• Tuberculosis and Respiratory Diseases
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• 제81권2호
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• pp.99-105
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• 2018

Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.

• Tuberculosis and Respiratory Diseases
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• 제56권6호
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• pp.670-676
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• 2004

유독성 물질의 흡인은 화학성 폐렴을 유발하며 이는 직업성 폐질환의 한 원인이다. 질산은 흔한 대기 오염물질의 한가지이고 작업장에서 사용되는 강력한 산화제로 직업적 노출의 가능성이 있다. 52세 남자 환자가 질산을 이용한 에어컨 도관 세척작업 중에 발생한 증기의 흡입 후 기침, 호흡곤란을 호소하며 병원에 방문하였다. 내원 당시 호흡수 분당 26회였고, 산소 투여 없이 시행한 동맥혈 가스분석에서 $PaO_2$ 42.6 mmHg, $SaO_2$ 80.2%로 저산소혈증이 나타났으며, 흉부 방사선 검사에서 양측폐야에 미만성 폐침윤과 젖빛유리 음영이 나타났다. 환자는 전신적인 스테로이드를 사용하지 않고, 보존적인 치료만으로 입원 2일째부터 임상적인 증상과 방사선 사진의 호전이 있었고 퇴원 후 폐기능의 손상 없이 호전되었기에 이를 보고하는 바이다.

• 대한임상독성학회지
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• 제13권1호
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• pp.46-49
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• 2015

Carbon monoxide (CO) intoxication is a leading cause of severe neuropsychological impairments. Peripheral nerve injury has rarely been reported. Following are brief statements describing the motor peripheral neuropathy involved bilateral lower extremities of a patient who recovered following acute carbon monoxide poisoning. After inhalation of smoke from a fire, a 60-year-old woman experienced bilateral leg weakness without edema or injury. Neurological examination showed diplegia and deep tendon areflexia in lower limbs. There was no sensory deficit in lower extremities, and no cognitive disturbances were detected. Creatine kinase was normal. Electroneuromyogram patterns were compatible with the diagnosis of bilateral axonal injury. Clinical course after normobaric oxygen and rehabilitation therapy was marked by complete recovery of neurological disorders. Peripheral neuropathy is an unusual complication of CO intoxication. Motor peripheral neuropathy involvement of bilateral lower extremities is exceptional. Various mechanisms have been implicated, including nerve compression secondary to rhabdomyolysis, nerve ischemia due to hypoxia, and direct nerve toxicity of carbon monoxide. Prognosis is commonly excellent without sequelae. Emergency physicians should understand the possible-neurologic presentations of CO intoxication and make a proper decision regarding treatment.

• Tuberculosis and Respiratory Diseases
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• 제84권3호
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• pp.217-225
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• 2021

Background: Despite the proven benefits of dexamethasone in hospitalized coronavirus disease 2019 (COVID-19) patients, the optimum time for the administration of dexamethasone is unknown. We investigated the progression of COVID-19 pneumonia based on the timing of dexamethasone administration. Methods: A single-center, retrospective cohort study based on medical record reviews was conducted between June 10 and September 21, 2020. We compared the risk of severe COVID-19, defined as the use of a high-flow nasal cannula or a mechanical ventilator, between groups that received dexamethasone either within 24 hours of hypoxemia (early dexamethasone group) or 24 hours after hypoxemia (late dexamethasone group). Hypoxemia was defined as room-air SpO₂ <90%. Results: Among 59 patients treated with dexamethasone for COVID-19 pneumonia, 30 were in the early dexamethasone group and 29 were in the late dexamethasone group. There was no significant difference in baseline characteristics, the time interval from symptom onset to diagnosis or hospitalization, or the use of antiviral or antibacterial agents between the two groups. The early dexamethasone group showed a significantly lower rate of severe COVID-19 compared to the control group (75.9% vs. 40.0%, p=0.012). Further, the early dexamethasone group showed a significantly shorter total duration of oxygen supplementation (10.45 days vs. 21.61 days, p=0.003) and length of stay in the hospital (19.76 days vs. 27.21 days, p=0.013). However, extracorporeal membrane oxygenation and in-hospital mortality rates were not significantly different between the two groups. Conclusion: Early administration of dexamethasone may prevent the progression of COVID-19 to a severe disease, without increased mortality.

