• 수면정신생리
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• 제3권1호
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• pp.85-95
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• 1996

Obstructive sleep apnea syndrome(OSAS) in childhood is unique and different n-om that in adulthood in several aspects, including pathophysiology, clinical features, diagnostic criteria, complications, management, and prognosis. Characteristic features of childhood OSAS in comparison with the adult form are the variety of severe complications such as developmental delay, more prominent behavioral and cognitive impairments, vivid cardiovascular symptoms, and increased death risk, warranting a special attention to the possible diagnosis of OSAS in children who snore. However, the childhood OSAS is often neglected and unrecognized. We, therefore, report a case of very severe OSAS in a 5-year-old boy who was sucessfully treated with continuous positive airway pressure(CPAP) treatment. Interestingly, the patient was comor-bid with the attention deficit hyperactivity disorder. Prior to the initial visit to us, adenotonsillectomy had been done at the age of 4 with no significant improvement of apneic symptoms and heavy snoring. On the initial diagnostic procedures, marked degree of snoring was audible even in the daytime wake state and the patient was observed to be very hyperactive. Increased pulmonary vascularity with borderline cardiomegaly was noted on chest X-ray. The baseline polysomnography revealed that the patient was very sleep-apneic and snored very heavily, with the respiratory disturbance index(RDI) of 46.9 per hour of sleep, the mean SaO2 of 78.8%, and the lowest SaO2 of 40.0%(the lowest detectable oxygen level by the applied oxymeter). The second night polysomnography was done for CPAP titration and the optimal pressure turned out to be $8.0\;cmH_2O$. The applied CPAP treatment was well tolerated by the patient and was found to be very effective in alleviating heavy snoring and severe repetitive sleep apneas. After 18 months of the CPAP treatment, the patient was followed up with nocturnal polysomnography(baseline and CPAP nights) and clinical examination. Sleep apneas were still present without CPAP on the baseline night. However, the severity of OSAS was significantly decreased(RDI of 15.7, mean SaO2 of 96.2%, and the lowest SaO2 of 83.0%), compared to the initial polysomnographic findings before initiation of long-term CPAP treatment. Wechsler intelligence tests done before and after the CPAP treatment were compared with each other and surprising improvement of intelligence(total 9 points, performance 16 points) was noted. Clinically he was found to be markedly improved in his attention deficit hyperactive behavior after CPAP treatment, but with minimal change of TOVA(test of variables of attention) scores except conversion of reaction time score into normal range. On the chest X-ray taken after 18 months of CPAP application, the initial cardiopulmonary abnormalities were not found at all. We found that the CPAP treatment in a young child is very effective, safe, and well-tolerated and also improves the co-morbid attention deficit hyperactive symptoms. Overall, the growth and development of the child has been facilitated with the long-term use of CPAP. Cardiovascular complications induced by OSAS have been also normalized with CPAP treatment. We suggest that early diagnosis and active treatment intervention of OSAS in children are crucial in preventing and ameliorating possible serious complications caused by repetitive sleep apneas and consequent hypoxic damage during sleep.

• Tuberculosis and Respiratory Diseases
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• 제43권5호
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• pp.755-762
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• 1996

연구배경: 지속적 기도 양압 치료는 폐쇄성 수면 무호흡증 환자의 가장 효과적인 내파적 치료법으로 알려져 있다. 폐쇄성 무호흡증 환자에 사용되는 지속적 기도 양암 치료는 양압이 상기도에서 단순히 물리적인 공기 부목과 같은 역할로 작용한다. 폐쇄성 무호흡 환자에서 지속적 기도 양암 치료시 최적 양압의 결정에 영향을 미치는 변수를 파악하고 이러한 변수들로 다중 선형 회귀 분석을 하여 최적압치를 예측해 보기위하여 이 연구를 하였다. 방법: 폐쇄성 수면 무호흡증이 있는 72명의 환자를 대상으로 이틀동안 진단 및 치료적 수면 다원 검사를 실시하였다. 이들 중 지속적 기도 양압 최적지가 $5cmH_2O$ 이하였던 35명과 최적치가 $10cmH_2O$이상이었던 37명의 환자에서 나이, 키, 몸무게, body mass index(BMI)와 수면 다원 검사의 각 변수의 차이를 분석하고 이러한 변수들로 지속적 기도 양압의 최적치를 다중선형 회귀분석하였다. 결과: 지속적 기도 양압의 최적치가 $10cmH_2O$이상이었던 환자에서 body mass index(BMI)가 의의있게 더 높았고 무호흡 지수와 무호흡 저호흡 지수도 의의있게 더 높았으며 최저 산소 포화도는 의의있게 낮았다. 이러한 변수들로 구한 최소의 지속적 기도 양압의 공식은 CPAP titer = 8.382 + 0.064 x BMI + 0.077 x AI - 0.004 x AHI - 0.077 x lowest $SaO_2$였다. 수면 다원 검사로 실제로 측정한 지속적 기도 양압의 최적압은 평균 $7.93{\pm}4.00cmH_2O$였으며 다중 선형 회귀분석하여 공식으로 구한 예측 최적압치는 $7.80{\pm}2.96cmH_2O$로 이들 두 수치사이의 의의있는 차이는 없었다. 결론: 폐쇄성 수면 무호흡의 치료시의 지속적 기도 양압의 최적압은 신체의 비만도, 무호흡의 심한 정도와 최저 산소 포화도와 관계가 있었으며 이러한 변수들로 비교적 정확하게 최적압치를 예측할 수 있었다.

