• Title/Summary/Keyword: Volume-controlled ventilation

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The Usefulness of Pressure-regulated Volume Control(PRVC) Mode in Mechanically Ventilated Patients with Unstable Respiratory Mechanics (기계 호흡 중 불안정한 호흡역학을 보인 환자에서 압력조절용적조정양식(Pressure-regulated Volume Control Mode)의 효용)

  • Sohn, Jang-Won;Koh, Youn-Suck;Lim, Chae-Man;Shim, Tae-Sun;Lee, Jong-Deog;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.6
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    • pp.1318-1325
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    • 1997
  • Background : Since the late 1960s, mechanical ventilation has been accomplished primarily using volume controlled ventilation(VCV). While VCV allows a set tidal volume to be guaranteed, VCV could bring about excessive airway pressures that may be lead to barotrauma in the patients with acute lung injury. With the increment of knowledge related to ventilator-induced lung injury, pressure controlled ventilation(PCV) has been frequently applied to these patients. But, PCV has a disadvantage of variable tidal volume delivery as pulmonary impedance changes. Since the concept of combining the positive attributes of VCV and PCV(dual control ventilation, DCV) was described firstly in 1992, a few DCV modes were introduced. Pressure-regulated volume control(PRVC) mode, a kind of DCV, is pressure-limited, time-cycled ventilation that uses tidal volume as a feedback control for continuously adjusting the pressure limit However, no clinical studies were published on the efficacy of PRVC until now. 'This investigation studied the efficacy of PRVC in the patients with unstable respiratory mechanics. Methods : The subjects were 8 mechanically ventilated patients(M : F=6 : 2, $56{\pm}26$ years) who showed unstable respiratory mechanics, which was defined by the coefficients of variation of peak inspiratory pressure for 15 minutes greater than 10% under VCV, or the coefficients of variation of tidal volume greater than 10% under PCV. The study was consisited of 3 modes application with VCV, PCV and PRVC for 15 minutes by random order. To obtain same tidal volume, inspiratory pressure setting was adjusted in PCV. Respiratory parameters were measured by pulmonary monitor(CP-100 pulmonary monitor, Bicore, Irvine, CA, USA). Results : 1) Mean tidal volumes($V_T$) in each mode were not different(VCV, $431{\pm}102ml$ ; PCV, $417{\pm}99ml$ ; PRVC, $414{\pm}97ml$) 2) The coefficient of variation(CV) of $V_T$ were $5.2{\pm}3.9%$ in VCV, $15.2{\pm}7.5%$ in PCV and $19.3{\pm}10.0%$ in PRVC. The CV of $V_T$ in PCV and PRVC were significantly greater than that in VCV(p<0.01). 3) Mean peak inspiratory pressure(PIP) in VCV($31.0{\pm}6.9cm$ $H_2O$) was higher than PIP in PCV($26.0{\pm}6.5cm$ $H_2O$) or PRVC($27.0{\pm}6.4cm$ $H_2O$)(p<0.05). 4) The CV of PIP were $13.9{\pm}3.7%$ in VCV, $4.9{\pm}2.6%$ in PVC and $12.2{\pm}7.0%$ in PRVC. The CV of PIP in VCV and PRVC were greater than that in PCV(p<0.01). Conclusions : Because of wide fluctuations of VT and PIP, PRVC mode did not seem to have advantages compared to VCV or PCV in the patients with unstable respiratory mechanics.

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An Experimental Study for the Improvement of Ventilation Conditions and Effectiveness in the Manufacturing Industry by Increasing the Mixing Factor (K-Factor) (혼합계수(K-Factor) 증가에 따른 사업장의 환기 조건 및 효율 개선에 관한 연구)

  • Lee, Yun-ho;Lee, Seokwon;Lee, Kyoungho;Kim, Hyunwook
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.29 no.3
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    • pp.343-350
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    • 2019
  • Objectives: This study aims to identify whether ventilation conditions and their effectiveness can be significantly improved in an experimental chamber by increasing the mixing factor (K-Factor). Methods: In a chamber with a volume of $1m^3$, air velocity was measured at six different points with four roof fans in the upper part of the chamber being operated in order. The impact of the ventilation conditions was analyzed when the flow rates were increasing and the first inlet of the chamber was either open or closed. Smoke patterns were also observed at four corner points where ventilation was limited. Kruskal Wallis and Mann-Whitney tests were performed to compare air velocities measured in the chamber. Results: The air velocities measured at only the third point increased significantly from $0.03{\pm}0.03m/s$ (door open) and $0.05{\pm}0.06m/s$ (door closed) with two fans, $0.08{\pm}0.08m/s$ with three fans, and $0.09{\pm}0.09m/s$ with four fans operating (p<0.05). However, air velocities at the four corner points did not significantly increase. Smoke patters also showed that the open inlet of the chamber had no effect on improvement of ventilation conditions and effectiveness. Conclusions: In this study, the air velocities at six points in the chamber did not significantly increase despite the increase in the mixing factor and flow rates of ventilation in the controlled environment. Therefore, the inflow of outdoor air throughout an open inlet and installation of a forced ventilation system can potentially increase the indoor air velocity and improve ventilation condition without an increase in the mixing factor.