• Clinical Endoscopy
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• 제57권2호
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• pp.196-202
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• 2024

Background/Aims: Hypoxemia is a common side effect of propofol sedation during endoscopy. Applying mild positive airway pressure (PAP) using a nasal mask may offer a simple way to reduce such events and optimize the conditions for diagnostic and therapeutic upper gastrointestinal endoscopies. Methods: We compared overweight patients (body mass index >25 kg/m²) with a nasal PAP mask or standard nasal cannula undergoing upper gastrointestinal endoscopies by non-anesthesiologists who provided propofol sedation. Outcome parameters included the frequency and severity of hypoxemic episodes. Results: We analyzed 102 procedures in 51 patients with nasal PAP masks and 51 controls. Episodes of hypoxemia (oxygen saturation [SpO₂] <90% at any time during sedation) occurred in 25 (49.0%) controls compared to 8 (15.7%) patients with nasal PAP masks (p<0.001). Severe hypoxemia (SpO₂ <80%) occurred in three individuals (5.9%) in both groups. The mean delta between baseline SpO₂ and the lowest SpO₂ recorded was significantly decreased among patients with nasal PAP mask compared to controls (3.7 and 8.2 percentage points difference, respectively). There were significantly fewer airway interventions performed in the nasal PAP mask group (15.7% vs. 41.2%, p=0.008). Conclusions: Using a nasal PAP mask may be a simple means of increasing patient safety and ease of examination.

• 대한약침학회지
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• 제18권4호
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• pp.59-62
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• 2015

Objectives: A previous study showed that bee venom (BV) could cause anaphylaxis or other hypersensitivity reactions. Although hypersensitivity reactions due to sweet bee venom (SBV) have been reported, SBV has been reported to be associated with significantly reduced sensitization compared to BV. Although no systemic immediate hypersensitive response accompanied by abnormal vital signs has been reported with respect to SBV, we report a systemic immediate hypersensitive response that we experienced while trying to use SBV clinically. Methods: The patient had undergone BV treatment several times at other Oriental medicine clinics and had experienced no adverse reactions. She came to acupuncture & moxibustion department at Semyung university hospital of Oriental medicine (Je-cheon, Korea) complaining of facial hypoesthesia and was treated using SBV injections, her first SBV treatment. SBV, 0.05 cc, was injected at each of 8 acupoints, for a total of 0.40 cc: Jichang (ST4), Daeyeong (ST5), Hyeopgeo (ST6), Hagwan (ST7), Yepung (TE17), Imun (TE21), Cheonghoe (GB2), and Gwallyeo (SI18). Results: The patient showed systemic immediate hypersensitive reactions. The main symptoms were abdominal pain, nausea and perspiration, but common symptoms associated with hypersensitivity, such as edema, were mild. Abdominal pain was the most long-lasting symptom and was accompanied by nausea. Her body temperature decreased due to sweating. Her diastolic blood pressure could not be measured on three occasions. She remained alert, though the symptoms persisted. The following treatments were conducted in sequence; intramuscular epinephrine, 1 mg/mL, injection, intramuscular dexamethasone, 5 mg/mL, injection, intramuscular buscopan, 20 mg/mL, injection, oxygen ($O_2$) inhalation therapy, 1 L/minutes, via a nasal prong, and intravascular injection of normal saline, 1 L. After 12 hours of treatment, the symptoms had completely disappeared. Conclusion: This case shows that the use of SBV does not completely eliminate the possibility of hypersensitivity and that patients who received BV treatment before may also be sensitized to SBV. Thus, a skin test should be given prior to using SBV.

