• Clinical and Experimental Pediatrics
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• 제49권4호
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• pp.455-459
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• 2006

급성 호흡곤란 증후군은 다양하게 유발되는 신체의 손상에 대한 방어기전으로 염증반응이 유발되어 생성되는 폐포 내의 부종으로 인해 호흡곤란과 저산소증이 초래되는 질환이다. 이 질환에서 표면활성제의 결핍과 폐포 표면 장력의 증가로 인해 폐포 동원에 장애가 오는 것이 결정적인 병인이고 표면활성제의 보충이 저산소증을 개선시킴으로써 중요한 치료 방안이 될 수 있다는 가설이 제시되었고 실제로 소아 환자들에서 저산소증을 개선시키고 증상의 호전을 얻었던 보고들이 여러 차례 있었다. 또한 이 질환의 주요 병인인 폐에서의 염증 반응에 주안점을 두고 스테로이드를 투여해 본 연구들에서 저용량 methylprednisolone으로 증상이 호전되고 생존율이 향상되었다는 결론을 얻은 바 있으나 두 치료 모두 ARDS에서 일반적인 적용은 확립되어 있지 않은 실정이다. 저자들은 급성 호흡곤란 증후군으로 진단받은 61일된 소아가 인공 호흡기 등의 보존적인 치료에 반응하지 않고 지속적으로 증상의 악화를 보이다가 표면활성제 120 mg/kg를 기도 내로 주입한 후 호흡곤란 증상과 저산소증 호전되고 $PaO_2/FiO_2$ 상승, 이후 저용량 methylprednisolone을 투여(2 mg/kg 14일간, 1 mg/kg 7일간, 0.5 mg/kg 7일간, 0.25 mg/kg 2일간, 0.125 mg/kg/d 2일간)한 후 2개월간의 추적 관찰에서 증상의 재발없고 방사선학적 검사상 섬유화 등의 합병증을 보이지 않았던 1례를 보고하는 바이다.

• Tuberculosis and Respiratory Diseases
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• 제82권3호
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• pp.251-260
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• 2019

Background: Beyond its current function as a rescue therapy in acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) may be applied in ARDS patients with less severe hypoxemia to facilitate lung protective ventilation. The purpose of this study was to evaluate the efficacy of extended ECMO use in ARDS patients. Methods: This study reviewed 223 adult patients who had been admitted to the intensive care units of 11 hospitals in Korea and subsequently treated using ECMO. Among them, the 62 who required ECMO for ARDS were analyzed. The patients were divided into two groups according to pre-ECMO arterial blood gas: an extended group (n=14) and a conventional group (n=48). Results: Baseline characteristics were not different between the groups. The median arterial carbon dioxide tension/fraction of inspired oxygen ($FiO_2$) ratio was higher (97 vs. 61, p<0.001) while the median $FiO_2$ was lower (0.8 vs. 1.0, p<0.001) in the extended compared to the conventional group. The 60-day mortality was 21% in the extended group and 54% in the conventional group (p=0.03). Multivariate analysis indicated that the extended use of ECMO was independently associated with reduced 60-day mortality (odds ratio, 0.10; 95% confidence interval, 0.02-0.64; p=0.02). Lower median peak inspiratory pressure and median dynamic driving pressure were observed in the extended group 24 hours after ECMO support. Conclusion: Extended indications of ECMO implementation coupled with protective ventilator settings may improve the clinical outcome of patients with ARDS.

• 제어로봇시스템학회:학술대회논문집
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• 제어로봇시스템학회 2004년도 ICCAS
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• pp.165-170
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• 2004

The purpose of this work was to assess and quantify the beneficial effects of long-term gas exchange, at varying frequencies, for the development of a vibrating intravascular lung assistance device (VIVLAD), for patients suffering from acute respiratory distress syndrome (ARDS). The experimental design and procedure have been applied to the construction of a new device for assessing the effectiveness of membrane vibrations. An analytical solution has been developed for the hydrodynamics of flow through a bundle of sinusoidally vibrated hollow fibers, with the intention of gaining insight into how wall vibrations might enhance the performance of the VIVLAD. As a result, the maximum oxygen transfer rate was reached at the maximum amplitude and through the transfer of vibrations to the hollow fiber membranes. The device was excited by a frequency band of 7Hz at various water flow rates, as this frequency was the 2nd mode resonance frequency of the flexible beam. 675 hollow fiber membranes were also bundled, within the blood flow, into the device.

