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New Platform of Orientalism-Based Design Education (동양성 기반의 디자인 교육의 새로운 플랫폼)

  • Choi, Kyung Ran
    • Korea Science and Art Forum
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    • v.20
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    • pp.455-464
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    • 2015
  • As the recognition toward the Korean design education development to nurture creative talents for the future society has been expanded recently, various supports and promoting strategies are being suggested. This study suggests the orientalism-based new design education platform in design education field to nurture creative talents. To have the competitiveness of creative talent nurturing, the system and education programs to rear creative talents are required. The purpose of this study is to suggest the new platform for the change of direction in design education and search for the methods in detail. The research process can be described as following: First, this study stated about the research background and its boundary. Based on the literature review and the condition of the crisis of Korean design education (Korean Industrial Statistic Investigation), it described the current condition and the characteristics. Second, this study stated about the education which will be disappeared in the information society, the change of direction in design education, and the new platform. In the current study, the change toward the strategies that give priority to the growth strategies on the knowledge-based industry was stated. Third, this study stated about that the future design education should be centered on the orientalism-based creativity in the trend changing to the six conditions for the future talents and the beliefs and values toward Asia, and what methods should be sought to achieve this trend. It suggested focusing on the aim for the direction for College education and its program curriculums as the solutions in detail. Fourth, based on the contents stated earlier in this study, it stated synthetically the direction of practice through the network of the design cluster and derived the implications. In conclusion, based on the recent orientalism-based mind, this study suggested the ways to find the identity of Korean design education itself and have the competitiveness in design education programs. The ways to secure them is to come from the integrated system innovation of the network. By actively applying the design clusters, colleges and universities, designers, studios, government policy organizations, design institutes, corporates, media, and fairs, this study suggests the sustainable education system and the practical methods.

Visible and SWIR Satellite Image Fusion Using Multi-Resolution Transform Method Based on Haze-Guided Weight Map (Haze-Guided Weight Map 기반 다중해상도 변환 기법을 활용한 가시광 및 SWIR 위성영상 융합)

  • Taehong Kwak;Yongil Kim
    • Korean Journal of Remote Sensing
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    • v.39 no.3
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    • pp.283-295
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    • 2023
  • With the development of sensor and satellite technology, numerous high-resolution and multi-spectral satellite images have been available. Due to their wavelength-dependent reflection, transmission, and scattering characteristics, multi-spectral satellite images can provide complementary information for earth observation. In particular, the short-wave infrared (SWIR) band can penetrate certain types of atmospheric aerosols from the benefit of the reduced Rayleigh scattering effect, which allows for a clearer view and more detailed information to be captured from hazed surfaces compared to the visible band. In this study, we proposed a multi-resolution transform-based image fusion method to combine visible and SWIR satellite images. The purpose of the fusion method is to generate a single integrated image that incorporates complementary information such as detailed background information from the visible band and land cover information in the haze region from the SWIR band. For this purpose, this study applied the Laplacian pyramid-based multi-resolution transform method, which is a representative image decomposition approach for image fusion. Additionally, we modified the multiresolution fusion method by combining a haze-guided weight map based on the prior knowledge that SWIR bands contain more information in pixels from the haze region. The proposed method was validated using very high-resolution satellite images from Worldview-3, containing multi-spectral visible and SWIR bands. The experimental data including hazed areas with limited visibility caused by smoke from wildfires was utilized to validate the penetration properties of the proposed fusion method. Both quantitative and visual evaluations were conducted using image quality assessment indices. The results showed that the bright features from the SWIR bands in the hazed areas were successfully fused into the integrated feature maps without any loss of detailed information from the visible bands.

