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Acute Respiratory Distress Syndrome in Respiratory Intensive Care Unit (호흡기계 중환자실에서 치료 관리된 급성호흡곤란증후군의 임상특성)

  • Moon, Seung-Hyug;Song, Sang-Hoon;Jung, Ho-Seuk;Yeun, Dong-Jin;Uh, Su-Tack;Kim, Yong-Hoon;Park, Choon-Sik
    • Tuberculosis and Respiratory Diseases
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    • v.45 no.6
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    • pp.1252-1264
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    • 1998
  • Background : Patients with established ARDS have a mortality rate that exceeds 50 percent despite of intensive care including artificial ventilation modality, Mortality has been associated with sepsis and organ failure preceding or following ARDS ; APACHE II score ; old age and predisposing factors. Revised ventilator strategy over last 10 years especially at ARDS appeared to improve the mortality of it. We retrospectively investigated 40 ARDS patients of respiratory-care unit to examine how these factors influence outcome. Methods : A retrospective investigation of 40 ARDS patients in respiratory-care unit with ventilator management over 46 months was performed. We investigated the clinical characteristics such as a risk factor, cause of death and mortality, and also parameters such as APACHE II score, number of organ dysfunction, and hypoxia score (HS, $PaO_2/FIO_2$) at day 1, 3, 7 of severe acute lung injury, and simultaneously the PEEP level and tidal volume. Results : Clinical conditions associated with ARDS were sepsis 50%, pneumonia 30%, aspiration pneumonia 20%, and mortality rate based on the etiology of ARDS was sepsis 50%, pneumonia 67%(p<0.01 vs sepsis), aspiration pneumonia 38%. Overall mortality rate was 60%. In 28 day-nonsurvivors, leading cause of death was severe sepsis(42.9%) followed by MOF(28.6%), respiratory failure(19.1 %), and others(9.5%). There were no differences in variables of age, sex, APACHE II score, HS, and numbers of organ dysfunction at day 1 of ARDS between 28-days survivor and nonsurvivors. In view of categorized variables of age(>70), APACHE II score(>26), HS(<150) at day 1 of ARDS, there were significant differences between 28-days survivor and nonsurvivors(p<0.05). After day 1 of ARDS, the survivors have improved their APACHE II score, HS, numbers of organ dysfunction over the first 3d to 7d, but nonsurvivors did not improve over a seven-day course. There were significant differences in APACHE II score and numbers of organ dysfunction of day 3, 7 of ARDS, and HS of day 7 of ARDS between survivors and nonsurvivors(p<0.05). Fatality rate of ARDS has been declined from 68% to less than 40% between 1995 and 1998. There were no differences in APACHE II score, HS, numbers of organ dysfunction, old age at presentation of ARDS. In last years, mean PEEP level was significantly higher and mean tidal volume was significantly lower than previous years during seven days of ARDS(p<0.01). Conclusions : Improvement of HS, APACHE II score, organ dysfunction over the first 3d to 7d is associated with increased survival Decline in ARDS fatality rates between 1995 and 1998 seems that this trend must be attributed to improved supportive therapy including at least high PEEP instead of conventional-least PEEP approach in ventilator management of acute respiratory distress syndrome.

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A Survey of the Status of Nutrition in Rural Korea (농촌(農村) 영양실태(營養實態)에 관(關)한 조사(調査))

  • Lee, Geum-Yeong;Suh, Myung-Sook
    • Journal of Nutrition and Health
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    • v.6 no.1
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    • pp.71-76
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    • 1973
  • 1. This survey is somewhat different from that conducted by Yonsei University, although being in many respects, very similar. We found the average per capita caloric intake to be 7 or 8% of what it should be. Of that caloric intake, 84.5% in the model village here and 82.2% in the compared village Bupyong, by and large depends on cereal grains. Since such grains tend to distend the stomach, the farmers, it seems,should substitute fat for a part of their diet so as to dimish digestive pain and still receive the necessary calories. 2. Protein is the most important nutrient for the development of physical strength and improvement of health, but the average daily intake is only 68.3% of the necessary amount. It is desirable that the ratio of vegetable protein to that of animal be one to three for maintaining one's health. Most of the villager's protein, however, comes from plants: the intake of animal protein, at a level of only 13.6 g, is far below such a one to three ratio. 3. In the model village, 497.6 mg, of inorganic calcium is the daily intake level. In the compared village it is 505.5 mg, making a difference of only 8mg. This, however, is 35% less than the recommended intake. More than 50% of this calcium comes from cereals and other plants. Moreover, plant calcium which has much oxakuc acud us not as nutritional as animal calcium, so their calcium diet is less than it would appear. We must, therefore, make efforts to receive as good nutritional calcium as possible. 4. Among the vitamin group, the daily average intake of vitamin A and vitamin $B_{2}$ are respectively 40% and 32% less than the desired intake, while vitamin $B_{1}$ happens to be taken in sufficient quantities and more niacin is taken than which is even necessary. The intake of vitamin C is much more than the necessary quantity. However, this figure was calculated from uncooked food; if the loss from cooking were to be considered, the real intake might well be a little less. Also, as this survey was carried out in May, some of these results were influenced by the fact that lettuce and spinach are seasonally popular. In conclusion, except for a few nutrients which are in abundance, the normal food intake in a day is, on the whole, less than the average recommended. Furthermore despite the fact that both of these places are model villages in the development of nutrition, it seems that they have not gotten out of such conventional eating habiys as the almost dependancy on cereal grains. Cow's milk, sheep's milk, eggs and so on produced by each farmhouse are not used for their own families but are taken to the market for the purpose of making money. Accordingly, I think from now we must seek to improve, guide and enlighten the farmers as to how to correct their eating habits and implement changes in their lives so that our firm purpose may be achieved.

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