Analysis of Differences in Indoor Environment and Fatigue Response According to Ventilation in Lecture Hall (대형강의실의 환기여부에 따른 실내환경과 피로감 반응의 차이분석)

  • Oh, Ye-Seul;Hwang, Jin-A;Choi, Yoon-Jung
    • Korean Journal of Human Ecology
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    • v.19 no.2
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    • pp.417-428
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    • 2010
  • The purpose of this study was to analyze differences of the indoor environment and student's fatigue response according to ventilation in university lecture hall. The experiments consisted of measuring the indoor environmental parameters and a survey of student's responses. The experiments were in the lecture hall that the actual lecture was conducted in on the $25^{th}$ of May 2009 (not opening windows and door- A) and the $1^{st}$ of June 2009 (opening windows and door- B). The experimental variable was ventilation by opening the windows and door, and the controlled conditions were indoor temperature by air conditioner, volume of the microphone and VTR, lighting conditions and teaching method. The results are as follows: 1) The indoor temperature was maintained in controlling A, B but the $CO_2$ and relative humidity of A (average 3579ppm, 62.6%) was higher than B (average 1697ppm, 48.1%). 2) There were differences in the student's subjective responses and student's fatigue responses between A and B. 3) Therefore, it was found that ventilation by opening the windows and door was a valid way to improve the relative humidity and to reduce $CO_2$ in the lecture hall.

Effects of Inspiratory Pressure Preset on Alveolar Gas Exchange Using Anesthetic Ventilator (전시마취시 흡입압력기준의 양압조절호흡이 폐포환기 정도에 미치는 영향)

  • Suh, III-Soak;Kang, Hee-Ju;Kim, Heung-Dae
    • Journal of Yeungnam Medical Science
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    • v.5 no.1
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    • pp.105-110
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    • 1988
  • The study was undertaken to determine the most adequate tidal volume when used volume preset ventilator during anesthesia. The thirty patients were received controlled mechanical ventilation with constant inspiratory pressure of 10cmH2O and respiratory frequency of 12/minute. The results were as follows : 1) The PH was $7.39{\pm}0.01$ and it is within normal limit. 2) The $PaCO_2$ was $34.0{\pm}0.6$ mmHg and it is a slightly hyperventilatory state. 3) The $PaO_2$ was $228.0{\pm}8.2$ mmHg. 4) The Buffer base was $20.7{\pm}0.3mEql$ and it is a slightly buffer base deficient state. From the above results. We concluded that if patients were fully relaxed during general anesthesia, it is desirable to maintain the inspiratory pressure of anesthetic mechanical ventilator to $10cmH_2O$ for adeguate alveolar ventilation.

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The effect of Schroth's three-dimensional exercises in combination with respiratory muscle exercise on Cobb's angle and pulmonary function in patients with idiopathic scoliosis

  • Kim, Min-Jae;Park, Dae-Sung
    • Physical Therapy Rehabilitation Science
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    • v.6 no.3
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    • pp.113-119
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    • 2017
  • Objective: The objective of this study was to investigate the effects of Schroth's three-dimensional exercises in combination with respiratory muscle exercise (SERME) on Cobb's angle and functional movement screen (FMS). Design: Randomized controlled trial. Methods: Fifteen subjects with scoliosis were randomly assigned to two groups. Eight subjects were assigned to the experimental group and seven subjects were assigned to the control group. The experimental group underwent SERME using SpiroTiger (Idiag, Switzerland), while the control group performed only the Schroth's three-dimensional exercises (SE). Both groups performed exercises for one hour per day, three times a week for eight weeks. Cobb's angle, pulmonary function (forced vital capacity, forced expiratory volume at one second, and peak expiratory flow) and FMS were measured before and after the experiment. Results: After intervention, the SERME group showed a significant difference in Cobb's angle, FMS scores, and pulmonary function as compared to before intervention (p<0.05). In the SE group, there was a statistically significant difference in Cobb's angle, pulmonary function, and FMS scores compared to before intervention (p<0.05). The SERME group showed a significant difference in Cobb's angle and peak expiratory flow in pulmonary function compared to the SE group (p<0.05). Conclusions: The results suggest that SERME could be a more effective intervention for improvement of the Cobb's angle and pulmonary function for scoliosis patients.