Syugendo(修驗道) and Noh(能) Performance (수험도(修驗道)와 노(能) - 노 <다니코(谷行)>의 작품분석을 중심으로 -)

  • Kim, Hyeonwook
    • (The) Research of the performance art and culture
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    • no.23
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    • pp.37-61
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    • 2011
  • The Noh(能) performance is a traditional drama that represents Japan. The Noh performance was approved in the background of religious thought such as Shintoism(神道), Buddhisms(佛敎), and Syugendo(修驗道). Especially, the influence from Shugendo is large. Shugendo was active in the Middle Ages. Especially, the influence from Shugendo is large. Shugendo was active in the Middle Ages. The Noh was approved while receiving a large influence from Shugendo. It can know the feature of the Shugen(修驗) culture in the Middle Ages through the consideration of . Moreover, the appearance of the training of 'Yamabusi(山伏)' can be seen. "Yamabusi" has not been paid to attention up to now in the research of . And, the focus was appropriated to Yamabusi and it researched in this text. Moreover, the problem of "Chigo(稚子)" is thought through . "Chigo culture" was general in the Middle Ages. It is thought that "Chigo culture" is reflected in . is an Noh performance for the boy named 'Wakamatsu' to enter the mountain and to train. It is because mother's sickness was cured. However, the boy gets sick while it is training. It was dropped to the valley according to the law of Shugendo, and it died. However, it revives by the Yamabusi's prayers. 'Taniko' is to drop to the valley and to bury it when the Yamabusi gets sick while lived. The title of the Noh originated in here. has elements of history, content of training of Shugendo, "Filial piety", and the Chigo culture, etc. These are features of the culture in the Middle Ages. It is not only a sad content though this is a content of the cruel remainder. It is because of the revival though waited rapidly at the end. As for the difficulty of training is drawn in the round, and the appearance of the training at that time is understood well. The essence of Shugendo is to train in the mountain. Supernatural power can be obtained through training. Moreover, it was thought that it was able to be newly reborn through training. The leading part of Shugendo is an Yamabusi. The Yamabusi took an active part in not only the mountain but also the village. The Yamabusi is ordinary people's lives and because the relation is deep, an important factor it knows the folk customs of Japan. The word 'Chigo' is not written in . However, a spectator at that time is 'Chigo' Wakamatsu and is already sure to have understood 'Chigo'. Because everyone knew the Chigo culture in the Middle Ages. A religion at that time and knowledge of the society are necessary to understand the play of Nho well.

Interpretation of the Meaning of Korean Traditional Colors Symbol Found out in Soswaewon (소쇄원에 나타나는 전통 색채 분석과 의미 해석)