• Journal of Korean Neurosurgical Society
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• 제53권3호
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• pp.139-144
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• 2013

Objective : Transient anterograde amnesia is occasionally observed in a number of conditions, including migraine, focal ischemia, venous flow abnormalities, and after general anesthesia. The inhalation anesthetic, isoflurane, is known to induce transient anterograde amnesia. We examined the involvement of brain-derived neurotrophic factor (BDNF) and its receptor tyrosine kinase B (TrkB) in the underlying mechanisms of the isoflurane-induced transient anterograde amnesia. Methods : Adult male Sprague-Dawley rats were divided into three groups : the control group, the 10 minutes after recovery from isoflurane anesthesia group, and the 2 hours after recovery from isoflurane anesthesia group (n=8 in each group). The rats in the isoflurane-exposed groups were anesthetized with 1.2% isoflurane in 75% nitrous oxide and 25% oxygen for 2 hours in a Plexiglas anesthetizing chamber. Short-term memory was determined using the step-down avoidance task. BDNF and TrkB expressions in the hippocampus were evaluated by immunofluorescence staining and western blot analysis. Results : Latency in the step-down avoidance task was decreased 10 minutes after recovery from isoflurane anesthesia, whereas it recovered to the control level 2 hours after isoflurane anesthesia. The expressions of BDNF and TrkB in the hippocampus were decreased immediately after isoflurane anesthesia but were increased 2 hours after isoflurane anesthesia. Conclusion : In this study, isoflurane anesthesia induced transient anterograde amnesia, and the expressions of BDNF and TrkB in the hippocampus might be involved in the underlying mechanisms of this transient anterograde amnesia.

• 대한간호
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• 제36권1호
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• pp.59-76
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• 1997

The purposes of this study were to identify the contents and satisfaction level of the patients received home care service, and to compare the differences of the contents by the characteristics of the patients. Seventy eight patients received home care service from 1st Jan. to 30th Sept., 1996 were data-collected to analyze the contents and outcomes of home care service. Sixty-nine patients currently receiving home care service were participated to evaluate the satisfaction level of home care service. The data were analyzed using mean, standard deviation, $x^2$ test, and ANOVA by SPSS $PC^+$ program. The findings of this study were as follow : 1. The contents & outcomes of home care service 1) The mean age of the subjects was 64.4 years: 58% of them were female. Those who living in Seoul were 83% and the rest of the subjects was living in Kyung-Gi. 2) The subjects who had one diagnosis were 41%. Over 60% of them had the disease of neurologic & sensory system. 3) The mean number of visit was 6. Only one visit was 22%. The mean time of care was 79 minutes. Duration of visit from 31 minutes to 60 minutes were 47 %. The subjects who terminated the visit because of death were 67.3%. 62% of the persons who referred them to the home care service were nurses. 4) The pain after the service was more relieved than before. The amounts of intake, the degree of bed sore, edema & fracture after the service were more improved than before. Health status after the service was improved in general. 5) There were significant differences between initial and last conscious level in tracheostomy care & oxygen inhalation care. There was significant difference between initial and last degree of activity in blood sugar check. 6) There were significant differences on the number of visit in assessment of the status, evaluation & observation, vital sign check, skin care, injection, medication, bed sore care, colostomy care, relaxation therapy for pain relief, patient education, family care, exercise therapy, position change, supply of disinfected equipments and infection control. There were significant differences on visiting time in nasogastric tube care, drainage tube care and oxygen inhalation care. 2. The satisfaction level of home care service 1) 50% were male. Over 60 years of the subjects was 61 %. Those who living in Seoul were 82%. 2) The subjects who had one or two diagnosis were 32% respectively. 55% of the persons who referred them to the home care service were nurses. 3) Total level of satisfaction of home care service was very high. 4) The older the age, the higher the satisfaction level. The larger the number of visit, the higher the satisfaction level. 5) The subjects who were in cloudy state were higher level of satisfaction than in alert or coma state. The subjects whose activity were normal or who needed assistance were higher level of satisfaction than bedridden or immobilized subjects. These findings suggested that the patients had substantial need for posthospital care. They tended to be elderly and to have experienced the wide range of health problems associated with aging, chronicity, including limitations in activities, and other serious health problems. So, the nationwide home care systems beyond the limit of demonstration program by local association and the development of the effective financial system of home based health care are necessary for the clients who are in need of home care.

