• Journal of Chest Surgery
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• 제54권1호
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• pp.2-8
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• 2021

Since the first reported case of coronavirus disease 2019 (COVID-19) in December 2019, the numbers of confirmed cases and deaths have continued to increase exponentially despite multi-factorial efforts. Although various attempts have been made to improve the level of evidence for extracorporeal membrane oxygenation (ECMO) treatment over the past 10 years, most experts still hesitate to take an active position on whether to apply ECMO in COVID-19 patients. Several ECMO management guidelines have been published recently, but they reflect some important differences from the Korean medical system and aspects of real-world medical practice in Korea. We aimed to find evidence on the efficacy of ECMO for COVID-19 patients by reviewing the published literature and to propose expert recommendations by analyzing the Korean COVID-19 ECMO registry data.

• Journal of Chest Surgery
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• 제47권2호
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• pp.100-105
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• 2014

Background: We evaluated the safety and efficacy of percutaneous extracorporeal membrane oxygenation (ECMO) in patients with primary graft dysfunction after heart transplantation. Methods: Of 65 patients (44 males and 21 females) who underwent heart transplantation from January 2006 to December 2012, 13 patients (group I) needed peripheral ECMO support due to difficulty in weaning from cardiopulmonary bypass (CPB) and 52 patients (group II) were weaned from CPB without mechanical support. The mean age of the patients at the time of operation was $54.4{\pm}13.6$ years. There were no differences in the preoperative characteristics of the two groups. Multivariable analysis was performed to identify the risk factors for ECMO therapy. Results: All group I patients were successfully weaned from ECMO after $53{\pm}9$ hours of circulatory support. Early mortality occurred in four patients (1 [7.7%] in group I and 3 [5.8%] in group II, p>0.999). There were no differences in the postoperative complications between the two groups, with the exception of reoperation for bleeding. A greater number of group I patients underwent reoperation for bleeding (5 [38.5%] in group I vs. 6 [11.5%] in group II, p=0.035). In multivariable analysis, preoperative mechanical support (ECMO and intra-aortic balloon pump) and longer CPB time were the risk factors of ECMO therapy for graft dysfunction (odds ratio, 6.377; 95% confidence interval, 1.519 to 26.77; p=0.011 and odds ratio, 1.010; 95% confidence interval, 1.001 to 1.019; p=0.033). Conclusion: Percutaneous ECMO support could be a viable option for rescuing patients when graft dysfunction refractory to medical management develops after heart transplantation.

• Radiation Oncology Journal
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• 제9권1호
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• pp.7-15
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• 1991

Pentoxifylline (PENTO)는 적혈구의 유동성을 증가시켜 모세혈관의 적혈구 흐름을 증가시킨다. 또한 적혈구내 2,3-DPG를 증가시켜서 산소 친화력을 감소시켜 산소의 해리를 촉진시킨다. Nicotinamide (NA)는 종양내 혈류를 일시적으로 증가시켜서 종양내 급성 저산소 세포의 수를 감소시킨다. PENTO와 NA의 병용이 저산소 세포의 산소화에 의해서 방사선 감수성을 증가시킬 수 있는지를 확인하기 위하여 FSaII생쥐의 섬유육종을 이용하여 실험을 시행하였다. 방사선에 의한 성장 장애가 유의하게 증가하였으며, 증가율은 2.5~2.8이었다. $TCD_{50}$가 대조 종양군에서는 57Gy였으나 PENTO+NA투여 종양군에서는 32Gy로 1.8배의 $TCD_{50}$의 감소를 보였다. 정상피부의 방사선 감수성에는 영향이 없었다. PENTO+NA의 방사선 감수성의 증가를 규명하기 위하여 종양내 혈류의 변화, 종양내 산소농도를 laser Doppler flowmetry와 산소 미소전극 방법으로 측정하였다. PENTO+NA투여후 10분 경과하여 혈류가 유의하게 증가하였으며 종양내 산소 분압도 8 mmHg에서 19 mmHg로 유의하게 증가함을 관찰하였다. 따라서 PEHTO또는 NA단독보다 PENTO+NA병통이 더욱 효과적이라 사료되며 생체내 종양의 방사선 감수성의 증가는 종양내 산소의 증가로 생각되며 더욱 방사선 감수성을 증가시키기 위하여 여러 농도의 PENTO의 단독 또는 NA와의 병용등에 대한 지속적인 연구가 필요하다.

