• Title/Summary/Keyword: Aspiration Levels

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The Changes of Cuff Pressure from Endotracheal Intubation for Long-term Mechanical Ventilation (장기간 기계호흡 환자에서 기관내 관의 기낭압의 변화)

  • Jung, Bock-Hyun;Park, Whan;Koh, Youn-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.2
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    • pp.156-165
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    • 2002
  • Background: A tracheal stenosis is caused by mucosal ischemic injury related to a high cuff pressure ($P_{cuff}$) of the endotracheal tube. In contrast, aspiration of the upper airway secretion and impaired gas exchange due to cuff leakage is related to a low $P_{cuff}$. To prevent these complications, the $P_{cuff}$ should be kept appropriately because the appropriate $P_{cuff}$ appears to change according to the patient's daily respiratory mechanics. However, the constant cuff volume($V_{cuff}$) has frequently been instilled to the cuff balloon on a daily basis to maintain the optimal $P_{cuff}$ instead of monitoring the $P_{cuff}$ directly at the patients' bedside. To address the necessity of continuous $P_{cuff}$ monitoring, the change in the $P_{cuff}$ was evaluated at various $V_{cuff}$ levels on a daily basis in patients with long-term mechanical ventilation. The utility of mercury column sphygmomanometer for the continuous monitoring $P_{cuff}$ was also investigated. Method: The change in $P_{cuff}$ according to the increase in $V_{cuff}$ was observed in 17 patients with prolonged endotracheal intubation for mechanical ventilation for 2 week or more. This maneuver measured the change in $P_{cuff}$ daily during the mechanical ventilation days. In addition, the $P_{cuff}$ measured by mercury column sphygmomanometer was compared with the $P_{cuff}$ measured by an automatic cuff pressure manager. Results : There were no statistically significant changes of $P_{cuff}$ during more than 14 days of intubation for mechanical ventilation. However the $V_{cuff}$ required to maintain the appropriate $P_{cuff}$ varied from 1.9 cc to 9.6 cc. In addition, the intra-individual variation of the $P_{cuff}$ was observed from 10 $cmH_2O$ to 46 $cmH_2O$ at constant 3 cc $V_{cuff}$. The $P_{cuff}$ measured by the bedside mercury column sphygmomanometer is well coincident with that measured by the automatic cuff pressure manager. Conclusion: Continuous monitoring and management of the $P_{cuff}$ to maintain the appropriate $P_{cuff}$ level in order to prevent cuff related problems during long-term mechanical ventilation is recommended. For this purpose, mercury column sphygmomanometer may replace the specific cuff pressure monitoring equipment.

The National Survey of Acute Respiratory Distress Syndrome in Korea (급성호흡곤란증후군의 전국 실태조사 보고)

  • Scientific Subcommittee for National Survey of Acute Respiratory Distress Syndrome in Korean Academy of Tuberculosis and Respiratory Disease
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.1
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    • pp.25-43
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    • 1997
  • Introduction : The outcome and incidence of acute respiratory distress syndrome (ARDS) could be variable related to the varied definitions used for ARDS by researchers. The purpose of the national survey was to define the risk factors of ARDS and investigate the prognostic indicies related to mortality of ARDS in Korea according to the definition of ARDS determined by the American-European Concensus Conference on 1992 year. Methods : A Multicenter registry of 48 University or University-affliated hospital and 18 general hospital s equipped with more than 400 patient's beds conducted over 13 months of patients with acute respiratory distress syndrome using the same registry protocol. Results : 1. In the 12 months of the registry, 167 patients were enrolled at the 24 hospitals. 2. The mean age was 56.5 years (${\pm}17.2$ years) and there was a 1.9:1 ratio of males to females. 3. Sepsis was the most common risk factors (78.1%), followed by aspiration (16.6%), trauma (11.6%), and shock (8.5%). 4 The overall mortality rate was 71.9%. The mean duration was 11 days (${\pm}13.1$ days) from the diagnosis of ARDS to the death. Respiratory insufficiency appeared to be a major cause in 43.7% of the deaths followed by sepsis (36.1%), heart failure (7.6%) and hepatic failure (6.7%). 5. There were no significant differences in mortality based on sex or age. No significant difference in mortality in infectious versus noninfectious causes of ARDS was found. 6. There were significant differences in the pulse rate, platelet numbers, serum albumin and glucose levels, the amounts of 24 hour urine, arterial pH, $Pa0_2$, $PaCO_2$, $Sa0_2$, alveolar-arterial oxygen differences, $PaO_2/FIO_2$, and PEEP/$FI0_2$ between the survivors and the deaths on study days 1 through 6 of the first week after enrollment. 7. The survivors had significantly less organ failure and lower APACHE III scores at the time of diagnosis of ARDS (P<0.05). 8. The numbers of organ failure (odd ratio 1.95, 95% confidence intervals:1.05-3.61, P=0.03) and the score of APACHE III (odd ratio 1.59, 95% confidence interval:1.01-2.50, P=0.04) appeared to be independent risk factors of the mortality in the patients with ARDS. Conclusions : The mortality was 71.9% of total 167 patients in this investigation using the definition of American-European Consensus Conference on 1992 year, and the respiratory insufficiency was the leading cause of the death. In addition, the numbers of organ failure and the score of APACHE III at the time of diagnosis of ARDS appeared to be independent risk factors of the mortality in the patients with ARDS.

