• Journal of Korean Clinical Nursing Research
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• v.16 no.3
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• pp.111-121
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• 2010

Purpose: This meta-analysis was aimed to investigate the evidence of proper period of the ventilator circuit change using existing research. Methods: For this study, 14 published studies between 1995 and 2010 were tested by Macaskill, Funnel Plot, the Odds Ratio of DerSimonian and Laird, Fisher and Liptak analysis. Results: There were no publication bias found in the subjects. The results of the meta-analysis demonstrated no statistically significant differences were observed in neither the Odds Ratio (OR=1.18, 95% CI=0.94-1.47) of the frequency of ventilator-associated pneumonia and the mortality based on the period of the ventilator circuit change (Fisher p=.332, Liptak p=.498), nor the ventilation duration of ventilator (Fisher p=.843, Liptak p=.506), and the hospital length of stay (Fisher p=.254, Liptak p=.480). Conclusion: In order to present more concrete guidelines on the period of the ventilator circuit change, further research is warranted to thoroughly control confounding variables which related to the periods of the ventilator circuit change.

• Korean Journal of Adult Nursing
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• v.15 no.3
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• pp.463-471
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• 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 Korean Academy of Nursing
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• v.40 no.6
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• pp.799-807
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• 2010

Purpose: To determine whether the practice of not routinely changing ventilator circuits in patients who require prolonged mechanical ventilation is associated with ventilator-associated pneumonia (VAP). Methods: Patients were divided into two groups, ventilator circuits were routinely changed every 7 days for the control group (39) and every 14 days for the experimental group (40) over a period of 1 yr (April 1, 2009-March 31, 2010). Pediatric patients (age 17 yr or less) were not included. VAP was diagnosed by the criteria of the Centers of Disease Control and Prevention (CDC). Incidence of VAP and characteristics of infection were evaluated. Results: In the experimental group, 2 episodes of pneumonia were observed in 40 patients and 1,322 ventilator days. The rate of VAP was 1.5 per 1,000 ventilator days. There was 1 episode of pneumonia in 39 patients and 481 ventilator days for the control group. The rate of VAP was 2.1 per 1,000 ventilator days. The difference between both groups was not significant (p=.695). Conclusion: Extending ventilator circuit change interval from 7 days to 14 days does not increase the risk for VAP.

• Journal of Korean Clinical Nursing Research
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• v.17 no.2
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• pp.150-162
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• 2011

Purpose: Multi-drug resistant (MR) infections among intensive care unit (ICU) patients with oral intubation and a ventilator are serious nosocomial infections. This study was done to compare the effects of oral care and ventilator circuit on reduction of MR infections. Methods: A total of 92 participants were recruited from an ICU at C University Hospital in G-city, Korea, assigned to one of 4 groups and evaluated: group I received oral care with sponge and reusable circuit; group II received oral care with tooth brush and reusable circuit; group III received oral care with sponge and disposable circuit; group IV received oral care with tooth brush and disposable circuit. Results: Prevalence rate of MR infections was highest in group I (47.8%), followed by group II (30.4%), group IV (19.0%), and group III (13.6%). Of the four groups, group III showed a significantly decreased MR infections (p=.035) and higher possibility of survival rate as time passes according to survival analysis (p=.019). Conclusion: Results of this study indicate that using disposable ventilator circuit significantly decreases MR infections and raises the possibility of a higher survival rate as time passes. According to this study, the use of disposable ventilator circuit is useful in prevention of MR infections.

• Quality Improvement in Health Care
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• v.8 no.1
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• pp.44-55
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• 2001