• Archives of Plastic Surgery
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• 제37권2호
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• pp.148-152
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• 2010

Purpose: In treating diabetic foot ulcers, satisfactory vascularity is an essential prerequisite. To improve vascularity, a bypass graft has long been carried out. Recently, however, percutaneous transluminal angioplasty (PTA) has also been tried since the PTA is less invasive than the bypass graft. However, publication demonstrating the improvement of vascularity after the PTA are lacking. Therefore, this study was designed to show usefulness of the PTA in treating vasculopathy of diabetic foot. Materials: and Methods This study included 30 feet of 24 ischemic diabetic foot patients. Inclusion criteria were diabetes (duration > 5 years) and a significant lower extremity ischemia, as determined by a transcutaneous oxygen pressure ($TcpO_2$) < 30 mmHg. The PTA was carried out in 61 arteries. PTA procedure was considered successful, when residual stenosis was less than 30%. The procedure was considered failed when residual stenosis was more than 50%. Residual stenosis between 30% and 50% was considered acceptable. For evaluation of PTA effect, foot $TcpO_2$ and infrared thermography were measured before and 7th day after PTA. Results: Immediately after PTA performed in 61 arteries, 58 and 3 arteries were evaluated as being successful and acceptable, respectively. Before PTA, average foot $TcpO_2$ was $12.6{\pm}8.8$ mmHg and its value was increased to $44.2{\pm}23.9$ on 7th day after PTA (p<0.01). Average skin temperature was $31.8{\pm}1.2^{\circ}C$ before PTA and it was increased to $33.5{\pm}1.1^{\circ}C$ on 7th day after PTA (p<0.01). Conclusion: PTA procedure increases tissue oxygenation of ischemic diabetic feet which do not have wound healing potential due to low tissue oxygenation, to the level of possible wound healing. In addition, PTA increases skin temperature of ischemic diabetic feet which can imply an improvement of peripheral circulation.

• Journal of Chest Surgery
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• 제48권5호
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• pp.318-327
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• 2015

Background: With improvements in cardiopulmonary resuscitation (CPR) techniques, the quality and the effectiveness of CPR have been established; nevertheless, the survival rate after cardiac arrest still remains poor. Recently, many reports have shown good outcomes in cases where extracorporeal membrane oxygenation (ECMO) was used during prolonged CPR. Accordingly, we attempted to evaluate the impact of extracorporeal cardiopulmonary resuscitation (ECPR) on the survival of patients who experienced a prolonged cardiac arrest and compared it with that of conventional CPR (CCPR). Methods: Between March 2009 and April 2014, CPR, including both in-hospital and out-of-hospital CPR, was carried out in 955 patients. The ECPR group, counted from the start of the ECPR program in March 2010, included 81 patients in total, and the CCPR group consisted of 874 patients. All data were retrospectively collected from the patients' medical records. Results: The return of spontaneous circulation (ROSC) rate was 2.24 times better in CPR of in-hospital cardiac arrest (IHCA) patients than in CPR of out-of-hospital CA (OHCA) patients (p=0.0012). For every 1-minute increase in the CPR duration, the ROSC rate decreased by 1% (p=0.0228). Further, for every 10-year decrease in the age, the rate of survival discharge increased by 31%. The CPR of IHCA patients showed a 2.49 times higher survival discharge rate than the CPR of OHCA patients (p=0.03). For every 1-minute increase in the CPR duration, the rate of survival discharge was decreased by 4%. ECPR showed superiority in terms of the survival discharge in the univariate analysis, although with no statistical significance in the multivariate analysis. Conclusion: The survival discharge rate of the ECPR group was comparable to that of the CCPR group. As the CPR duration increased, the survival discharge and the ROSC rate decreased. Therefore, a continuous effort to reduce the time for the decision of ECMO initiation and ECMO team activation is necessary, particularly during the CPR of relatively young patients and IHCA patients.

• 성인간호학회지
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• 제12권1호
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• pp.122-133
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• 2000

