• 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.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.149-159
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• 2016

Purpose : To evaluate the usefulness of the breathing exercise,we analyzed the change in the RPM signal and the diaphragm imagebefore 4D respiratory gated radiation therapy planning of lung cancer patients. Materials and Methods : The breathing training was enforced on 11 patients getting the 4D respiratory gated radiation therapy from April, 2016 until August. At the same time, RPM signal and diaphragm image was obtained respiration training total three steps in step 1 signal acquisition of free-breathing state, 2 steps respiratory signal acquisition through the guide of the respiratory signal, 3 steps, won the regular respiration signal to the description and repeat training. And then, acquired the minimum value, maximum value, average value, and a standard deviation of the inspiration and expiration in RPM signal and diaphragm image in each steps. Were normalized by the value of the step 1, to convert the 2,3 steps to the other distribution ratio (%), by evaluating the change in the interior of the respiratory motion of the patient, it was evaluated breathing exercise usefulness of each patient. Results : The mean value and the standard deviation of each step were obtained with the procedure 1 of the RPM signal and the diaphragm amplitude as a 100% reference. In the RPM signal, the amplitudes and standard deviations of four patients (36.4%, eleven) decreased by 18.1%, 27.6% on average in 3 steps, and 2 patients (18.2%, 11 people) had standard deviation, It decreased by an average of 36.5%. Meanwhile, the other four patients (36.4%, eleven) decreased by an average of only amplitude 13.1%. In Step 3, the amplitude of the diaphragm image decreased by 30% on average of 9 patients (81.8%, 11 people), and the average of 2 patients (18.2%, 11 people) increased by 7.3%. However, the amplitudes of RPM signals and diaphragm image in 3steps were reduced by 52.6% and 42.1% on average from all patients, respectively, compared to the 2 steps. Relationship between RPM signal and diaphragm image amplitude difference was consistent with patterns of movement 1, 2 and 3steps, respectively, except for No. 2 No. 10 patients. Conclusion : It is possible to induce an optimized respiratory cycle when respiratory training is done. By conducting respiratory training before treatment, it was possible to expect the effect of predicting the movement of the lung which could control the patient's respiration. Ultimately, it can be said that breathing exercises are useful because it is possible to minimize the systematic error of radiotherapy, expect more accurate treatment. In this study, it is limited to research analyzed based on data on respiratory training before treatment, and it will be necessary to verify with the actual CT plan and the data acquired during treatment in the future.

• Tuberculosis and Respiratory Diseases
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• v.67 no.1
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• pp.21-26
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• 2009

Background: Non-invasive positive pressure ventilation (NPPV) ensures adequate gas exchange during bronchoscopy in spontaneously breathing, hypoxemic patients, thus avoiding endotracheal intubation. However, in some patients, endotracheal intubation is eventually required after bronchoscopy. This study investigated the incidence of intubation and predictors of a need for emergency intubation prior to NPPV bronchoscopy initiation. Methods: On a retrospective basis, we reviewed the medical records of 36 patients (median age, 55 years; interquartile range [IQR], 43~65 years) with acute hypoxemic respiratory failure who required NPPV during bronchoscopy between January 2005 and October 2007. Results: All patients were hypoxemic (median $PaO_2/FiO_2$ ratio 155; IQR 90~190), but tolerated bronchoscopy with NPPV support. SOFA score and SAPS II score immediately before NPPV initiation were 4 (3~7) and 36 (30~42), respectively. Seventeen (47%) patients needed endotracheal intubation at a median time of 22 (2~50) hours after bronchoscopy. Patients who needed intubation after bronchoscopy had a higher in-hospital mortality (11 [65%] vs. 4 [21%], p=0.017). Upon multiple logistic regression analysis, the need for intubation after bronchoscopy was independently associated with a $P_aO_2/FiO_2$ ratio (OR, 0.961; 95% CI, 0.924~0.999; p=0.047) immediately before NPPV initiation for bronchoscopy. Conclusion: The severity of the hypoxemia immediately prior to NPPV initiation for bronchoscopy was associated with the need for intubation after bronchoscopy in patients with hypoxemic respiratory failure.

