• Tuberculosis and Respiratory Diseases
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• 제42권5호
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• pp.723-730
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• 1995

Background: Noninvasive ventilation has been used extensively for the treatment of patients with neuromuscular weakness or restrictive chest wall disorders complicated by hypoventilatory respiratory failure. Recently, noninvasive positive pressure ventilation has been used in patients with alveolar hypoventilation, chronic obstructive pulmonary disease(COPD), and adult respiratory distress syndrome. Sanders and Kern reported treatment of obstructive sleep apnea with a modification of the standard nasal CPAP device to deliver seperate inspiratory positive airway pressure(IPAP) and expiratory positive airway pressure(EPAP). Bi-level positive airway pressure(BiPAP) unlike nasal CPAP, the unit delivers a different pressure during inspiration from that during expiration. The device is similar to the positive pressure ventilator or pressure support ventilation. Method and purpose: Bi-level positive airway pressure(BiPAP) system(Respironics, USA) was applied to seven patients with acute respiratory failure and three patients on conventional mechanical ventilation. Results: 1) Two of three patients after extubation were successfully achieved weaning from conventional mechanical ventilation by the use of BiPAP ventilation with nasal mask. Five of seven patients with acute respiratory failure successfully recovered without use of conventional mechanical ventilation. 2) $PaO_2$ 1hour after BiPAP ventilation in acute respiratory failure patients significantly improved more than baseline values(p<0.01). $PaCO_2$ 1hour after BiPAP ventilation in acute respiratory failure patients did not change significantly more than baseline values. Conclusion: Nasal mask BiPAP ventilation can be one of the possible alternatives of conventional mechanical ventilation in acute respiratory failure and supportive method for weaning from mechanical ventilation.

• The Korean Journal of Pain
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• 제25권2호
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• pp.105-107
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• 2012

A 41-year-old male patient presented with idiopathic persistent hiccups. The hiccups did not respond to pharmacologic treatments including cisapride, omeprazole, and baclofen. Phrenic nerve block was also ineffective. However, the persistent hiccups were successfully treated with short-term positive pressure ventilation using a short-acting muscle relaxant.

• 한국응급구조학회지
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• 제24권1호
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• pp.67-76
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• 2020

Purpose: Effective time management, as well as life-saving care, are important in maximizing the prognosis of patients who have sustained major traumas. This study evaluated the appropriateness of emergency medical system (EMS) provider's essential care and how this care impacted on-scene time in patients with major traumas. Methods: This retrospective observational study analyzed the EMS major trauma documents, classified according to the physiological criteria (Glasgow coma scale <14, systolic blood pressure <90mmHg, Respiration rate <10 or >29) in Daejeon, from January, 2015 to December, 2018. Results: Of the 707 major trauma cases, the mean on-scene time was 7.75±4.64 minutes. According to EMS guidelines, essential care accuracy was 67.5% for basic airway, 36.4% for advanced airway, 91.2% for cervical collar, 81.5% for supplemental oxygen, 47.0% for positive pressure ventilation, 19.9% for intravenous access and fluid administration, and 96.0% for external hemorrhage control. Factors affecting on-scene time were positive pressure ventilation (p<.004), and intravenous access and fluid administration (p<.002). Conclusion: Adherence to guidelines was low during advanced airway procedures, positive pressure ventilation, intravenous access, and fluid administration. In addition, the on-scene time was prolonged when the practitioner provided positive pressure ventilation, intravenous access, and fluid administration; however, these durations did not exceed the recommended 10 minutes.

• Neurospine
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• 제15권4호
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• pp.394-399
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• 2018

Subarachnoid pleural fistula (SPF) is an aberrant communication between the pleural cavity and subarachnoid space, resulting in uncontrolled cerebrospinal fluid drainage. The negative pressure of the pleural cavity creates a continuous suctioning effect, thereby impeding the spontaneous closure of these fistulas. Dural tears or punctures in cardiothoracic procedures, spinal operations, and trauma are known to cause such abnormal communications. Failure to recognize this entity may result in sudden neurological or respiratory complications. Hence, a high index of suspicion is required for early diagnosis and prompt management. Noninvasive positive pressure ventilation has been described to be effective in managing such fistulas, thus mitigating the high morbidity associated with exploratory surgery for primary repair. Herein, we describe the typical presentation of SPF and the clinical course, treatment, and follow-up of a patient who sustained SPF following anterior thoracic spinal surgery.