  • Han, Hee-Jeong;Cho, Se-Hwan
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.32 no.1
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    • pp.63-73
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    • 2014
  • This study was intended to analyze the correlation between the builder's intentions and the colors that are revealed through the analysis of the manifestation of symbolic colors as the signs and symbols that are shown in the traditional space of Soshaewon as one of the representative retreating villa gardens of Chosun Dynasty and the interpretation of the meanings. The research on the traditional colors and the intended background of Soshaewon and so on was conducted by examining the relative literature and the contents as the objects for the empirical analysis were the scenic beauties and spatial elemnts that are shown in the plan of Soshewon and the poems about Soshewon 48 scenes as well as the contents of the poems related to Five Primary Colors that are used based on "the Ideology of Five Elements of the Positive and Negative". Espectially, this study was conducted by dividing the spatial elements shown in Soswaewon broadly into the visual, synesthetic and symbolic & cognitive spaces in order to classify the locations and directions of the spaces and natural objects as the visual space, the seasons, the points of times and the five sensory organs as the synesthetic space and the "Four Moral Begginings" & the "Seven Emotions" of New Confucianism as the symbolic and cognitive space and by analyzing if there are any correlation between the decided intentions and the spatial meanings that are revealed by analyzing the system of five primary colors which are used in each spatial element.7) As a result from the analysis of the colors that are used based on the three spatial components of Soshaewon, it was found that one of Five Primary Colors were used 74 times in total. First, in the visual spatial component, one of the colors was used 18 times in total including 2 times of blue, 1 time of red, 6 times of yellow, 4 times of white and 5 times of black. The fact that yellow symbolizing the source of everything and white symoblizing cleanness and pureness are used relatively more often than blue and red symbolizing nature and life respectively can be interpreted that the builder, Mr. San-bo Yang's intention to build Soshaewon is related to the meaning symbolizing the pure will of the builder who wanted to seclude himself from society rather than to give priority to enjoying nature. Second, in the synesthetic spatial component which are selected from the 48 scenes of Soshaewon, one of Five Primary Colors was used 38 times in total including 11 times of blue, 8 times of red, 4 times of yellow, 5 times of white and 10 times of black. Since blue and red symbolizing nature and life respectively are used more often than yellow and black symbolizing the source of the world and pureness & knowledge respectively, it was interpreted that the builder means to be faithful to the unique basic functions of the retreating villa with which the builder wanted to enjoy his passion for enjoying nature and exploring knowledge even though the builder built the villa garden for the purpose of keeping himself pure while being unstained by the world. Finally, it was analyzed that one of Five Primary Colors was used 18 times in total including 4 times of blue, 5 times of red and 9 times of white in the symbolic and cognitive spatial components of the 48 scenes. Since it was found that white symbolizing the builder's political pureness is used at the same frequency as blue and red symbolizing nature and life respectively are used as a result from the analysis, it was interpreted that the intention of creating Soshaewon was emotionally revealed at the same percentage in the aspects of his political pureness and enjoyment of nature through his poems. Especially, as a result from such 3 kinds of analyses regarding to the frequency of using Five Primary Colors, it was found that the number of times using Five Primary Colors in the synesthetic spatial component was 38 as the highest percentage, around 51% followed by each 18 times as the24.5% respectively in the visual and cognitive & symbolic spatial spaces. Based on such results, it can be interpreted that the builder, Mr. San-bo Yang's intention of creating Soshaewon sympolizes that his intention for enjoying the basic nature and the vitality of nature within the retreating villa garden is hidden at the same proportion as his intention for keeping himself pure from the unrightful world. It was intended to reveal the traditional colors which are hidden in a traditional retreating villa by analyzing the correlation between the symbolic meanings and the spatial components of Soshaewon based on the Five Primary Colors which are originated from the "Ideology of the Five Natural Elements of the Positive and Negative", but it is thought that it is possible to explore whether such a theory can be generally applied to other kinds of retreating villa gardens or not through a study on other retreating villa gardens as other examples in which the builder's apparent pure intentions, such as enjoyment of nature and persuit of study, etc., unlike Soshaewon are hidden.

The Use of Analgesics in the Last 24 hours of Life of Patients with Advanced Cancer : A Comparison of Medical Physicians and Surgeons (말기 암 환자의 마지막 24시간 동안 진통제 사용의 분석 : 내과의사와 외과의사의 비교)

  • Choi, Youn-Seon;Kim, Jong-Min;Lee, Young-Mee;Lim, Jong-Kuk;Lee, Tai-Ho;Hong, Myung-Ho
    • Journal of Hospice and Palliative Care
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    • v.1 no.1
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    • pp.47-55
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    • 1998
  • Background : It is almost important therapy modality to control pain for the terminal cancer patients for the last 24 hours because those terminally illed patient deserved to have pain free and peaceful time before death. Physician who is deal with terminal cancer patients for their last 24 hours does not need to worry about drug addiction or other untoward side reactions of pain medications. The purpose of this study was to evaluate if terminally illed cancer patient was given pain medication properly and sufficiently and if there was any different behavior to control pain of terminal cancer patients between medical physicians and surgeons in terms of type, amount and administration route and frequency. Methods : A retrospective chart audit of analgesic type, amount and administration route was performed on the medical recorders of 160 hospitalized terminal cancer patients who had died in the Korea University Medical Center Anam Hospital during the period of July 1, 1994 to June 30, 1995. Patients were classified into 103 patients were cared for by medical physicians and 57 patients were cared for by surgeons. After then, we analysed the difference of pain control pattern between them. Different types and amount of analgesics were converted to a common standard, an oral morphine equivalents(OME) relative to 1mg of oral morphine. Results : 1) The total number of patients was 160, male 102 cases(63.8%), and the female was 58 cases(36.2%) respectively. 2) The mean age was 56.4(${\pm}14.62$) years old and mean admission period was 27.8 days(${\pm}34.85$). 3) The frequent cancer site was stomach 42 cases(26.315), lung and liver 29 cases(18.1%) each, pancreas 10 cases(6.2%) in order 4) 125 out of 160 subjects (78.13%) complained pain, and 66 out of 103(64.08%) and 31 out of 57(54.39%) were treated with analgesics to relieve pain. 50 out of 97(51.55%) were able to continue on oral medication. 5) 86 cases(53.75%) were well oriented 24 hours prior to death. 6) The frequent analgesics for regular basis were long acting form of oral morphine 34 cases(Medical phsicians 24, Surgeons 10), intravenous morphine 26 cases(Medical physicians 20, Surgeons 6) in order, and the most common p.r.n.(pro re nata) analgesics used was intravenous morphine. 7) The mean amount of analgesics on regular basis was 115.41 OME by medical physicians and 52.7 OME by surseons(P<0.05). The mean amount of p.r.n. analgesics was significantly larger in patients are for by surgeons(66.64 OME) than medical physicians 23.49 OME(P<0.01). 8) The mean frequency of administrated number of p.r.n. analgesics was 0.62 times/day on medical part and 1.88 times/day on surgical part (P<0.001). Conclusion : Of the 97 patients with advanced cancer, 51.55% were able to take oral medications in the last day of life. The parenteral analgesics were more frequently used in the patients cared for by surgeons than medical physicians. Over the half of terminal cancer patients were well oriented in the last day of life. Doctor's knowledge and attitude towards pain is very important to mange the pain, effectively.