The purpose of this study was to identify the effect of body positioning on $PaO_2$, $SpO_2$, systolic blood pressure, diastolic blood pressure, pulse, and respiration(above all defined physiologic index), of patients with unilateral lung disease. The subjects for this study were eleven patients admitted to I.C.U. of K.H.M.C. with a diagnosis of unilateral lung disease confirmed by chest X-ray and the attending doctor, from January 30th. to April 20th. 1999. A quasi-experimental repeated-measures cross-over design was used to compare three body positions(semi-Fowler's, lateral decubitus with good lung dependent, and lateral decubitus with diseased lung dependent). Each subject spent 30 minutes in semi-Fowler's position and 2 hours in good lung dependent position and diseased lung dependent position. Starting in the semi-Fowler's position, then in the lateral position with the good lung dependent or the diseased lung dependent as assigned in random order. Thirty minutes after each positioning, arterial blood sample was analyzed. Measurements of all physiologic index were recorded at the specified intervals(0, 30, 60 90, and 120 minutes) in good lung dependent and diseased lung dependent position. Statistical comparison of $PaO_2$ value was done using the Wilcoxon Signed Rank Test, and Multivariate repeated-measures analysis of variance was performed to analyse the within-subject effect of two dependent position for 2 hours on the five dependent variables: (1) $PaO_2$ (2) $SpO_2$ (3) systolic blood pressure (4) diastolic blood pressure (5) pulse. The results obtained were as follows: 1. The $PaO_2$ value in the good lung dependent position was significantly higher than the $PaO_2$ value in the diseased lung dependent position(Z=-2.8451, p=.002). 2. The $PaO_2$ value in the good lung dependent position was significantly higher than the $PaO_2$ value in the semi-Fowler's position (Z=-2.6673, p=.003). 3. The difference between the $PaO_2$ value in the semi-Fowler's position and the $PaO_2$ value in the diseased lung dependent position was not significant(Z=-1.2448, p=.10). 4. There were no statistically significance in the trends of physiologic index in the good lung dependent position and the diseased lung dependent position. From the results, it may be concluded that the good lung dependent position is the most effective position for patients with unilateral lung disease that improve oxygenation. Identification of positioning over time may be need further studies.

• 한국산학기술학회논문지
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• 제17권12호
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• pp.128-137
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• 2016

본 연구는 신생아 중환자실에 입원한 미숙아를 대상으로 캥거루식 접촉이 미숙아의 신체발달, 외부환경 적응, 어머니의 역할수행 자신감에 미치는 효과를 파악하기 위해 시도되었다. 연구대상은 B광역시에 소재한 1개 종합병원에서 제왕절개분만을 한 미숙아와 미숙아 어머니로서 캥거루식 접촉을 시행 한 실험군 19명과 캥거루식 접촉을 하지 않은 대조군 19명이다. 자료수집기간은 2013년 6월 1일부터 2015년 6월 30일까지이며, 실험군에게 캥거루식 접촉을 하루 3회(1회 60분), 총 10회를 실시하였다. 미숙아의 신체발달(체중, 신장, 머리둘레)과 외부환경 적응(체온, 심박동수, 산소포화도)을 캥거루식 접촉 전에 측정하였고, 중재를 제공한 후 다시 측정하였다. 어머니 역할수행 자신감은 자가보고식 설문지로 측정하였다. 연구결과 캥거루식 접촉을 시행한 실험군과 접촉을 시행하지 않은 대조군 간의 차이에서 미숙아의 신체발달은 통계적으로 유의한 차이가 없었으며(체중 t=-0.83, p=.21 신장 t=-0.34, p=.37, 머리둘레 t=1.29, p=.10), 외부환경 적응에서 산소포화도가 유의한 차이가 있었다(t=2.27, p=.02). 미숙아 어머니의 역할수행 자신감은 유의한 차이가 없었다(t=-0.41, p=.34). 결론적으로 캥거루식 접촉은 미숙아의 외부환경 적응에 효과가 있는 것으로 나타났다.

• Journal of Chest Surgery
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• 제4권2호
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• pp.69-80
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• 1971

Total body perfusion using Rygg-Kyvsgaard Heart-Lung-Machine, Mark IV, Polystan was attempted in the dogs by the hemodilution method with total prime of buffered Hartman's solution and under hypothermia. The first of all, the functions of Rygg--Kyvsgaard Heart-Lung-Machine and the effects of the hemodilution perfusion by buffered Hartman's solution was studied. At the same time the changes of blood pressure, oxygen consumption, and influence on the blood pictures were observed before, during, and in 1-3 days after perfusion. Hemodilution rates were the average 74. 22cc/Kg(the ranges of 67 to 81 cc/Kg) and perfusion flow rates were maintained in the mean 62. 6cc/Kg/min., Although it was possible to check up to 87 cc/ Kg/min. The total body perfusion continued for 60-80 minutes. Hypothermia was employed between $36^{\circ}C$ and $32^{\circ}C$ of the rectal temperature. Arterial pressure was ranged approximately between 68mmHg and 149mmHg, but generally, it was maintained over 80mmHg. Venous pressure was measured between 6.5cm $H_2O$and 11.5cm $H_2O$. Optimum oxygenation can be expected when oxygen flow into the disposable bubble oxygenator was maintained approximately at 3.5 L/min .. Inthis way, the oxygen contents were measured in the mean value of 13.11${\pm}$O.56 vol. % of arterial blood and 8.67+1.08 vol.% of venous blood(P${\pm}$0.86 vol.% in arteriovenous oxygen difference and 2. 97${\pm}$0.62cc/Kg in oxygen consumption were calculated. According to these dates, it is as plain as pikestaff that excellent oxygenation and good tissue perfusion was accomplished. Erythrocyte, hemoglobin and hematocrit were decreased about 38% during extracorporeal circulation and these were not recovered until 1-3 days after perfusion. These decrease was resulted from relatively high degree of hemodilution rate and no blood transfusion to compensate during these experimental studies. The platelets were also decreased about 76% during perfusion, but on the contrary, it was increased progressively after perfusion and in 1-3 days after perfusion was returned to the control level. Leucocyte were also decreased during perfusion, but it was increased progessively after perfusion and in 1-3 days after perfusion exceed the control level. This increase was resulted from postoperative infection of the wound, but its analysis were not changed significantly.