• Biomedical Science Letters
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• v.19 no.3
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• pp.254-260
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• 2013

The purpose of this study was to survey the effects of Karvonen exercise prescription in coronary artery disease patients reaching age-predicted maximal heart rates with the exercise stress test on hemodynamic responses and cardiorespiratory fitness. The subject group was comprised of acute coronary syndrome (ACS) patients, who were divided into the maximal heart rate (MHR) group that included those who completed the test with their heart rates reaching the number of 220-age and the maximal dyspnea (MD) group that included those who could not continue the test due to respiratory difficulty and were asked to stop the test. Both groups had the exercise stress test before and after the experiment. In the exercise stress test before the experiment, the exercise prescription intensity of Karvonen was set at the target heart rates of 50~85% with a six-week exercise monitoring arrangement. As a result, there were no interactive effects in rest heart rate (RHR) according to time and group, but interactive effects were observed in maximal heart rate (MHR) (P=0.000). Both rest systolic blood pressure (RSBP) and rest diastolic blood pressure (RDBP) had no interactive effects according to time and group. Maximal systolic blood pressure (MSBP) showed significant interactive effects according to time and group (P=0.017). Maximal diastolic blood pressure (MDBP) showed no interactive effects according to time and group, while maximal rate pressure product (MRPP) showed significant interactive effects according to time and group (P=0.003). Maximal time (MT) had no interactive effects according to time and group. $VO_{2max}$ and maximal metabolic equivalent (MMET) showed significant interactive effects according to time and group (P=0.000, P=0.002, respectively), whereas maximal respiratory exchange ratio (MRER) and maximal rating of perceived exertion (MRPE) showed no interactive effects according to time and group. The exercise test that was discontinued as the subjects reached the predicted maximal heart rates considering age did not reach the maximal exercise intensity and accordingly showed low exercise effects when applied to Karvonen exercise prescription intensity. That is, the test should keep going by monitoring cardiac events, MRER and MRPE until the heart rates exceed the predicted MHR by up to 10~12 even after the subject reaches the predicted MHR considering age in the exercise stress test.

• Journal of radiological science and technology
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• v.20 no.2
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• pp.56-62
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• 1997

To evaluated the image quality and the patient exposure for the chest radiography, its fundamental imaging properties were investigated. The basic imaging properties were evaluated by measuring characteristic curves, relative speeds, average gradient, and patient exposure dose. The image qualities were evaluated by using a rotating meter. It was found that the film gradient of SRO750/SRH system was 3.13 and that of SRO750/HR-C30 was 1.77. The ratio of SRO1000/TMH to FS/RP-1 was 1 to 18.2. It was possible to visualize the static image when the exposure time was less than 2.5 msec in patient that had respiratory excessive motion, heart beat and natural physical motion, and less than 8.5 msec in normal. The ratio of medical exposure dose compared with our method was 1 to 25 in the routine chest radiography and maximum was 1 to 70. In estimation of the image quality in same cases, we found that the image of SRO1000/SRH and TMH of super sensitive systems was the same results. We found that these super sensitive screen-film systems were available for the chest radiography considering the relationship between the image quality and patient exposure.

• Tuberculosis and Respiratory Diseases
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• v.86 no.2
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• pp.142-149
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• 2023