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Diffuse Panbronchiolitis : Clinical Significance of High-resolution CT and Radioaerosol Scan Manifestations (미만성 범세기관지염에서 흉부 고해상도 전산화 단층촬영의 임상적의의 및 폐환기주사 소견)

  • Song, So Hyang;Kim, Hui Jung;Kim, Young Kyoon;Moon, Hwa Sik;Song, Jeong Sup;Park, Sung Hak;Kim, Hak Hee;Chung, Soo Kyo
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.1
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    • pp.124-135
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    • 1997
  • Background : Diffuse panbronchiolitis(DPB) is a disease characterized clinically by chronic cough, expectoration and dyspnea; and histologically by chronic inflammation localized mainly in the region of the respiratory bronchiole. It is prevalent in Japanese, but is known to be rare in Americans and Europians. Only a few cases in Chinese, Italians, North Americans and Koreans have been reported. It is diagnosed by characteristic clinical, radiological and pathologic features. High-resolution CT(HRCT) is known to be valuable in the study of the disease process and response to therapy in DPB. To our knowledge, there has been no correlation of its appearance on HRCT with the severity of the disease process, and radioaerosol scan(RAS) of the lung has not previously been used for the diagnosis of DPB. Method : During recent two years we have found 12 cases of DPB in Kangnam St. Mary's Hospital, Catholic University Medical College. We analysed the clinical characteristics, compared HRCT classifications with clinical stages of DPB, and determined characteristic RAS manifestations of DPB. Results : 1. The ages ranged from 31 to 83 years old(mean 54.5 years old), and male female ratio was 4:8. 75%(9/12) of patients had paranasal sinusitis, and only one patient was a smoker. 2. The patients were assigned to one of three clinical stages of DPB on the basis of clinical findings, sputum bacterology and arterial blood gas analysis. of 12 cases, 5 were in the first stage, 4 were in the second stage, and 3 were in the third stage. In most of the patients, pulmonary function tests showed marked obstructive and slight restrictive impairments. Sputum culture yielded P.aeruginosa in 3 cases of our 12 cases, K.pneumoniae in 2 cases, H.influenzae in 2 cases, and S.aureus in 2 cases. 3. Of 12 patients, none had stage I characteristics as classified on HRCT scans, 4 had slage II findings, 5 had stage III findings, and 3 had stage IV characteristics. 4. We peformed RAS in 7 of 12 patients With DPB. In 71.4% (5/7) of the patients, RAS showed mottled aerosol deposits characteristically in the transitional and intermediary airways with peripheral airspace defects, which contrasted sharply with central aerosol deposition of COPD. 5. There were significant correlations between HRCT stages and clinical stages(r= 0.614, P < 0.05), between HRCT types and Pa02(r= -0.614, P < 0.05), and between HRCT types and ESR(r= 0.618, P < 0.01). Conclusion : The HRCT classifications correspond well to the clinical stage. Therfore in the examination of patients with DPB, HRCT is useful in the evaluation of both the location and severity of the lesions. Also, RAS apears to be a convenient, noninvasive and useful diagnostic method of DPB.