PWAM Based THD Reduction of Inverter for Air-Conditioning Blower (PWAM 방식을 이용한 공조시스템용 인버터의 THD 저감 방법)

  • Lim, Seung-Beom;Lee, Yun-Ha;Zun, Chan-Yong
    • Proceedings of the KIPE Conference
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    • 2011.07a
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    • pp.97-98
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    • 2011
  • The HVAC(Heating Ventilation and Air conditioning) system is controlled by two ways, one is ON/OFF control and the other is PWM inverter with V/F. Control of blower with the use of PWM inverter has quite some benefits such as the capability of changing speed, high efficiency and reduced noise level compared with ON/OFF control. But if blower is operated at low speed, high THD generated by decrease of ma, and output voltage lowered in proportion to frequency. To solve these problems, filter should be installed at the output stage of inverter, which can decrease THD but has problems such as increase of volume size and additional braking resistance. This paper proposes the PWAM method which can reduce THD instead of installing the filter at the output stage of inverter. The proposed PWAM method is an inverter modulation method that fixes the modulation index of inverter to reduce THD by varying DC link voltage of inverter unlike conventional PWM method. Finally, the validity of proposed PWAM methods verified by experiments.

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Employee Exposures to Waste Anesthetic Gases in Hospital Operating Rooms (종합병원 수술실 종사자의 마취가스 노출에 관한 연구)

  • Cha, Jung Young;Paek, Do Myung;Paik, Nam Won
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.16 no.3
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    • pp.193-201
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    • 2006
  • This study was performed to investigate employee exposures to waste anesthetic gases, such as enflurane and sevoflurane in operating rooms of general surgical, children's and dental clinics of a large hospital located in Seoul and to analyze factors affecting the concentrations of waste anesthetic gases. The results of the study are summarized below. 1. Based on results of personal and area samples for airborne enflurane, all of the employees investigated in this study were exposed to airborne enflurane concentrations below the ACGIH-threshold limit value (TLV) of 75 ppm. 2. However, based on results of personal samples for sevoflurane, employees of two (2) out of eleven (11) operating rooms were exposed to sevoflurane concentrations in excess of the NIOSH recommended exposure limit (REL) of 2 ppm. A similar trend was found in the area samples. 3. To investigate the source of sevoflurane emissions, airborne sevoflurane concentrations were measured on an anesthesia machine, a drug cabinet and a desk. It was indicated that the geometric means were 0.93 ppm, 0.83 ppm and 0.72 ppm, respectively. 4. Factors affecting waste anesthetic gas concentrations were the age of anesthesia machine, the volume of operating room and the extent of ventilation (p<0.05). 5. It is recommended that the use of anesthesia equipments be properly controlled, the operating room be well ventilated, and the airborne concentrations of anesthetic gases be continuously monitored.

Comparison of Two Treadmill Gait Training Techniques on the Gait and Respiratory Function in Stroke Patients

  • Park, Sung-Hun;Kim, Nan-Hyang;Cha, Yong-Jun
    • Journal of the Korean Society of Physical Medicine
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    • v.15 no.4
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    • pp.47-54
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    • 2020
  • PURPOSE: This study compared two different techniques of treadmill gait training, and evaluated the outcomes on gait and respiratory function in patients with hemiplegic stroke. METHODS: This was a single-blinded, randomized, controlled, comparative study, enrolling a total of 21 stroke patients in a rehabilitation hospital. Subjects were randomly assigned to either the treadmill walking training group with gradual speed increase (GSI group, n = 10), or treadmill walking training group with random speed changing (RSC group, n = 11). All participants performed 60 min of comprehensive rehabilitation therapy (5 × / week for 6 weeks). In additional, each group received either GSI or RSC treadmill walking training for 20 min (5 × / week for 6 weeks, total 30 sessions). Gait and respiratory function were measured before and after the 6-week training. RESULTS: Both groups showed significant improvements in the 10-m walking test, 6-minute walking test, timed up and go test, forced vital capacity (FVC), forced expiratory volume in 1 second, and maximal voluntary ventilation after training (p < .05). The GSI group showed a significantly greater increase in the FVC than the RSC group (+14.8 L vs. +12.5 L, p < .05). CONCLUSION: Both training methods can be effective for improving the walking and respiratory functions of stroke patients. However, our results indicate that treadmill walking training with gradual speed increase might be a more effective method for improving the respiratory function (FVC) than treadmill walking training with random speed changing.

