• Title/Summary/Keyword: oxygenation

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Meta-Analysis on the Effectiveness of Interventions Applied to Preventing Endotracheal Suction-Induced Hypoxemia (기관내 흡인으로 인한 저산소증 예방을 위한 중재 효과에 대한 메타분석)

  • 오현수
    • Journal of Korean Academy of Nursing
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    • v.33 no.1
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    • pp.42-50
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    • 2003
  • Purpose: This study was conducted to investigate the effects of the suction-induced hypoxemia interventions. Method: 30 suction-induced hypoxemia interventions were reviewed for the purpose of meta-analysis. Result: The study showed that both preoxygenation and insufflation were the most frequently examined oxygenation time periods, and hyperoxygenation combined with hyperinflation was the most commonly applied oxygenation method in order to prevent suction-induced hypoxemia. The greatest effect was obtained by providing oxygenation before and after suctioning, whereas negative effect(the contrary results from the study hypotheses) was frequently obtained by applying insufflation only. Applying hyperoxygenation combined with hyperinflation had the greatest effect over that of applying hyperoxygenation only, even though the difference between effect sizes of both methods were statistically significant. Conclusion: The results of meta-analysis showed that the occurrence rate of hypoxemia after suctioning was significantly reduced with the overall interventions for hypoxemia (decreasing 40% of occurrence rate), independent with time periods or methods for providing oxygenation.

Outcomes after Extracorporeal Membrane Oxygenation in Neonates with Congenital Diaphragmatic Hernia: A Single-Center Experience

  • Choi, Wooseok;Cho, Won Chul;Choi, Eun Seok;Yun, Tae-Jin;Park, Chun Soo
    • Journal of Chest Surgery
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    • v.54 no.5
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    • pp.348-355
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    • 2021
  • Background: Congenital diaphragmatic hernia (CDH) is a rare disease often requiring mechanical ventilation after birth. In severe cases, extracorporeal membrane oxygenation (ECMO) may be needed. This study analyzed the outcomes of patients with CDH treated with ECMO and investigated factors related to in-hospital mortality. Methods: Among 254 newborns diagnosed with CDH between 2008 and 2020, 51 patients needed ECMO support. At Asan Medical Center, a multidisciplinary team approach has been applied for managing newborns with CDH since 2018. Outcomes were compared between hospital survivors and nonsurvivors. Results: ECMO was established at a median of 17 hours after birth. The mean birth weight was 3.1±0.5 kg. Twenty-three patients (23/51, 45.1%) were weaned from ECMO, and 16 patients (16/51, 31.4%) survived to discharge. The ECMO mode was veno-venous in 24 patients (47.1%) and veno-arterial in 27 patients (52.9%). Most cannulations (50/51, 98%) were accomplished through a transverse cervical incision. No significant between-group differences in baseline characteristics and prenatal indices were observed. The oxygenation index (1 hour before: 90.0 vs. 51.0, p=0.005) and blood lactate level (peak: 7.9 vs. 5.2 mmol/L, p=0.023) before ECMO were higher in nonsurvivors. Major bleeding during ECMO more frequently occurred in nonsurvivors (57.1% vs. 12.5%, p=0.007). In the multivariate analysis, the oxygenation index measured at 1 hour before ECMO initiation was identified as a significant risk factor for in-hospital mortality (odds ratio, 1.02; 95% confidence interval, 1.01-1.04; p=0.05). Conclusion: The survival of neonates after ECMO for CDH is suboptimal. Timely application of ECMO is crucial for better survival outcomes.

Oxygenation Index in the First 24 Hours after the Diagnosis of Acute Respiratory Distress Syndrome as a Surrogate Metric for Risk Stratification in Children

  • Kim, Soo Yeon;Kim, Byuhree;Choi, Sun Ha;Kim, Jong Deok;Sol, In Suk;Kim, Min Jung;Kim, Yoon Hee;Kim, Kyung Won;Sohn, Myung Hyun;Kim, Kyu-Earn
    • Acute and Critical Care
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    • v.33 no.4
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    • pp.222-229
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    • 2018
  • Background: The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS. Methods: Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality. Results: PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001). Conclusions: Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.