• Journal of Yeungnam Medical Science
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• 제35권2호
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• pp.165-170
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• 2018

Background: The purpose of this study was to investigate whether tidal volume (TV) of 8 mL/kg without positive end-expiratory pressure (PEEP) and TV of 6 mL/kg with or without PEEP in pressure-controlled ventilation-volume guaranteed (PCV-VG) mode can maintain arterial oxygenation and decrease inspiratory airway pressure effectively during one-lung ventilation (OLV). Methods: The study enrolled 27 patients undergoing thoracic surgery. All patients were ventilated with PCV-VG mode. During OLV, patients were initially ventilated with TV 8 mL/kg (group TV8) without PEEP. Ventilation was subsequently changed to TV 6 mL/kg with PEEP ($5cmH_2O$; group TV6+PEEP) or without (group TV6) in random sequence. Peak inspiratory pressure ($P_{peak}$), mean airway pressure ($P_{mean}$), and arterial blood gas analysis were measured 30 min after changing ventilator settings. Ventilation was then changed once more to add or eliminate PEEP ($5cmH_2O$), while maintaining TV 6 mL/kg. Thirty min after changing ventilator settings, the same parameters were measured once more. Results: The $P_{peak}$ was significantly lower in group TV6 ($19.3{\pm}3.3cmH_2O$) than in group TV8 ($21.8{\pm}3.1cmH_2O$) and group TV6+PEEP ($20.1{\pm}3.4cmH_2O$). $PaO_2$ was significantly higher in group TV8 ($242.5{\pm}111.4mmHg$) than in group TV6 ($202.1{\pm}101.3mmHg$) (p=0.044). There was no significant difference in $PaO_2$ between group TV8 and group TV6+PEEP ($226.8{\pm}121.1mmHg$). However, three patients in group TV6 were dropped from the study because $PaO_2$ was lower than 80 mmHg after ventilation. Conclusion: It is postulated that TV 8 mL/kg without PEEP or TV 6 mL/kg with $5cmH_2O$ PEEP in PCV-VG mode during OLV can safely maintain adequate oxygenation.

• Clinical and Experimental Pediatrics
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• 제48권12호
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• pp.1310-1316
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• 2005

Mechanical ventilation in children has some differences compared to in neonates or in adults. The indication of mechanical ventilation can be classified into two groups, hypercapnic respiratory failure and hypoxemic respiratory failure. The strategies of mechanical ventilation should be different in these two groups. In hypercapnic respiratory failure, volume target ventilation with constant flow is favorable and pressure target ventilation with constant pressure is preferred in hypoxemic respiratory failure. For oxygenation, fraction of inspired oxygen($FiO_2$) and mean airway pressure(MAP) can be adjusted. MAP is more important than FiO2. Positive end expiratory pressure(PEEP) is the most potent determinant of MAP. The optimal relationship of $FiO_2$ and PEEP is PEEP≒$FiO_2{\times}20$. For ventilation, minute volume of ventilation(MV) product of tidal volume(TV) and ventilation frequency is the most important factor. TV has an maximum value up to 15 mL/kg to avoid the volutrauma, so ventilation frequency is more important. The time constant(TC) in children is usually 0.15-0.2. Adequate inspiratory time is 3TC, and expiratory time should be more than 5TC. In some severe respiratory failure, to get 8TC for one cycle is impossible because of higher frequency. In such case, permissive hypercapnia can be considered. The strategy of mechanical ventilation should be adjusted gradually even in the same patient according to the status of the patient. Mechanical ventilators and ventilation modes are progressing with advances in engineering. But the most important thing in mechanical ventilation is profound understanding about the basic pulmonary mechanics and classic ventilation modes.

• 한국산학기술학회논문지
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• 제20권1호
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• pp.284-289
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• 2019