Background: Coronavirus disease 2019 (COVID-19) is an ongoing global public health threat and different variants of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have been identified. This study aimed to analyse the factors associated with negative conversion of polymerase chain reaction (PCR) and prognosis in critically ill patients according to the SARS-CoV-2 variant. Methods: This study retrospectively analysed 259 critically ill patients with COVID-19 who were admitted to the intensive care unit of a tertiary medical center between January 2020 and May 2022. The Charlson comorbidity index (CCI) was used to evaluate comorbidity, and a negative PCR test result within 2 weeks was used to define negative PCR conversion. The cases were divided into the following three variant groups, according to the documented variant of SARS-CoV-2 at the time of diagnosis: non-Delta (January 20, 2020-July 6, 2021), Delta (July 7, 2021- January 1, 2022), and Omicron (January 30, 2022-April 24, 2022). Results: The mean age of the 259 patients was 67.1 years and 93 (35.9%) patients were female. Fifty (19.3%) patients were smokers, and 50 (19.3%) patients were vaccinated. The CCI (hazard ratio [HR], 1.555; p<0.001), vaccination (HR, 0.492; p=0.033), and Delta variant (HR, 2.469; p=0.002) were significant factors for in-hospital mortality. The Delta variant (odds ratio, 0.288; p=0.003) was associated with fewer negative PCR conversion; however, vaccination (p=0.163) and remdesivir (p=0.124) treatments did not. Conclusion: The Delta variant of SARS-CoV-2 is associated with lower survival and negative PCR conversion. Contrary to expectations, vaccination and remdesivir may not affect negative PCR conversion in critically ill patients with COVID-19.

• The Journal of Pediatrics of Korean Medicine
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• v.12 no.1
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• pp.63-76
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• 1998

BACKGROUND : The purpose of this study was to investigate the new effective oriental medical treatments in pediatric diseases and its clinical applicability. METHOD : The study was composed of 1725 new patients who had been treated at the pediatric unit in the Dongguk Bun-Dang Oriental Medicine Hospital for 1 year, from 1 January 1997 to 31 December 1997, and had ages between 0 and 18 years. The chief complaint was mainly categorized by oral examination on patients and their care-givers. RESULT 1. The ratio of male to female was 1.35:1 and the number of each age group and its percentage distribution was 228 patients (13.2%) for the age group between 0 and 1 year, 746 patients (43.2%) between 2 and 6 years, and 751 patients (43.6%) for the age group over 7 years. 2. The chief complaint of the new outpatients was weakness, asthma, common cold, sinustis, skeletal disease, atopic dermatitis, stomach-ache, short stature, diarrhea, nasal blooding, night terror, allergic rhinitis, gastric disorder, enuresis, dermatitis, strabismus in the order of majority.3. The number of patients and its percentage for the most three complaints was 494 patients (28.6%) for weakness, 647 patients (37.4%) for respiratory disease, 144 patients (8.3%) for digestive disease. 4. The digestive disease tended to increase in summer, and appeared mostly in the age group between 0 and 2 years. The respiratory disease increased In inter-season and winter, but decreased significantly in summer. The age group between 1 and 5 years was the largest group of respiratory disease. CONCLUSION 1. The chief complaint in pediatric diseases that needed an oriental medical treatment was mainly the disease that tends to take long time and the weakness, and appeared frequently in digestive and respiratory diseases. 2. The oriental medical treatment was still preferred as a way to improve the weakness by patients, rather than a way to overcome their disease. In particular, the study shows that the oriental medical treatment should be emphasized in terms of preventing the disease. 3. The new diseases, which were developed with the change of human life and environment, (atopic dermatitis, enuresis, short stature, obesity, dysthymic disorder, strabismus), should be investigated as a new field of oriental medical treatment.

• Journal of Chest Surgery
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• v.3 no.1
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• pp.3-12
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• 1970