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Clinical Presentation of the Patients with Non-traumatic Chest Pain in Emergency Department (응급의료센터에 내원한 비외상성 흉통환자의 임상 양상)

  • Chung, Jun-Young;Lee, Sam-Beom;Do, Byung-Soo;Park, Jong-Seon;Shin, Dong-Gu;Kim, Young-Jo
    • Journal of Yeungnam Medical Science
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    • v.16 no.2
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    • pp.283-295
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    • 1999
  • Background: Patients with acute non-traumatic chest pain are among the most challenging patients for care by emergency physicians, so the correct diagnosis and triage of patients with chest pain in the emergency department(ED) becomes important. To avoid discharging patients with acute myocardial infarction(AMI) without medical care, most emergency physicians attempt to admit almost all patients with acute chest pain and order many laboratory tests for the patients. But in practice, many patients with non-cardiac pain can be discharged with simple tests and treatment. These patients occupy expensive intensive care beds, substantially increasing financial cost and time of stay at ED for the diagnosis and treatment of myocardial ischemia and AMI. Despite vigorous efforts to identify patients with ischemic heart disease, approximately 2% to 5% of patients presented to the ED with AMI and chest pain are inadvertently discharged. If the cause for the chest pain is known, rapid and accurate diagnosis can be implemented, preventing wastes in time and money and inadvertent discharge. Methods and Results: The medical records of 488 patients from Jan. 1 to Dec. 31, 1997 were reviewed. There were 320(angina pectoris 140, AMI 128) cases of cardiac diseases, and 168(atypical chest pain 56, pneumothorax 47) cases of non-cardiac diseases. The number of associated symptoms were $1.1{\pm}0.9$ in non-cardiac diseases, $1.4{\pm}1.1$ in cardiac diseases and $1.7{\pm}1.1$ in AMI(p<0.05). In laboratory finding the sensitivity of electrocardiography(EKG) was 96.1%, while the sensitivity of myoglobin test ranked 45.1%. Admission rate was 71.6% in for cardiac diseases and 50.6% for non-cardiac diseases(p<0.01). Mortality rate was 8.8% in all cases, 13.8% in cardiac diseases, 0.6% in non-cardiac diseases, and 28.1% especially in AMI. Conclusion: In conclusion, all emergency physicians should have thorough knowledge of the clinical characteristics of the diseases which cause non-traumatic chest pain, because a patient with any of these life-threatening diseases would require immediate treatment. Detailed history on the patient should be taken and physical examination performed. Then, the most simple diagnostic approach should be used to make an early diagnosis and to provide treatment.

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Clinical Characteristics of the Patients with Mycobacterium avium Complex Pulmonary Disease (Mycobacterium avium complex 폐질환 환자의 임상적 특징)