접이식 대피통로는 철도터널 및 대공간 화재시 임시 피난로를 확보하기 위한 피난지원 시스템으로 화재시 구조물 상부에 거치되어 있던 차연 스크린이 펼쳐지며 피난로를 확보하는 시스템이다. 차연 스크린은 적절한 내화성능을 갖추어야 될 뿐 아니라 밀폐성을 확보하여 외부의 연기를 최대한 막을 수 있는 시스템이 요구된다. 이를 위해 접이식 대피통로 시스템에는 피난로 내부에 양압 조건을 유지해 주기 위한 제연설비가 필요하며, 제연 설비의 설계 및 용량 산정을 위해서는 화원에서 거리별 온도 분포 및 압력 해석이 필요하다. 본 연구에서는 신형전동차의 화재 현상을 모사하여 터널 길이방향별 온도 및 압력 분포를 해석하였다. 차연 스크린 설치 위치에서는 길이방향으로 20미터 이상일 경우에는 차연 스크린 내열온도인 200도를 넘지 않는 것으로 해석되었으며, 압력 또한 거리 증가에 따라 감소하며, 최대 14 Pa, 평균 6 Pa 정도를 보이는 것으로 해석되었다. 또한 상부 보단 하부에서의 압력이 낮기 때문에 실제 양압조건은 이보다 낮을 것으로 보인다. 따라서 접이식 대피통로 설치를 위해서는 차연 스크린내 양압조건을 6 Pa 내외로 유지할 수 있는 제연설비가 필요할 것으로 예측된다.

• 운동영양학회지
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• 제14권2호
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• pp.95-101
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• 2010

The purpose of this study was to evaluate changes of body composition, cardio-respiratory function in ventilation threshold (VT) and maximal state exercise, systolic (SBP) and diastolic blood pressure (DBP) and serum nitric oxide (NO) production during acute reducing salt (RS) supplementation in college elite athletes. Variables of cardio-respiratory function during rest, ventilation threshold and maximal exercise was not shown a significantly difference between RS supplementation and non-supplementation, there was shown a significant increase in ventilation threshold time (p<0.05) and exhaustion time (p<0.05) during RS supplement compared to non-supplement. SBP and DBP were not shown a significant difference between RS supplement and non-supplement. This result suggests that acute intake of RS is not increased a blood pressure. Serum NO production was not significant difference in the RS supplement group, but it was shown a significantly increased levels (p<0.01, vs. recovery 30 min.) immediately after maximal exercise in the non-supplement group. This result suggests that acute intake of RS have important role in inhibition of serum NO production during maximal exercise. Conclusively, This study suggest that acute intake of RS was not influence in body composition variables, but it was positive effect in ventilation threshold time, exhaustion time, maintenance of blood pressure and inhibition of serum NO production in maximal treadmill exercise.

• 한국화재소방학회논문지
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• 제20권4호
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• pp.135-142
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• 2006

화재시 구조물 내부의 열 및 연기를 급속하게 배기시키기 위하여 Positive Pressure Ventilation 방식을 적용하였으며, 이의 적용에 따른 열 배출과 연기농도의 변화를 측정하였고, 송풍기의 경사각 등 송풍조건의 변화에 따른 영향을 측정하였다. 또한 화염억제 효율증대를 위하여 PPV에 미세물분무 시스템을 결합하여 열 배출과 구조물 내부 연기제거 효과를 측정하였다. PPV 방식의 적용에 따라 화염주위의 온도가 급격히 낮아졌으며, 경사각의 영향이 큰 것으로 나타났다. 화재시 발생되는 연기의 농도도 PPV의 적용에 의해 크게 감소시킬 수 있었으며, 본 실험에서는 경사각 $0^{\circ}$에서 가장 높은 효율을 나타내었다. 한편, PPV와 함께 미세물분무를 적용한 경우 열 및 연기농도의 저감효과가 더욱 크게 나타났으며, 이 경우에도 경사각의 영향이 크게 나타났다.

• Clinical and Experimental Pediatrics
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• 제63권1호
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• pp.3-7
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• 2020

High-flow nasal cannula (HFNC) is a relatively safe and effective noninvasive ventilation method that was recently accepted as a treatment option for acute respiratory support before endotracheal intubation or invasive ventilation. The action mechanism of HFNC includes a decrease in nasopharyngeal resistance, washout of dead space, reduction in inflow of ambient air, and an increase in airway pressure. In preterm infants, HFNC can be used to prevent reintubation and initial noninvasive respiratory support after birth. In children, flow level adjustments are crucial considering their maximal efficacy and complications. Randomized controlled studies suggest that HFNC can be used in cases of moderate to severe bronchiolitis upon initial low-flow oxygen failure. HFNC can also reduce intubation and mechanical ventilation in children with respiratory failure. Several observational studies have shown that HFNC can be beneficial in acute asthma and other respiratory distress. Multicenter randomized studies are warranted to determine the feasibility and adherence of HFNC and continuous positive airway pressure in pediatric intensive care units. The development of clinical guidelines for HFNC, including flow settings, indications, and contraindications, device management, efficacy identification, and safety issues are needed, particularly in children.