• Journal of Chest Surgery
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• 제48권3호
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• pp.180-186
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• 2015

Background: Extracorporeal membrane oxygenation (ECMO) has recently attracted interest as a treatment for severe acute respiratory distress syndrome (ARDS). However, the outcomes of this procedure in post-surgical settings have not yet been characterized. In this study, we evaluated the outcomes of ECMO in patients with severe postoperative ARDS. Methods: From January 2007 to December 2012, a total of 69 patients (aged $58.3{\pm}11.5$ years, 23 females) who underwent venovenous ECMO to treat severe postoperative ARDS were reviewed. Of these patients, 22 (31.9%) had undergone cardiothoracic surgery, 32 (46.4%) had undergone liver transplantation, and 15 (21.7%) had undergone other procedures. Results: Thirty-four patients (49.3%) were successfully weaned from ECMO, while the other 35 patients (50.7%) died on ECMO support. Among the 34 patients who were successfully weaned from ECMO, 21 patients (30.4%) eventually died before discharge from the hospital, resulting in 13 hospital survivors (18.8%). Multivariable analysis showed that the duration of pre-ECMO ventilation was a significant independent predictor of death (odds ratio [OR], 2.25; 95% confidence interval [CI], 1.29 to 3.90; p=0.004), whereas the concomitant use of continuous venovenous hemodialysis (CVVHD) was associated with improved survival (OR, 0.55; 95% CI, 0.31 to 0.97; p=0.038). Conclusion: Although the overall survival rate of patients treated with ECMO for postoperative ARDS was unfavorable, ECMO offered an invaluable opportunity for survival to patients who would not have been expected to survive using conventional therapy. CVVHD may be beneficial in improving the outcomes of such patients, whereas a prolonged duration of pre-ECMO ventilator support was associated with poor survival.

• The Korean journal of internal medicine
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• 제33권6호
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• pp.1129-1136
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• 2018

Background/Aims: Vitamin D modulates innate and adaptive immune responses, and vitamin D deficiency is associated with increased mortality in hospitalized patients with pneumonia. We evaluated the prevalence of vitamin D deficiency in Korean patients with acute respiratory distress syndrome (ARDS) and its effect on the clinical outcomes of ARDS. Methods: We retrospectively analyzed the data of 108 patients who had a measured serum level of 25-hydroxy vitamin D3 ($25(OH)D_3$) at the time of diagnosis with ARDS. The clinical outcomes were evaluated based on $25(OH)D_3$ levels of 20 ng/mL and stratified by quartiles of $25(OH)D_3$ levels. Results: The mean age of patients was 59.4 years old; 77 (71.3%) were male. Vitamin D deficiency was found in 103 patients (95.4%). The mean $25(OH)D_3$ level was $8.3{\pm}7.0ng/mL$. Neither in-hospital mortality (40.0% vs. 68.0%) nor 6-month mortality (40.0% vs. 71.8%) significantly differed between groups. There were no significant differences in $25(OH)D_3$ level between survivors ($8.1{\pm}7.6ng/mL$) and non-survivors ($8.5{\pm}6.8ng/mL$, p = 0.765). There were no trends toward a difference in mortality among quartiles of $25(OH)D_3$ levels. However, $25(OH)D_3$ levels were inversely related with length of hospital stay and intensive care unit stay among in-hospital survivors. Conclusions: Vitamin D deficiency was prevalent in Korean patients with ARDS. However, levels of vitamin D were not associated with mortality. A large, prospective study is needed to evaluate the effects of vitamin D deficiency on clinical outcomes of ARDS.