Background : This study aimed at identifying the effect of the standardized protocol on lowering the incidence of the ventilator associated pneumonia(VAP). Methods : The standard protocol focusing on decreasing VAP was made and applied at 5 ICUs (Medical ICU, surgical ICU, Respiratory ICU, Neonatal ICU, Pediatric ICU) in a university affiliated tertiary hospital, from April 1, 2000 to Oct 31, 2000. The protocol involved 3 parts : hand washing, the suctioning method and ventilator circuit management. All the nursing personnel received intensive education which was consisted of lecture, video film and demonstration. 176 nurses reported the performance of handwashing pre and post intervention. And randomly selected 15 nurses were observed by charge nurse and the handwashing practice was analyzed pre and post intervention. The incidence of VAP was compared with the former year incidence. Results : The self reported frequency of hand washing increased. In the direct observation of handwashing, the frequency, time, thoroughness of hand washing during 8 hours day duty was found to be improved. The frequency was increased from 1.1 time to 4.1 times; the time was improved from 1.7 seconds to 5.7 seconds and the thoroughness of the washing practice was from 0.2 times to 3.0 times respectively (p<0.001). The incidence of VAP decreased from at a rate of 15.63 number of case per 1,000 ventilator-day (April 1~August 31, 1999) to 7.23 number of case per 1,000 ventilator-days(April 1~Oct 31, 2000)(P<0.001). Conclusion : We developed the protocols which included hand washing, the suctioning method, and ventilator circuit management. Through the implementation of the protocol, the performance of hand washing improved and the VAP incidence rate in ICU was decreased.

• Journal of the Korean Society of Safety
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• v.31 no.4
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• pp.22-26
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• 2016

"Always-on" small ventilators are likely to experience thermal decomposition of insulating material due to thermal, electrical, mechanical and environmental influences, and lose insulating properties by the process of oxidation and physiochemical reaction. This increases the risk of electrical fire because of layer short, short circuit, overload and Plastics are usually used to make ventilator and ventilator enclosures since they make less noise and are cheaper. Although more preferred than iron, plastic, a combustible material, has a higher risk of fire. In this study, several experiments were carried out to find out how RCD(Residual Current Protective Device) and Thermal fuses, which are electric motor protection devices, work and what needs to be done to reduce the risk of fire.

• Journal of Biomedical Engineering Research
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• v.40 no.6
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• pp.260-267
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• 2019

In the present study, we aimed to demonstrate that MV2000-MT(SU:M2)^® (MV, MEK-ICS, Paju, Korea), a domestic ventilator, is not inferior in terms of usability, safety, and medical staff satisfaction as compared to Hamilton G5 (G5, Hamilton Medical AG, Rhäzuns, Switzerland). A total of 39 patients who applied MV (group M) or G5 (group H) were included in the study sample. Usability was evaluated by the following factors: the number of alarm errors, replacement requirement of breathing circuit, replacement requirement of a right-angle connector, and ease of ventilator weaning. For safety evaluation, the number of ventilator replacements due to malfunction of the ventilator was evaluated. Items for medical staff satisfaction survey were as follows: the number of MV and G5 uses, hardware, and software assessment. In the usability evaluation, the replacement requirement of the right-angle connector was lower in Group M than in Group H (mean ± standard deviation, Group M: 7.39 ± 6.72, Group H: 14.19 ± 10.24, p = 0.021); however, the evaluations of other parts were not significantly different between the two groups. The number of ventilator replacements due to a malfunction of the ventilator did not differ between two groups. The number of MV and G5 uses was 3.0 [3.0-4.0] and 10.0 [5.0-10.0] (median [interquartile range], p < 0.001). Overall, the mean medical staff satisfaction score of Hamilton G5 was higher than that of MV2000-MT(SU:M2)^®. The usability of MV is comparable to that of G5. However, medical staff satisfaction with Hamilton G5 was higher than that with MV2000-MT(SU:M2)^®, and this difference could be due to the difference in the number of uses. In order to improve the penetration rate of the domestic mechanical ventilator, it is necessary to find ways to increase familiarity of medical staff with domestic mechanical ventilators.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1399-1403
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• 1992