Pretreatment of Hyperbaric Oxygenation Increases the Activities of Myocardial Antioxidant Enzymes and Protects the Ischemia-Reperfusion Injury of the Heart (고압산소 전처치의 심근 항산화효소 활성 증가 및 허혈-재관류손상 보호 효과)

  • Oh, Dong-Jin;Kim, Young-Hoon;Kim, Chan-Hyung;Park, Jong-Wan;Kim, Myung-Suk
    • The Korean Journal of Physiology and Pharmacology
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    • v.1 no.6
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    • pp.749-758
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    • 1997
  • Myocardial ischemia-reperfusion injury is known to be mediated by reactive oxygen species. The myocardial cell is equipped with endogenous antioxidant defensive system which can be adaptively stimulated by various oxidative stress. It is postulated that an increased oxygen partial pressure induced by hyperbaric oxygenation impose an oxidative stress on the cells, resulting alterations in the endogenous antioxidant system. In this study we investigated the effect of hyperbaric oxygenation on the activities of myocardial antioxidant enzymes and observed whether the hyperbaric oxygenation could protect the ischemia-reperfusion injury of heart. Rats or rabbits were pretreated with hyperbaric $oxygenation(2{\sim}3\;atm\;O_2/1{\sim}3\;hrs/1{\sim}10\;days)$. The changes in activities of major antioxidant enzymes(superoxide dismutase, catalase, glutathione peroxidase, glutathione reductase, glucose-6-phasphate dehydrogenase), functional recovery and infarct size were observed in the experimentally induced ischemia-reperfused hearts. In the hearts isolated from rats pretreated with $2\;atm\;O_2/1{\sim}2\;hrs$ for 5 days, the functional recovery after reperfusion(20 min) following global ischemia(25 min) was significantly increased without any observable oxygen toxicity. Lactate dehydrogenase release was also significantly reduced in this hyperbaric oxygenated rat hearts. In in vivo regional ischemia(30 min) model of rabbit hearts, pretreatrment with $2\;atm\;O_2/1\;hr$ for 5 days significantly limited the infarct size. Among the myocardial antioxidant enzymes of rat hearts pretreated with the hyperbaric oxygenation, the activities of catalase, superoxide dismutase and glucose-6-phosphatase dehydrogenase were increased, while those of glutathione peroxidase and reductase were not changed. There were lethal cases in the groups of rats exposed to 3 atm $3\;atm\;O_2/2{\sim}3\;hrs$ for 5 days. A lipid-peroxidation product, rnnlondialdehyde was increased in brains and livers of the rats exposed to$2\;atm\;O_2/2{\sim}3\;hrs/5\;days\;and\;3\;atm\;O_2/1\;hr/5days$. The present results suggest that the pretreatment of hyperbaric oxygenation can protect the post-ischemic rererfused hearts in association with a stimulation of the activities of myocardial antioxidant defensive enzymes, and that the hyperbaric oxygenation of $2\;atm\;O_2/1\;hr$for 5 days would be a safe condition which does not produce any oxygen toxicity.

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Delayed Repair of Ventricular Septal Rupture Following Preoperative Awake Extracorporeal Membrane Oxygenation Support

  • Park, Bong Suk;Lee, Weon Yong;Lim, Jung Hyeon;Ra, Yong Joon;Kim, Yong Han;Kim, Hyoung Soo
    • Journal of Chest Surgery
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    • v.50 no.3
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    • pp.211-214
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    • 2017
  • Outcomes of ventricular septal rupture (VSR) as a complication of acute myocardial infarction are extremely poor, with an in-hospital mortality rate of 45% in surgically treated patients and 90% in patients managed with medication. Delaying surgery for VSR is a strategy for reducing mortality. However, hemodynamic instability is the main problem with this strategy. In the present case, venoarterial extracorporeal membrane oxygenation (ECMO) was used to provide stable hemodynamic support before the delayed surgery. Awake ECMO was also used to avoiding the complications of sedatives and mechanical ventilation. Here, we describe a successful operation using awake ECMO as a bridge to surgery.