• 대한의용생체공학회:의공학회지
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• 제32권1호
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• pp.32-36
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• 2011

The insufflators in endoscopic surgery supply carbon dioxide to make the air-filled cavity in the abdomen. It contains many kinds of pneumatic and electronic parts and they are connected with the air tubes and electrical wires. The printed circuit boards (PCB) perform wiring, holding and cooling tasks in electronic systems. In this study, the PCB is used as the air channel for insufflators to decrease the cost, volume, and the malfunction according to aging of the device. Three layers of PCB made of FR4 are combined with prepreg as adhesive which has the internal airway channel according to the design. By mounting the pressure sensors and valves, the PCB based fluidic system is implemented. After calibration of flow sensor, the flow rate of the gas also can be measured. The climate test, temperature test, and biocompatibility test showed this idea can be used in insufflators for laparoscopic surgery.

• Clinical and Experimental Pediatrics
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• 제59권10호
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• pp.389-394
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• 2016

The incidence of bronchopulmonary dysplasia (BPD) has not decreased over the last decade. The most important way to decrease BPD is by weaning the patient from the ventilator as soon as possible in order to reduce ventilator-induced lung injury that underlies BPD, and by using a noninvasive ventilator (NIV). Use of a heated, humidified, high flow nasal cannula (HHHFNC), which is the most recently introduced NIV mode for respiratory support in preterm infants, is rapidly increasing in many neonatal intensive care units due to the technical ease of use without sealing, and the attending physician's preference compared to other NIV modes. A number of studies have shown that nasal breakdown and neonatal complications were lower when using a HHHFNC than when using nasal continuous positive airway pressure (nCPAP), or nasal intermittent positive pressure ventilation. The rates of extubation failure during respiratory support were not different between patients who used HHHFNC and nCPAP. However, data from the use of HHHFNC as the initial respiratory support "after birth", particularly in extremely preterm infants, are lacking. Although the HHHFNC is efficacious and safe, large randomized controlled trials are needed before the HHHFNC can be considered an NIV standard, particularly for extremely preterm infants.

• 대한의용생체공학회:의공학회지
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• 제29권4호
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• pp.323-328
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• 2008

A patient with respiratory disorders such as a sleep apnea is increasing as the obese patient increase on the modern society. Positive Airway Pressure (PAP) devices are used in curing patient with respiratory disorders and turn out to be efficacious for patients of 75%. However, these devices are required for evaluating their performance to improve their performance by the mechanical breathing simulator. Recently, the mechanical breathing simulator was studied by the real time feedback control. However, the mechanical breathing simulator by an open loop control was specially required in order to analyze the effect of flow rate and pressure after operating the breathing auxiliary devices. Therefore the aims of this study were to make the mechanical breathing simulator by a piston motion and a valve function from the characteristic test of valve and motor, and to duplicate the flow rate and pressure profiles of some breathing patterns: normal and three disorder patterns. The mechanical simulator is composed cylinder, valve, ball screw and the motor. Also, the characteristic test of the motor and the valve were accomplished in order to define the relationship between the characteristics of simulator and the breathing profiles. Then, the flow rate and pressure profile of human breathing patterns were duplicated by the control of motor and valve. The result showed that the simulator reasonably duplicated the characteristics of human patterns: normal, obstructive sleep apnea (OSA), mild hypopnea with snore and mouth expiration patterns. However, we need to improve this simulator in detail and to validate this method for other patterns.