The evaluation of the effectivess of ongoing cardiopulmonary resucitation efforts is dependent on the commonly used methods, such as the presence of femoral or carotid artery pulsations, arterial blood gas determinations, peripheral arterial pressure and intracardiac pressure monitoring. But recent studies suggest that end-tidal carbon dioxide tension serves as a non-invasive measurement of pulmonary blood flow and therefore cardiac output under constant ventilation. A prospective clinical study was done to determine whether end-tidal carbon dioxide monitoring in open heart surgery under cardiopulmonary bypass could be used as a prognostic indicator of bypass weaning. We monitored end-tidal PCO2 values continuously during cardiopulmonary bypass in 30 patients. "Ohmeda 5210 CO-2 monitor" under infrared absorption method were incorperated into the ventilator circuit by means of a side point adaptor between endotracheal tube and ventilator tubing. 18 patients[Group I ] were res-ucitated from partial bypass followed by aorta cross clamp off and 12 patients[Group II ] from aorta cross clamp off followed by partial bypass. But there was no difference between two groups[p>0.05]. The value of end-tidal carbon dioxide tension during ventricular fibrillation or nearly arrest state was 6.6$\pm$2.9 mmHg, and at the time of spontaneous beating was 19.3$\pm$5.6 mmHg[Mean$\pm$Standard deviation], In conclusion end-tidal carbon dioxide tension monitoring provides clinically useful, continous, noninvasive and supplementary prognostic indicator during cardiopulmonary bypass weaning procedures.rocedures.

• Journal of Korean Clinical Nursing Research
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• v.26 no.2
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• pp.131-140
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• 2020

Purpose: This study aims to describe the characteristics of safety incidents and factors associated with injury for patients with Home Mechanical Ventilation (HMV) at the hospital. Methods: This is a retrospective study. Data were collected from the work log of respiratory home care nurses and the patients' electronic medical records were investigated. In order to compare group differences, independent t-test and χ² test were used. Associated factors with injury development were identified by generalized mixed modeling analysis controlling for age and gender. Results: A total of 304 patients on HMV were included in this study, among which 129 (42.4%) experienced 352 HMV-related incidents. Mean frequency of incidents for each patient was 5.11±3.98, ranged from 1 to 15 times. In 19.0% of the incidents, injury was developed. Types of incident and persons involved in the incidents were significantly associated with the patient's injury. In the case of the safety incidents, patient's injury was significantly higher in accidents caused by respiratory circuit problems compared to those caused by problems with the ventilator operation by the medical staff (coefficient=1.25, p=.020). In addition, in the case of those involved in the safety incidents, patient's injury was significantly higher in the accident caused by the patient family members or caregivers than that caused by the medical personnel (coefficient=1.25, p=.019). Conclusion: In order to minimize injury caused by incidents in patients with HMV, hospitals need to provide systemic education to their medical staff and caregivers to enhance awareness of the importance of reporting and safety management.

• Journal of Korean Academy of Nursing
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• v.31 no.1
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• pp.31-42
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• 2001

This study was done to evaluate the effect reducing artificial dead space on intubated children. Data were collected from July 1st, 1998 to August 31st, 1999. The subjects were selected from a pediatric intensive care unit of 'S' hospital and intubated with 3.5 mm or 4.5 mm endotracheal tube after open heart surgery. They were composed of 34 patients : 17 patients were assigned to the experimental group and the rest of them were placed in the control group. The artificial airway volume was minimized in the experimental group, and the control group maintained the artificial airway volume. ETCO2, PaCO2, SPO2 were measured as indicators of pulmonary ventilation. The tools of this study were GEM-Premier and Space-Lab patient monitors. The data were analyzed using the SPSS/PC+ program. The $\chi$2 -test was used to find general characteristics. The t-test was used to test the homogenety of the pulmonary ventilation status and mechanical ventilation setting before intervention between the two groups. Also, the paired t-test was used to examine the hypothesis. The results can be summerized as : 1. CO2 can be expelled effectively from the body in case artificial dead space was decreased. 2. As the artificial dead space was reduced, the difference between ETCO2 and PaCO2 was decreased, in other words pulmonary ventilation was improved. 3. If the artificial dead space occupied above 15 percent of tidal volume, the effect of CO2 was retention revealed in the body. 4. If the artificial dead space occupied below effect. Based on the results, the following is suggested to be applied practically : 1. A kind of the ventilator circuit acting artificial dead space should be removed from the intubated children with mechanical ventilaion. 2. The endotracheal tube should not be cut because extra-body space of the endotracheal tube did not have an effect on the dead space of the intubated children. Since the researcher could not cover this aspect in the study, they recommend the following. 1. The study should be extended to the other pulmonary disease patients for the effect of improving pulmonary ventilation. 2. Also, further studying with a more narrow interval in the extra-body space of the artificial airway will be able to explain the point of artificial dead space with proper ventilation.