During the last 10 years of period, one hundred patients with various pulmonary diseases were pneumonectomized upon at the Department of Chest Surgery of Pusan University Hospital. This paper is concerned with the clnical results of these patients along with the serious postoperative complications such as postoperative intrapleural infection and hemorrhage. The results were obtained as follows. 1.Left pneumonectomy was done in sixty-six of 100 patients [66 %] and the right one was done in the rest thirty-four[34 %]. The ratio between left and right was nearly 2:1. 2.Of all oostoperative complications, the intrapleural infection was most common, and these were 53 % in empyema thoracis and 12.7 % in pulmonary tuberculosis respectively. 3.More postoperative complications could be seen after right pneumonectomy than the left one. 4.It was thought that the postoperative intrapleural infection was closely correlated with the methods of pleural dissection at pneumonectomy,postoperatlve tube drainage, time of operation, massive hemorrhage during operation, prolongation of bleeding time, and dysfunction of the liver. 5.The repeated thoracenteses with infusion of neomycin into the infected thoracic cavity and intravenous administrations of the high units of penicillin were effective in treatment of the postoperative intrapleural infection, however, the refractory cases have to be cured by thoracoplasty with open window. 6.Immediate secondary open thoracotomy appears to be the method of choice in life saving who developed massive intrathoracic hemorrhage after pneumonectomy. 7.The mortality rate was 10 % in our cases and the main causes of death were postoperative respiratory insufficiency, pulmonary edema, hemorrhage and sudden cardiac arrest.

• The Journal of Korean Physical Therapy
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• v.34 no.5
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• pp.248-254
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• 2022

Purpose: This study was undertaken to identify the effect of amateur wind musical performance and choir activity on pulmonary function, and to determine the usefulness as a respiration training program by measuring the pulmonary functions of subjects. Methods: A total of 90 subjects (wind instrument players group=30, choir members group=30, control group=30) participated in the experiment. Pulmonary function test (FVC, FEV₁, FEV₁/FVC ratio, MVV, SVC, PEF, FEF 25-75%, IRV, ERV) was conducted using a spirometer (CardioTouch 3000S, Bionet, Seoul, Republic of Korea). Each factor was measured 3 times to meet the American Thoracic Society criteria, and the highest value was used in the analysis. Results: Comparing pulmonary function between the amateur wind instrument players (WP), amateur choir members (CH), and control (CG) groups revealed significant differences in FEV₁, FVC, FEV₁/FVC, and ERV (p<0.05). Highest values were obtained in the WP group. Significant differences were obtained for various factors in the multiple regression analysis of practice year (PY), practice time per week (PTPW), and exercise time per week (ETPW): FEV₁ and FVC in PY, FEV₁/FVC in PTPW, and FEV₁/FVC, MVV, PEF, and FEF (25-75%) in ETPW. Conclusion: Amateur wind instrument performance effectively improves lung function and is useful as a breathing training program for preventing debilitation and improving respiratory function.

• Tuberculosis and Respiratory Diseases
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• v.73 no.3
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• pp.162-168
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• 2012

Background: Idiopathic pulmonary fibrosis (IPF) is a progressive disease. Effective treatment is not currently available and the prognosis is poor. The aim of our study was to identify clinical predictors of survival in patients with IPF. Methods: By using medical record database of a university hospital, we reviewed the records of patients who had been diagnosed as having IPF from January 1996 through December 2007. Results: Among 89 patients considered as having interstitial lung disease (ILD) on computed tomography (CT) of the chest, 22 were excluded because of the diagnosis of other ILDs or connective tissue disease, and finally, 67 met the criteria of IPF. The mean age at the diagnosis of IPF was 70 years (range, 41~87 years) and 43 (64%) were male. The mean survival time following the diagnosis of IPF was 40 months (range, 0~179 months). Among them, 28 cases were diagnosed as the progressive state of IPF on the follow-up CT examination, and the mean duration between diagnosis of IPF and progression was 31 months. Multivariate analysis using Cox regression model revealed that body mass index (BMI) less than 18.5 $kg/m^2$ (p=0.030; hazard ratio [HR], 12.085; 95% confidence interval [CI], 1.277~114.331) and CT progression before 36 months from the diagnosis of IPF (p=0.042; HR, 13.564; 95% CI, 1.101~167.166) were independently associated with mortality. Conclusion: Since low BMI at the diagnosis of IPF and progression on follow-up CT were associated with poor prognosis, IPF patients with low BMI and/or progression before 36 months following the diagnosis should be closely monitored.