicrobial agents and the characteristics of isolated microorganism. Method : A prospective study was done with 25 patients under mechanical ventilation and antimicrobial treatment in ICU and NCU of Yongdong Severance Hospital from Apr. to Sep. 1999. Patients were classified into two groups: control group (n=5) and patients with VAP (n=20). The threshold of quantitative culture of BAL fluid in the diagnosis of VAP was $10^4$ cfu/ml. Results : 1) In gram staining of BALF, one patient in the control group and four in the VAP group showed positive results. Quantitative culture of BALF showed no organisms in the patients in the control group and in 9 VAP patients. Therefore the overall sensitivity was 43.8%. 2) Frequency of isolated organisms cultured above diagnostic threshold was in the following order: E. cloaclae, S. aureus, K. pneumoniae, and A. baumani. S. aureus and Staphylococcus coagulase(-) were a11 resistant to oxacillin. Seven out of 10 isolated G (-) organisms were suspected to be organisms producing extended spectrum $\beta$-lactamase (ESBL). 3) The concurrence between gram staining of sputum aspiration and that of BALF was only in 1 case. And the concurrence of culture results was observed in 3 cases. Conclusion : The sensitivity of gram staining and quantitative culture of BALF from patients under antibiotic therapy and the concordance rate between conventional tracheal aspiration and BAL were low, facts which were important in interpretation the data. Since the frequency of drug resistance organisms was not different from that of foreign data, antibiotics must be prudently selected and used.

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Recovery of Pulmonary Function according to the Operative Sites after General Anesthesia (전신마취를 이용한 수술에서 수술부위에 따른 폐기능의 회복)

  • Kim, Hyeon-Tae;Lee, Sang-Moo;Uh, Soo-Taek;Chung, Yeon-Tae;Kim, Yong-Hoon;Park, Choon-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.40 no.3
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    • pp.250-258
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    • 1993
  • Background: After general anesthesia, decrease of functional residual capacity and lung compliance, ventilation/perfusion imbalance, and transpulmonary shunting can provoke hypoxemia during postoperative periods. Diaphragmatic dysfunction may be the main cause of these physiological abnormalities. Thus, we evaluated the change of pulmonary function after general anesthesia according to the operative sites, which could suggest clinical course and critical period of respiratory care of postoperative patients. Method: Preoperative portable spirometric evaluation and arterial blood gas analysis were performed at sitting or most-sitting position just previous day of surgery. Pulmonary function tests were also as same condition from postoperative day 1 to day 5. Results: 1) For thoracic surgery, FEV1 and FVC were not recovered at day 5, but FEV1/FVC was not decreased. $PaCO_2$ was slightly elevated at postoperative one day. 2) After upper abdominal surgery, postoperative day 5 did not show the recovery of FEV1 and FVC, but mild hypoxemia was developed at postoperative day 1. 3) Pulmonary function was recovered as preoperative value at postoperative day 5 in lower abdominal operation, but mild hypoxemia was also noted at postoperative day 1. 4) Surgery of peripheral areas did not show significant pulmonary function change and hypoxemia and hypercapnia from postoperative day 1. Conclusion: Surgery involving diaphragm provoke significant postoperative pulmonary function change after day 5. For the operation of peripheral sites adequate respiratory care during operation and postoperative period within 24 hours could prevent patients from respiratory complication.

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Clinical Value of a Desktop Spirometer (HI-801) for Spirometry Screening (선별 검사를 위한 탁상용 폐활량기 (HI-801)의 임상적 유용성에 관한 고찰)