• 해양환경안전학회:학술대회논문집
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• 해양환경안전학회 2007년도 추계학술발표회
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• pp.185-185
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• 2007

20세기에 들어 산업, 군사 및 다양한 목적으로 비인화성 용매인 PCE와 TCE의 사용량이 증대하였다. 주의를 필요로 하는 물질임에도 불구하고 부주의한 사용과 보관으로 인해 토양, 퇴적토, 지하수에 심각하게 오염되었다. High-chlorinated ethenes은 호기성 박테리아의 oxygenation에 의해 분해되지 않는다. PEC및 TCE의 완전한 탈염소화는 혐기성조건에서만 관찰되어지며, 지난 10연년간의 연구에 의해서 탈염소화 혐기성 미생물의 수의 보고는 증가되었다. 혐기성 조건에서 탈염소화 미생물에 의해 PCE와 TCE는 less-chlorinated ethenes 또는 무해한 ethene으로 전환이 가능하다. 본 연구는 lactate를 electron donor로 이용해 PCE에서 ethene까지 완전히 탈염소화하는 혐기성 배양을 수행했다. PCE로 오염된 퇴적토 시료로부터 혐기성 미생물 배양을 성공했다. PCE가 ethene까지 완전히 분해되는 것이 관찰되었다. 추가적으로 혐기성 미생물 배양액에서 1,2-cis-dichloroethene (cis-DCE)와 vinyl chloride (VC)의 축적이 일어남을 관찰하였다. 혐기성 미생물 배양액에서 Dehalococcoides 16S rRNA gene sequences에 특이적으로 반응하는 primer를 이용한 DGGE를 통해 미생물 군집을 분석하였다. 결론적으로, 우리의 연구에서 PCE를 감소시키는 배양액을 배양했으며, 이 배양엑에는 Dehalococcoides sp. 존재하는 것을 확인하였다.

• Neonatal Medicine
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• 제18권1호
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• pp.124-129
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• 2011

목적: 최근 PPHN의 치료를 위해 iNO와 함께 많은 약물적 치료가 사용되고 있다. Sildenafil은 PDE5의 억제제로 선택적인 폐혈관 확장제로 알려져 있으며 iNO에 비하여 접근성이 뛰어나 iNO에 대안적인 약제로 연구되어 왔다. 저자들은 본원에서 sildenafil로 PPHN을 치료한 경험을 분석하였다. 방법: 심초음파를 통해 PPHN으로 진단된 재태 기간 35주 이상, FiO2 1.0을 필요로 하는 32명의 환아를 대상으로 하였으며 의무기록을 후향적으로 조사하였다. sildenafil은 0.5 mg/kg로 시작하여 6시간마다 1 mg/kg로 투약하였으며, 투약 전과 후 6, 12, 24, 48시간의 MAP, $FiO_2$, OI, MBP를 비교하였다. 부작용을 확인하기 위하여 환아들의 위장관 증상, 뇌초음파, 안저검사와 청성뇌간유발반응 검사의 결과를 조사하였다. 결과: 대상 환아 32명 중 태변 흡인 증후군 9명, 호흡곤란증후군 8명, 폐렴 3명이었으며, 12명은 특발성이었다. 이 중 31명이 생존하였으며 28명의 환아는 본원에서 sildenafil만으로 치료되었고 3명의 환아는 전원되어 iNO 치료 후 회복하였다. Sildenafil 단독으로 치료된 28명의 환아에서 $FiO_2$와 OI는 치료 6시간째부터 MAP는 48시간째부터 유의하게 감소하였다. 모든 환아에서 특별한 부작용은 관찰되지 않았다. 결론: Sildenafil은 35주 이상의 PPHN 환아에서 비교적 효과적이고 안전하게 시도해 볼 수 있는 대안 약제로서, 특히 iNO가 가능하지 않은 병원에서 유용할 것으로 생각된다.