• Parasites, Hosts and Diseases
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• 제51권5호
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• pp.551-555
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• 2013

Complicated malaria is mainly caused by Plasmodium falciparum, but, increasingly, Plasmodium vivax is also being reported as a cause. Since the reemergence of indigenous vivax malaria in 1993, cases of severe malaria have been steadily reported in Korea. Herein, we report a case of vivax malaria complicated by adult respiratory distress syndrome (ARDS) that was successfully managed with extracorporeal membrane oxygenation (ECMO). A 59-year-old man presented at our hospital with fever and abdominal pain, which had persisted for 10 days. On admission, the patient had impaired consciousness, shock, hypoxia and haziness in both lungs, jaundice, thrombocytopenia and disseminated intravascular coagulation, metabolic acidosis, and acute kidney injury. A peripheral blood smear and a rapid diagnostic test verified P. vivax mono-infection. Ten hours after admission, hypoxia became more severe, despite providing maximal ventilatory support. The administration of antimalarial agents, ECMO, and continuous venovenous hemofiltration resulted in an improvement of his vital signs and laboratory findings. He was discharged from the hospital 7 weeks later, without any sequelae.

• Tuberculosis and Respiratory Diseases
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• 제84권2호
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• pp.125-133
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• 2021

Background: The coronavirus disease (COVID-19) can manifest in a range of symptoms, including both asymptomatic systems which appear nearly non-existent to the patient, all the way to the development of acute respiratory distress syndrome (ARDS). Specifically, COVID-19-associated pneumonia develops into ARDS due to the rapid progression of hypoxia, and although arterial blood gas analysis can assist in halting this deterioration, the current environment provided by the COVID-19 pandemic, which has led to an overall lack of medical resources or equipment, has made it difficult to administer such tests in a widespread manner. As a result, this study was conducted in order to determine whether the levels of oxygen saturation (SpO₂) and the fraction of inhaled oxygen (FiO₂) (SF ratio) can also serve as predictors of ARDS and the patient's risk of mortality. Methods: This was a retrospective cohort study conducted from February 2020 to Mary 2020, with the study's subjects consisting of COVID-19 pneumonia patients who had reached a state of deterioration that required the use of oxygen therapy. Of the 100 COVID-19 pneumonia cases, we compared 59 pneumonia patients who required oxygen therapy, divided into ARDS and non-ARDS pneumonia patients who required oxygen, and then investigated the different factors which affected their mortality. Results: At the time of admission, the ratios of SpO₂, FiO₂, and SF for the ARDS group differed significantly from those of the non-ARDS pneumonia support group who required oxygen (p<0.001). With respect to the predicting of the occurrence of ARDS, the SF ratio on admission and the SF ratio at exacerbation had an area under the curve which measured to be around 85.7% and 88.8% (p<0.001). Multivariate Cox regression analysis identified that the SF ratio at exacerbation (hazard ratio [HR], 0.916; 95% confidence interval [CI], 0.846-0.991; p=0.029) and National Early Warning Score (NEWS) (HR, 1.277; 95% CI, 1.010-1.615; p=0.041) were significant predictors of mortality. Conclusion: The SF ratio on admission and the SF ratio at exacerbation were strong predictors of the occurrence of ARDS, and the SF ratio at exacerbation and NEWS held a significant effect on mortality.

• Tuberculosis and Respiratory Diseases
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• 제75권1호
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• pp.1-8
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• 2013

Several papers on respiratory and critical care published from March 2012 to February 2013 were reviewed. From these, this study selected and summarized ten articles, in which the findings were notable, new, and interesting: effects of high-frequency oscillation ventilation on acute respiratory distress syndrome (ARDS); safety and efficacy of hydroxyethyl starch as a resuscitation fluid; long-term psychological impairments after ARDS; safety and efficacy of dexmedetomidine for sedation; B-type natriuretic peptide-guided fluid management during weaning from mechanical ventilation; adding of daily sedation interruptions to protocolized sedations for mechanical ventilation; unassisted tracheostomy collar of weaning from prolonged mechanical ventilations; and effects of nighttime intensivist staffing on the hospital mortality rates.

