• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.140-152
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• 1998

Background: Prone position improves oxygenation in patients with ARDS probably by reducing shunt Reduction of shunt in prone position is thought to be effected by lowering of the critical opening pressure (COP) of the dorsal lung because the pleural pressure becomes less positive in prone position compared to supine position. It can then be assumed that prone position would bring about greater improvement in oxygenation when PEEP applied in supine position is just beneath COP than when PEEP is above COP. Hemodynamically, prone position is expected to attenuate the lifting of cardiac fossa induced by PEEP. Based on these backgrounds, we investigated whether the effect of prone position on oxygenation differs in magnitude according to the level of PEEP applied in supine position, and whether impaired cardiac output in supine position by PEEP can be restored in prone position. Methods: In seven mongrel dogs, $PaO_2/F_1O_2$(P/F) was measured in supine position and at prone position 30 min. Cardiac output (CO), stroke volume (SV), pulse rate (PR), and pulmonary artery occlusion pressure (PAOP) were measured in supine position, at prone position 5 min, and at prone position 30 min. After ARDS was established with warmed saline lavage(P/F ratio $134{\pm}72$ mm Hg), inflection point was measured by constant flow method($6.6{\pm}1.4cm$ $H_2O$), and the above variables were measured in supine and prone positions under the application of Low PEEP($5.0{\pm}1.2cm$ $H_2O$), and Optimal PEEP($9.0{\pm}1.2cm$ $H_2O$)(2 cm $H_2O$ below and above the inflection point, respectively) consecutively. Results : P/F ratio in supine position was $195{\pm}112$ mm Hg at Low PEEP and $466{\pm}63$ mm Hg at Optimal PEEP(p=0.003). Net increase of P/F ratio at prone position 30 min, however, was far greater at Low PEEP($205{\pm}90$ mm Hg) than at Optimal PEEP($33{\pm}33$ mm Hg)(p=0.009). Compared to CO in supine position at Optimal PEEP($2.4{\pm}0.5$ L/min), CO in prone improved to $3.4{\pm}0.6$ L/min at prone position 5 min (p=0.0180) and $3.6{\pm}0.7$ L/min at prone position 30 min (p=0.0180). Improvement in CO was attributable to the increase in SV: $14{\pm}2$ ml in supine position, $20{\pm}2$ ml at prone position 5 min (p=0.0180), and $21{\pm}2$ ml at prone position 30 min (p=0.0180), but not to change in PR or PAOP. When the dogs were turned to supine position again, MAP ($92{\pm}23$ mm Hg, p=0.009), CO ($2.4{\pm}0.5$ L/min, p=0.0277) and SV ($14{\pm}1$ ml, p=0.0277) were all decreased compared to prone position 30 min. Conclusion: Prone position in a dog with saline-lavaged acute lung injury appeared to augment the effect of relatively low PEEP on oxygenation, and also attenuate the adverse hemodynamic effect of relatively high PEEP. These findings suggest that a PEEP lower than Optimal PEEP can be adopted in prone position to achieve the goal of alveolar recruitment in ARDS avoiding the hemodynamic complications of a higher PEEP at the same time.

• Journal of Korean Society of Forest Science
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• v.52 no.1
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• pp.37-49
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• 1981

The purpose of the study is to find out the objective method of valuation on the forest stands through the analysis of logging costs that is positively related to timber production. The two forest (Amgog, Whangryoung), located nereby, but forest type, logging and skidding conditions being slightly different, were slected to carry out the study. The objective timber stumpage value were determined by investigating the appropriate timber production costs and profits of logging operations. The main result obtained in this study are as follows: 1. The rate of logging cost in consisting of timber market price is 13.15% in the area of Amgog logging place and 19.48% in Whangryoung. 2. The rate of the other production cost excluding logging cost is 15.36% in the area of Amgog logging place and 28.85% in Whangryoung. 3. The total rate of timber production cost in consisting of the market price is more than 28.51% in the area of Amgog logging place and 48.33% in Whangryoung, 4. Though the productivity of forest land is affected by the selection of tree species, tending, treatments and effective management of forest land, the more important problem is improvement of logging condition. 5. The rate of production cost in timber price is so high that we should endeavore to improve the productivity of labour and its quality, and minimize the difference of piece work per day in accordance to the various site condition. 6. Although the profit of forest industry is related to the period of recapturing investment, it is more closely related to the working condition, risk of investment and continuous change of social investment interest. 7. If the right variables which are related to the timber market, are objectively obtained, the stumpage value of mature forests can be objectively caculated by applying straight line discounting method or compound discounting method in caculating the stump to market price.