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The Impacts of Need for Cognitive Closure, Psychological Wellbeing, and Social Factors on Impulse Purchasing (인지폐합수요(认知闭合需要), 심리건강화사회인소대충동구매적영향(心理健康和社会因素对冲动购买的影响))

  • Lee, Myong-Han;Schellhase, Ralf;Koo, Dong-Mo;Lee, Mi-Jeong
    • Journal of Global Scholars of Marketing Science
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    • v.19 no.4
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    • pp.44-56
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    • 2009
  • Impulse purchasing is defined as an immediate purchase with no pre-shopping intentions. Previous studies of impulse buying have focused primarily on factors linked to marketing mix variables, situational factors, and consumer demographics and traits. In previous studies, marketing mix variables such as product category, product type, and atmospheric factors including advertising, coupons, sales events, promotional stimuli at the point of sale, and media format have been used to evaluate product information. Some authors have also focused on situational factors surrounding the consumer. Factors such as the availability of credit card usage, time available, transportability of the products, and the presence and number of shopping companions were found to have a positive impact on impulse buying and/or impulse tendency. Research has also been conducted to evaluate the effects of individual characteristics such as the age, gender, and educational level of the consumer, as well as perceived crowding, stimulation, and the need for touch, on impulse purchasing. In summary, previous studies have found that all products can be purchased impulsively (Vohs and Faber, 2007), that situational factors affect and/or at least facilitate impulse purchasing behavior, and that various individual traits are closely linked to impulse buying. The recent introduction of new distribution channels such as home shopping channels, discount stores, and Internet stores that are open 24 hours a day increases the probability of impulse purchasing. However, previous literature has focused predominantly on situational and marketing variables and thus studies that consider critical consumer characteristics are still lacking. To fill this gap in the literature, the present study builds on this third tradition of research and focuses on individual trait variables, which have rarely been studied. More specifically, the current study investigates whether impulse buying tendency has a positive impact on impulse buying behavior, and evaluates how consumer characteristics such as the need for cognitive closure (NFCC), psychological wellbeing, and susceptibility to interpersonal influences affect the tendency of consumers towards impulse buying. The survey results reveal that while consumer affective impulsivity has a strong positive impact on impulse buying behavior, cognitive impulsivity has no impact on impulse buying behavior. Furthermore, affective impulse buying tendency is driven by sub-components of NFCC such as decisiveness and discomfort with ambiguity, psychological wellbeing constructs such as environmental control and purpose in life, and by normative and informational influences. In addition, cognitive impulse tendency is driven by sub-components of NFCC such as decisiveness, discomfort with ambiguity, and close-mindedness, and the psychological wellbeing constructs of environmental control, as well as normative and informational influences. The present study has significant theoretical implications. First, affective impulsivity has a strong impact on impulse purchase behavior. Previous studies based on affectivity and flow theories proposed that low to moderate levels of impulsivity are driven by reduced self-control or a failure of self-regulatory mechanisms. The present study confirms the above proposition. Second, the present study also contributes to the literature by confirming that impulse buying tendency can be viewed as a two-dimensional concept with both affective and cognitive dimensions, and illustrates that impulse purchase behavior is explained mainly by affective impulsivity, not by cognitive impulsivity. Third, the current study accommodates new constructs such as psychological wellbeing and NFCC as potential influencing factors in the research model, thereby contributing to the existing literature. Fourth, by incorporating multi-dimensional concepts such as psychological wellbeing and NFCC, more diverse aspects of consumer information processing can be evaluated. Fifth, the current study also extends the existing literature by confirming the two competing routes of normative and informational influences. Normative influence occurs when individuals conform to the expectations of others or to enhance his/her self-image. Whereas informational influence occurs when individuals search for information from knowledgeable others or making inferences based upon observations of the behavior of others. The present study shows that these two competing routes of social influence can be attributed to different sources of influence power. The current study also has many practical implications. First, it suggests that people with affective impulsivity may be primary targets to whom companies should pay closer attention. Cultivating a more amenable and mood-elevating shopping environment will appeal to this segment. Second, the present results demonstrate that NFCC is closely related to the cognitive dimension of impulsivity. These people are driven by careless thoughts, not by feelings or excitement. Rational advertising at the point of purchase will attract these customers. Third, people susceptible to normative influences are another potential target market. Retailers and manufacturers could appeal to this segment by advertising their products and/or services as products that can be used to identify with or conform to the expectations of others in the aspiration group. However, retailers should avoid targeting people susceptible to informational influences as a segment market. These people are engaged in an extensive information search relevant to their purchase, and therefore more elaborate, long-term rational advertising messages, which can be internalized into these consumers' thought processes, will appeal to this segment. The current findings should be interpreted with caution for several reasons. The study used a small convenience sample, and only investigated behavior in two dimensions. Accordingly, future studies should incorporate a sample with more diverse characteristics and measure different aspects of behavior. Future studies should also investigate personality traits closely related to affectivity theories. Trait variables such as sensory curiosity, interpersonal curiosity, and atmospheric responsiveness are interesting areas for future investigation.

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