• 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.

• Tuberculosis and Respiratory Diseases
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• 제62권5호
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• pp.437-440
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• 2007

기관절개술은 가장 오래된 수술기술 중의 하나로 상기도 폐쇄의 경감, 장기간의 기계호흡유지, 보조적 기계호흡시에 기도 저항의 감소 등의 목적으로 시행할 수 있다. 기관절개술에 따른 초기합병증으로는 기흉, 피하조직기종, 절개부위 출혈, 종격동 기종, 흡인, 기관절개 관 전위 등을 들 수 있다. 수술에 따른 피하조직기종과 기흉은 0.9-5%에서 보고되었다. 본 증례에서는 기관절개술 직후에 피하조직기종과 양측 폐에서 발생한 긴장성 기흉을 경험하였기에 보고하는 바이다.

• 구강회복응용과학지
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• 제34권3호
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• pp.239-245
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• 2018

만약 혀 절제술로 인해 식괴의 형성 및 이동에 장애가 생기는 경우, 식괴가 기도를 막거나 기도로 흡인되는 연하장애가 발생할 수 있으며, 이런 경우에 구개 증대 보철물은 도움이 될 수 있다. 구강암으로 인해 부분 혀 절제술을 받은 후 음식물을 삼키기 어렵다는 주소로 내원한 환자에게 혀의 기능 운동을 인기한 상악의 연마면 인상채득을 통해 구개 증대 보철개념을 활용한 상악 총의치를 제작하여, 구개-혀 접촉 압력을 증가시켜서 연하 및 발음에 양호한 결과를 얻을 수 있었다.

• 한국화재소방학회논문지
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• 제26권3호
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• pp.14-20
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• 2012

이 연구는 뇌졸중 환자에게 시행되는 환자평가와 응급처치의 실태를 파악하는 연구이다. 구급대에 의해 이송된 뇌졸중환자 123명을 대상으로 하였으며, 수집된 자료는 SPSS 18.0 프로그램을 이용하여 분석하였다. 분석 결과 뇌졸중으로 진단 받은 123명의 환자 중 환자평가는 혈압 73.2 %, 맥박 73.2 %, 호흡 64.2 %, 산소포화도 79.7 %, 공동반응 88.6 %, 심전도 감시 14.6 %, 혈당측정 19.5 %의 시행률을 보였고, 시행된 응급처치로는 기도유지기 삽입 2.4 %, 손으로 조작하는 기도확보 17.1 %, 기관내삽관 2.7 %, 산소공급 35.4 %, 흡인, 정맥로 확보 및 수액투여가 시행된 환자는 아무도 없었다. 전반적으로 의식상태 평가는 적절하였으나 119구급대원에 의해 시행되는 환자평가 및 응급처치는 전반적으로 적절하지 못하였다.

• Journal of Dental Anesthesia and Pain Medicine
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• 제16권1호
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• pp.49-53
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• 2016

Background: General anesthesia is frequently considered for pediatric patients, as they often find it difficult to cooperate and stay calm during administration of potentially painful treatments. Sedation can overcome these adversities; however, this is challenging while maintaining unobstructed airways. Methods: The study involved 11 pediatric dental patients treated with LMA under deep sedation with sevoflurane, from 2011 through 2015. LMA size, sevoflurane concentration, and the vital signs of patients were assessed through a chart review. Results: The age distribution of the patients ranged from 6 to 10 years old. A total of 3 patients underwent mesiodens extraction, while the remaining 8 underwent an surgically assisted orthodontic forced tooth eruption The average sedation period was approximately 45 minutes and the LMA size was $2\small{^1/_2}$. The sevoflurane concentration was maintained at 2% on average, and overall, the measurements of vital signs were within the normal range; the patients had an average blood pressure of 98/49 mmHg, breathing rate of 26 times/min, pulse frequency of 95 times/min, $SpO_2s$ level of 99 mmHg, and $ETCO_2$ level of 41.2 mmHg. Conclusions: Deep sedation with sevoflurane coupled with LMA may be applied successfully in pediatric patients who undergo mesiodens extraction or a surgically assisted orthodontic forced tooth eruption