  • Choi, Hye Sook;Choi, Cheon Woong;Park, Myung Jae;Kang, Hong Mo;Yoo, Hong Ji
    • Tuberculosis and Respiratory Diseases
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    • v.62 no.4
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    • pp.276-283
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    • 2007
  • Background: A national health care initiative recommends routine spirometry screening of all smokers over age 45 or patients with respiratory symptoms. In response to the recommendation, new, simple, and inexpensive desktop spirometers for the purpose of promoting widespread spirometric screening were marketed. The performance of these spirometers was evaluated in vivo testing with healthy subjects. However, the clinical setting allows spirometric assessment of various pathologic combinations of flow and volume. Objective: The aim of this study was to compare the accuracy of a desktop spirometer to a standard laboratory spirometer, in a clinical setting with pathologic pulmonary function. Method: In a health check-up center, where screening pulmonary funct test was performed using the HI-801 spirometer. Subjects who revealed the ventilation defect in screening spirometry, performed the spirometry again using the standard Vmax spectra 22d spirometer in a tertiary care hospital pulmonary function laboratory. Pulmonary function test with both spirometer was performed according to the guidelines of the American Thoracic Society. Results: 109 patients were enrolled. Pulmonary function measurements (FVC, $FEV_1$, PEFR, FEF25%-75%) from the HI-801 correlated closely (r=0.94, 0.93, 0.81, 0.84, respectively) with those performed with the Vmax spectra 22d and showed the good limits of agreement and differences between the 2 devices; FVC +0.35 L, $FEV_1$ +0.16 L, PEFR +1.85 L/s, FEF25%-75%-0.13 L/s. With the exception of $FEV_1$, FEF25%-75%, these differences were significant(p<0.05) but small. Conclusion: The HI-801 spirometer is comparable to the standard laboratory spirometer, Vmax spectra 22d, with high accurary for $FEV_1$ and FVC and acceptable differences for clinical use.

The Study on Risk Factors Analysis and Improvement of VDT Syndrome in Nuclear Medicine (핵의학과 Video Display Terminals Syndrome 유해 요인 조사 및 개선에 관한 연구)

  • Kim, Jung-Soo;Kim, Seung-Jeong;Lee, Hong-Jae;Kim, Jin-Eui;Kim, Hyun-Joo;Han, In-Im;Joo, Yung-Soo
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.1
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    • pp.61-66
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    • 2010
  • Purpose: Recently, Department of Nuclear Medicine have an interest in Video Display Terminals (VDT) syndrome including musculoskeletal disorders, ophthalmologic disorders, trouble of electromagnetic waves and stress disorders occur to VDT workers as the growing number of users and rapid pace of service period supply in large amount. This study research on the actual condition for VDT syndrome in Nuclear Medicine, Seoul National University Hospital (SNUH), discover the problem and draw a plan of upcoming improvement. The aim of this study establish awareness about VDT syndrome and is to prevent for it in the long run. Materials and Methods: Department of Nuclear Medicine, SNUH is composed Principle part, Pediatric part and PET center. We estimated risk factors visit in each part directly. Estimation method use "Check list for VDT work" of Wonjin working environment health laboratory and check list is condition of VDT work, condition of work tables, condition of chairs, condition of keyboards, condition of monitors, working position, character of health management and other working environment. Analysis result is verified in Department of Occupational and Environment, Hallym University Sacred Heard Hospital. Results: As a result of analysis, VDT condition of Department of Nuclear Medicine, SNUH is rule good. In case of work tables, recent of things are suitable to users upon the ergonomical planning, but 15% of existing work tables are below the standard value. In case of chairs are suitable, but 5% of theirs lost optimum capacity become superannuated. The keyboards are suitable for 98% of standard value. In case of monitors, angle control of screen is possible of all, but positioning control is impossible for 38%. In case of working position, 10% is fixed positioning for long time and some of the items researched unsuitable things for standard. At health management point, needed capable of improvement. Also, other working condition as lighting, temperature, noise and ventilation, discovered the problem, but is sufficient to advice value. Conclusion: VDT syndrome is occurrences of possibility continuously, come economical expensive about improvement, is inherent in various causes and originate without your knowledge. So, there is need systematic management system. In Nuclear Medicine, VDT syndrome make it better that constant interest and effort as improvement of ergonomical working environment, improvement of working procedure, regular exercise and steady stretching, and can be prevented fairly. This promote physical and mental condition of worker in top form in comfortable working environment, so this is judged by enlargement of operations efficiency and rising of satisfaction ratings of the inside client.

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