• Journal of Trauma and Injury
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• 제28권1호
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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.

• Tuberculosis and Respiratory Diseases
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• 제53권1호
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• pp.17-26
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• 2002

연구배경: 급성 호흡곤란증후군은 아직도 사망율이 높지만 조기에 원인을 발견하여 교정 및 치료를 하여 진행을 막고 적절한 유지 요법을 같이 하면 그 예후를 좋게 할 수 있을 것이다. 급성 호흡곤란증후군의 원인으로 속립성 결핵은 몇몇의 보고는 있지만 일반적으로 잘 알려져 있지 않고 그 임상 특징도 알려진 것이 없다. 또한 단순 흉부 사진이나 객담 검사만으로는 진단율이 낮아 실용적이지 못하여 급성 호흡곤란 증후군의 원인으로 속립성 결핵의 조기 진단을 가능성과 진단율을 높이기 위해 환자들의 임상적 특징에 대한 분석을 시도하였다. 방 법: 1995년부터 2001년까지 7년 동안 서울 노원 을지병원에 입원하여 1992년 American-European Consense Conference 정의에 의거 급성 호흡곤란 증후군의 진단을 받고 그 유발 원인이 속립성 결핵으로 확진된 9 예에 대하여 의무기록을 근거로 후향적 조사를 하였다. 결 과: 대상 환자들의 평균 나이는 $67{\pm}18$세이며 성비는 남자:여자가 2:7 이다. 입원 시 주소는 호흡곤란 (5/9), 발열 (5/9), 기침 (3/9) 이었고, 발열의 과거력은 8 예에서 있었다. 이학적 검사에서는 라음(6/9) 이 관찰되었다. 급성 호흡곤란 증후군은 최초의 호흡기 증상이 나타난지 평균 6.7일 경과 후에 발생되었다. 급성 호흡곤란 증후군 환자에서 평균 $PaO_2/FiO_2$는 $133.5{\pm}53.4$였고 WBC는 5000/$mm^3$ 이하가 4/9 이었으며 혈색소의 평균은 $1l.5{\pm}2.0$mg/dl, 헤마토크릿 평균은 $33.5{\pm}4.7%$, 혈소판이 70,000/$mm^3$이하는 3/9었고 혈청 알부민은 평균 $2.6{\pm}0.6$ g/dL을 보였다. 입원시 촬영한 흉부 방사선 사진은 모든 예에서 간유리 음영과 폐경화(ground glass appearance, consolidation) 이 관찰되었다. 속립성 결절은 4/9 에서만 보였고 고해상도 흉부 전산화 단층촬영을 시행한 6예 모두에서 폐포성 병변과 consolidation을 보였으며 5예에서는 속립성 결절을 관찰 할 수 있었다. 속립성 결핵의 진단은 간 조직검사(4/4), 골수조직검사(1/2), 개흉 폐조직검사(1/1), 객담의 AFB 도말검사 (2/6), percutaneous needle asprration 을 1예 시행하여 얻었다. 환자들은 항결핵제제로 INH, RFP, EMB, PZA와 스테로이드를 사용하였으며 생존율은 55.5 %의 치료 결과를 얻었다. 결 론: ARDS 원인으로 결핵의 유병율이 높은 지역에서는 속립성 결핵의 가능성을 생각하여야 하며 입원 시 환자들의 증상은 주로 기침과 호흡곤란이었고 발열이 모든 예에서 있었으나 환자들의 호소하는 주된 증상은 아니었다. 이번 연구의 9예에서는 ARDS를 유발할만한 특별한 위험요소는 발견되지 않았고 인공호흡기 치료를 받고 있는 환자에서 ARDS의 원인을 찾기 위한 검사로 간 조직 검사가 유용하며 안전하였다. 치료로 조기에 항결핵제제와 스테로이드를 사용하였으며 55.5 %의 치료율을 성적을 얻었다.