  • Koh, Won-Jung;Kwon, O Jung;Kang, Eun Hae;Jeon, Ik Soo;Pyun, Yu Jang;Ham, Hyoung Suk;Suh, Gee Young;Chung, Man Pyo;Kim, Hojoong;Han, Daehee;Kim, Tae Sung;Lee, Kyung Soo
    • Tuberculosis and Respiratory Diseases
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    • v.54 no.1
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    • pp.33-44
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    • 2003
  • Background : Mycobacterium avium complex(MAC) is the most common respiratory pathogen in nontuberculous mycobacterial pulmonary disease. This study described the clinical characteristics of the patients with pulmonary disease caused by MAC. Materials and Methods : The clinical characteristics of 24 patients with pulmonary disease caused by the MAC, who fulfilled the 1997 American Thoracic Society diagnostic criteria for nontuberculous mycobacterial pulmonary disease, were retrospectively analyzed. Results : Fourteen patients(58%) were male and the median age at diagnosis was 61 years(range 46-75). Of the 24 patients, 16(67%) had a M. intracellulare infection, 7(29%) had a M. avium infection and one patient was not identified. Coughing (92%) and sputum (88%) were most frequently observed symptoms. The sputum smear for acid-fast bacilli was positive in 17(71%) patients. Fourteen(58%) patients had the upper lobe cavitary form and 10(42%) patients had the nodular bronchiectatic form. In a comparison between the patients with the upper lobe cavitary form and those with the nodular bronchiectatic form, significant differences were found according to sex(male 86% vs. 20%, p=0.003), smoking history(79% vs. 10%, p=0.008), the presence of an underlying disease(64% vs. 20%, p=0.036), the pulmonary function(% forced vital capacity, median 71% vs. 88%, p=0.022; % forced expiratory volume in one second, median 69% vs. 89%, p=0.051) and bilateral disease at chest radiography(29% vs. 90%, p=0.005). The time from the onset of symptoms to diagnosis was longer in those with the nodular bronchiectatic form(median 72 months, range 8-132) than those with the upper lobe cavitary form(median 22 months, range 6-60) Conclusions : MAC pulmonary disease occurs in two distinct populations with two distinct clinical presentations. For a correct diagnosis of MAC pulmonary disease, knowledge of the diverse clinical and radiological findings is essential.

Case Analysis of the Promotion Methodologies in the Smart Exhibition Environment (스마트 전시 환경에서 프로모션 적용 사례 및 분석)

  • Moon, Hyun Sil;Kim, Nam Hee;Kim, Jae Kyeong
    • Journal of Intelligence and Information Systems
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    • v.18 no.3
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    • pp.171-183
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    • 2012
  • In the development of technologies, the exhibition industry has received much attention from governments and companies as an important way of marketing activities. Also, the exhibitors have considered the exhibition as new channels of marketing activities. However, the growing size of exhibitions for net square feet and the number of visitors naturally creates the competitive environment for them. Therefore, to make use of the effective marketing tools in these environments, they have planned and implemented many promotion technics. Especially, through smart environment which makes them provide real-time information for visitors, they can implement various kinds of promotion. However, promotions ignoring visitors' various needs and preferences can lose the original purposes and functions of them. That is, as indiscriminate promotions make visitors feel like spam, they can't achieve their purposes. Therefore, they need an approach using STP strategy which segments visitors through right evidences (Segmentation), selects the target visitors (Targeting), and give proper services to them (Positioning). For using STP Strategy in the smart exhibition environment, we consider these characteristics of it. First, an exhibition is defined as market events of a specific duration, which are held at intervals. According to this, exhibitors who plan some promotions should different events and promotions in each exhibition. Therefore, when they adopt traditional STP strategies, a system can provide services using insufficient information and of existing visitors, and should guarantee the performance of it. Second, to segment automatically, cluster analysis which is generally used as data mining technology can be adopted. In the smart exhibition environment, information of visitors can be acquired in real-time. At the same time, services using this information should be also provided in real-time. However, many clustering algorithms have scalability problem which they hardly work on a large database and require for domain knowledge to determine input parameters. Therefore, through selecting a suitable methodology and fitting, it should provide real-time services. Finally, it is needed to make use of data in the smart exhibition environment. As there are useful data such as booth visit records and participation records for events, the STP strategy for the smart exhibition is based on not only demographical segmentation but also behavioral segmentation. Therefore, in this study, we analyze a case of the promotion methodology which exhibitors can provide a differentiated service to segmented visitors in the smart exhibition environment. First, considering characteristics of the smart exhibition environment, we draw evidences of segmentation and fit the clustering methodology for providing real-time services. There are many studies for classify visitors, but we adopt a segmentation methodology based on visitors' behavioral traits. Through the direct observation, Veron and Levasseur classify visitors into four groups to liken visitors' traits to animals (Butterfly, fish, grasshopper, and ant). Especially, because variables of their classification like the number of visits and the average time of a visit can estimate in the smart exhibition environment, it can provide theoretical and practical background for our system. Next, we construct a pilot system which automatically selects suitable visitors along the objectives of promotions and instantly provide promotion messages to them. That is, based on the segmentation of our methodology, our system automatically selects suitable visitors along the characteristics of promotions. We adopt this system to real exhibition environment, and analyze data from results of adaptation. As a result, as we classify visitors into four types through their behavioral pattern in the exhibition, we provide some insights for researchers who build the smart exhibition environment and can gain promotion strategies fitting each cluster. First, visitors of ANT type show high response rate for promotion messages except experience promotion. So they are fascinated by actual profits in exhibition area, and dislike promotions requiring a long time. Contrastively, visitors of GRASSHOPPER type show high response rate only for experience promotion. Second, visitors of FISH type appear favors to coupon and contents promotions. That is, although they don't look in detail, they prefer to obtain further information such as brochure. Especially, exhibitors that want to give much information for limited time should give attention to visitors of this type. Consequently, these promotion strategies are expected to give exhibitors some insights when they plan and organize their activities, and grow the performance of them.