Application of Extracorporeal Membranous Oxygenation in Trauma Patient with Possible Transfusion Related Acute Lung Injury (TRALI) (수혈 관련 급성 폐손상이 동반된 외상환자에서 체외막 산화기의 적용 경험)

  • Lee, Dae-Sang;Park, Chi-Min
    • Journal of Trauma and Injury
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    • v.28 no.1
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    • pp.34-38
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    • 2015
  • The case of a patient with a transfusion-related acute lung injury (TRALI) to whom extracorporeal membrane oxygenation (ECMO) had been applied is reported. A 55-year-old male injured with liver laceration (grade 3) without chest injury after car accident. He received lots of blood transfusion and underwent damage control abdominal surgery. In the immediate postoperative period, he suffered from severe hypoxia and respiratory acidosis despite of vigorous management such as 100% oxygen with mechanical ventilation, high PEEP and muscle relaxant. Finally, ECMO was applied to the patients as a last resort. Aggressive treatment with ECMO improved the oxygenation and reduced the acidosis. Unfortunately, the patient died of liver failure and infection. TRALI is a part of acute respiratory distress syndrome (ARDS). The use of ECMO for TRALI induced severe hypoxemia might be a useful option for providing time to allow the injured lung to recover.

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Whole Lung Lavage in Pulmonary Alveolar Proteinosis associated with Lung Cancer Using Extracorporeal Membrane Oxygenation (ECMO) (폐암을 동반한 폐포 단백증환자에시 경피적 체외막 산소화를 이용한 성공적인 전폐세척술 치험 1예)

  • Kim Jin Hyun;Kim Kyung-Hwan
    • Journal of Chest Surgery
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    • v.38 no.12 s.257
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    • pp.860-862
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    • 2005
  • We describe a case of pulmonary alveolar proteinosis in a male adult with lung cancer To achieve the successful operation of lung cancer, we used percutaneous veno-venous extracorporeal membrane oxygenation (ECMO) during whole lung lavage (WLL) of the contralateral lung. We performed successful WLL under ECMO support.

Extracorporeal Membrane Oxygenation Treatment of Traumatic Lung Injury - 2 cases - (외상성 폐손상시 체외막형 산화기 치료 - 2 예 -)

  • Yang, Jin-Sung;Shin, Hwa-Kyun;Her, Keun;Won, Yong-Soon
    • Journal of Trauma and Injury
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    • v.24 no.2
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    • pp.155-158
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    • 2011
  • Mechanical ventilation is usually the treatment of choice for severe respiratory failure associated with trauma. However, in case of severe hypoxia, mechanical ventilation may not be sufficient for gas exchange in lungs. Patients with Acute Respiratory Distress Syndrome (ARDS) undergo difficulties in oxygen and carbon dioxide exchange. Extracorporeal Membrane Oxygenation (ECMO) is the ideal therapeutic option for those patients with severe traumatic injuries. ECMO allows lungs to reserve their functions and decreases further lung injuries while increasing survival rate at the same time. We report two cases of patients with traumatic ARDS and Multiple Organ Failure including compromised heart function. The preservation of lung function was successful using ECMO therapy.

Extracorporeal Membrane Oxygenation Support in a Patient with Status Asthmaticus

  • Ju, Min-Ho;Park, Jeong-Jun;Jhang, Won-Kyoung;Park, Seong-Jong;Shin, Hong-Ju
    • Journal of Chest Surgery
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    • v.45 no.3
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    • pp.186-188
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    • 2012
  • Status asthmaticus is a rare, fatal condition, especially in children. Sometimes respiratory support is insufficient with a mechanical ventilator or medical therapy for patients with status asthmaticus. In such situations, early extracorporeal membrane oxygenation application is a useful method for treating refractory respiratory failure. We report on a case of a six-year-old, male child who underwent venovenous extracorporeal membrane oxygenation support for refractory status asthmaticus.

Preoperative Extracorporeal Membrane Oxygenation for Severe Ischemic Mitral Regurgitation - 2 case reports -

  • Kim, Tae-Sik;Na, Chan-Young;Baek, Jong-Hyun;Kim, Jae-Hyun;Oh, Sam-Sae
    • Journal of Chest Surgery
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    • v.44 no.3
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    • pp.236-239
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    • 2011
  • Indication for extracorporeal membrane oxygenation (ECMO) has been extended as the experience of ECMO in various clinical settings accumulates and the outcome after ECMO installation improves. We report two cases of successful mitral valve surgery for severe ischemic mitral regurgitation in patients on ECMO support for cardiogenic shock which developed upon coronary angiography.