Effects of Breathing Re-education Training on Pain and Dysfunction Levels, Posture, Quality of Life, Pulmonary Function in Patients with Chronic Neck Pain: A Randomized Controlled Trial (호흡 재교육 훈련이 만성 목통증 환자의 통증과 기능장애 수준, 자세, 삶의 질, 폐 기능에 미치는 영향: 무작위 대조군 실험)

  • Sang-hyu Lee;Suhn-yeop Kim
    • The Journal of Korean Academy of Orthopedic Manual Physical Therapy
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    • v.30 no.1
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    • pp.29-42
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    • 2024
  • Background: This study aimed to determine the effects of training on breathing re-education on pain and dysfunction levels, posture, quality of life (QoL), and pulmonary function in patients. Methods: This study included 34 patients with chronic neck pain and upper thoracic breathing pattern were included. The participants were assigned to either the routine physical therapy program (RPTP) (CG; n=17) or RPTP and breathing pattern re-education training (EG; n=17). The CG and EG groups performed RPTP for 40 minutes, and only the EG groups performed breathing re-education training for 10 minutes. Exercises were performed thrice weekly for both groups. Level of pain and dysfunction, posture, QoL and pulmonary function status were assessed before and after the intervention. Results: After four weeks of intervention, numeric pain rating scale (NPRS), Korean version of neck disability index, cranio-vertebral angle, cranial rotation angle, and 12-item short form health survey-physical and mental component summaries had significant differences before and after intervention in both groups (p<.01). However, only NPRS, forced vital capacity, forced expiratory volume in 1s, and maximum voluntary ventilation showed significant interactions between the two groups and measurement time (p<.01). Conclusion: Breathing re-education training and RPTP may be optimal for patients with chronic neck pain and may be more effective in improving neck pain and pulmonary function.

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Evaluation of Parameters of Gas Exchange During Partial Liquid Ventilation in Normal Rabbit Lung (토끼의 정상 폐 모델에서 부분액체환기 시 가스교환에 영향을 주는 인자들에 대한 연구)

  • An, Chang-Hyeok;Koh, Young-Min;Park, Chong-Wung;Suh, Gee-Young;Koh, Won-Jung;Lim, Sung-Yong;Kim, Cheol-Hong;Ahn, Young-Mee;Chung, Man-Pyo;Kim, Ho-Joong;Kwon, O-Jung
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.1
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    • pp.14-23
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    • 2002
  • Background: The opitmal ventilator setting during partial liquid ventilation(PLV) is controversial. This study investigated the effects of various gas exchange parameters during PLV in normal rabbit lungs in order to aid in the development of an optimal ventilator setting during PLV. Methods: Seven New-Zealand white rabbits were ventilated in pressure-controlled mode with the following settings; tidal volume($V_T$) 8 mL/kg, positive end-expiratory pressure(PEEP) 4 $cmH_2O$, inspiratory-to-expiratory ratio(I:E ratio) 1:2, fraction of inspired oxygen($F_TO_2$) 1.0. The respiration rate(RR) was adjusted to keep $PaCO_2$ between 35~45 mmHg. The ventilator settings were changed every 30 min in the following sequence : (1) Baseline, as the basal ventilator setting, (2) Inverse ratio, I:E ratio 2:1, (3) high PEEP, adjust PEEP to achieve the same mean inspiratory pressure (MIP) as in the inverse ratio, (4) High $V_T$, $V_T$ 15 mL/kg, (5) high RR, the same minute ventilation (MV) as in the High $V_T$. Subsequently, the same protocol was repeated after instilling 18 mL/kg of perfluorodecalin for PLV. The parameters of gas exchange, lung mechanics, and hemodynamics were examined. Results: (1) The gas ventilation(GV) group showed no significant changes in the $PaO_2$ at all phases. The $PaCO_2$ was lower and the pH was higher at the high $V_T$ and high RR phases(p<0.05). No significant changes in the lung mechanics and hemodynamics parameters were observed. (2) The baseline $PaO_2$ for the PLV was $312{\pm}$ mmHg. This was significantly lower when decreased compared to the baseline $PaO_2$ for GV which was $504{\pm}81$ mmHg(p=0.001). During PLV, the $PaO_2$, was significantly higher at the high PEEP($452{\pm}38$ mmHg) and high $V_T$ ($461{\pm}53$ mmHg) phases compared with the baseline phase. However, it did not change significantly during the inverse I:E ratio or the high RR phases. (3) The $PaCO_2$ was significantly lower at high $V_T$ and RR phases for both the GV and PLV. During the PLV, $PaCO_2$ were significantly higher compared to the GV (p<0.05). (4) There were no important or significant changes in of baseline and high RR phases lung mechanics and hemodynamics parameters during the PLV. Conclusion: During PLV in the normal lung, adequate $V_T$ and PEEP are important for optimal oxygenation.