The Usefulness of Pressure-regulated Volume Control(PRVC) Mode in Mechanically Ventilated Patients with Unstable Respiratory Mechanics (기계 호흡 중 불안정한 호흡역학을 보인 환자에서 압력조절용적조정양식(Pressure-regulated Volume Control Mode)의 효용)

  • Sohn, Jang-Won;Koh, Youn-Suck;Lim, Chae-Man;Shim, Tae-Sun;Lee, Jong-Deog;Lee, Sang-Do;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.6
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    • pp.1318-1325
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    • 1997
  • Background : Since the late 1960s, mechanical ventilation has been accomplished primarily using volume controlled ventilation(VCV). While VCV allows a set tidal volume to be guaranteed, VCV could bring about excessive airway pressures that may be lead to barotrauma in the patients with acute lung injury. With the increment of knowledge related to ventilator-induced lung injury, pressure controlled ventilation(PCV) has been frequently applied to these patients. But, PCV has a disadvantage of variable tidal volume delivery as pulmonary impedance changes. Since the concept of combining the positive attributes of VCV and PCV(dual control ventilation, DCV) was described firstly in 1992, a few DCV modes were introduced. Pressure-regulated volume control(PRVC) mode, a kind of DCV, is pressure-limited, time-cycled ventilation that uses tidal volume as a feedback control for continuously adjusting the pressure limit However, no clinical studies were published on the efficacy of PRVC until now. 'This investigation studied the efficacy of PRVC in the patients with unstable respiratory mechanics. Methods : The subjects were 8 mechanically ventilated patients(M : F=6 : 2, $56{\pm}26$ years) who showed unstable respiratory mechanics, which was defined by the coefficients of variation of peak inspiratory pressure for 15 minutes greater than 10% under VCV, or the coefficients of variation of tidal volume greater than 10% under PCV. The study was consisited of 3 modes application with VCV, PCV and PRVC for 15 minutes by random order. To obtain same tidal volume, inspiratory pressure setting was adjusted in PCV. Respiratory parameters were measured by pulmonary monitor(CP-100 pulmonary monitor, Bicore, Irvine, CA, USA). Results : 1) Mean tidal volumes($V_T$) in each mode were not different(VCV, $431{\pm}102ml$ ; PCV, $417{\pm}99ml$ ; PRVC, $414{\pm}97ml$) 2) The coefficient of variation(CV) of $V_T$ were $5.2{\pm}3.9%$ in VCV, $15.2{\pm}7.5%$ in PCV and $19.3{\pm}10.0%$ in PRVC. The CV of $V_T$ in PCV and PRVC were significantly greater than that in VCV(p<0.01). 3) Mean peak inspiratory pressure(PIP) in VCV($31.0{\pm}6.9cm$ $H_2O$) was higher than PIP in PCV($26.0{\pm}6.5cm$ $H_2O$) or PRVC($27.0{\pm}6.4cm$ $H_2O$)(p<0.05). 4) The CV of PIP were $13.9{\pm}3.7%$ in VCV, $4.9{\pm}2.6%$ in PVC and $12.2{\pm}7.0%$ in PRVC. The CV of PIP in VCV and PRVC were greater than that in PCV(p<0.01). Conclusions : Because of wide fluctuations of VT and PIP, PRVC mode did not seem to have advantages compared to VCV or PCV in the patients with unstable respiratory mechanics.

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