• Journal of Hospice and Palliative Care
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• 제18권2호
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• pp.128-135
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• 2015

목적: 2006년부터 가정산소치료 서비스에 대해 보장을 시작함에 따라, 기준에 부합하는 사람들은 가정산소 서비스이용에 대해 20%의 본인부담만을 지출하게 되었다. 이 같은 제도의 도입은 환자의 가정산소치료 서비스에 대한 부담을 경감시키게 됨에 따라 주요 이용자인 만성 폐쇄성 폐질환 환자들에게 긍정적인 효과를 미쳤을 것으로 예상된다. 하지만, 제도 도입 후 가정산소치료 서비스 제도의 효과에 대한 연구가 많지 않았고, 실증적 근거자료 또한 부족한 실정이다. 따라서, 본 연구는 제도 도입 후, 가정산소치료 서비스가 만성 폐쇄성 폐질환 환자들의 상태에 긍정적 영향을 미쳤는지를 알아보고자 한다. 방법: 만성폐쇄성 폐질환으로 2007년부터 2012년까지 병원을 방문한 사람(N=10,798)의 청구데이터를 분석에 이용하였으며, 가정산소치료 서비스 제도 적용의 기준인 호흡기장애등급에 따라 분포의 차이를 설명하기 위해 ${\chi}^2$ test을 하였다. 또한, 가정산소치료 서비스 이용에 대한 요인을 알아보고자 Multiple Logistic Regression Analysis을 하였으며, 가정산소치료 서비스 이용이 호흡기장애등급의 변화에 어떠한 영향을 주었는지 알아보고자 Generalized Linear Mixed Model 분석을 하였다. 결과: 분석대상 중 호흡기장애등급 1등급에 속하는 대상은 2,490명이었으며, 2/3등급에 속하는 대상은 8,308명이었다. 가정산소치료 서비스 이용에 대해서는 호흡기 장애등급 3등급이 1 또는 2등급에 비해 적게 이용하였다(OR: 0.33, 95% CI: 0.30~0.37). 또한, 가정산소치료를 이용함에 따라 환자의 상태의 변화에 대해 분석한 결과, 가정산소치료 이용자는 미이용자에 비해 상태의 완화 또는 유지에 대해 높은 값을 보였다(OR: 1.41, 95% CI: 1.23~1.61). 결론: 가정산소치료 서비스 이용은 만성 폐쇄성 폐질환 환자의 상태 악화방지에 대해서 긍정적인 영향을 준다.

• Clinical and Experimental Pediatrics
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• 제50권3호
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• pp.255-261
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• 2007

목 적 : 산소치료를 받았던 극소저출생 체중아에서 교정 주령 38에서 42주에 폐 HRCT를 시행하여 폐 실질 내의 변화를 관찰하고 기관지폐이형성증의 임상적 중증도와 비교 하고자 하였다. 방 법 : 산소 치료 받은 재태연령 32주미만, 출생체중 1,500 g미만의 극소저출생 체중아 44명을 대상으로 출생 후 교정주령 38-42주에 폐 HRCT를 시행하였다. 흔히 관찰되는 폐 HRCT 소견들을 기술하고 그들의 빈도를 구했다. 폐 HRCT 소견에서 폐 손상 정도를 정량적으로 표시한 공기폐색 점수, 무기폐 점수, 총 CT 점수와 기관지-폐동맥 직경 비를 기관지 폐이형성증 환아군과 기관지폐이형성증이 없는 환아군 사이에 비교하고, Jobe-Bancalari 진단 기준에 의한 기관지폐이형성증의 임상적 중증도와 비교하였다. 결 과 : 1) 폐 HRCT 소견은 공기 폐색(56.8%), 무기폐(70.5 %), 선상 음영 증가(77.3%), 기관지-폐혈관 다발의 변형(65.9%) 등이 흔히 관찰되었다. 이들 소견들은 기관지폐이형성증이 있는 환아 군에서 기관지폐이형성증이 없는 환아 군에 비해 통계적으로 의미 있게 혼재되어 자주 관찰되었으나(P<0.05), 기관지폐이형성증이 없는 환아 군 일부에서도 관찰되었다. 공기폐색 점수, 무기폐 점수, 총 CT 점수는 기관지폐이형성증이 있는 환아 군에서 기관지폐이형성증이 없는 환아 군에 비해 통계적으로 의미 있게 높았고(P<0.05), 기관지-폐동맥 직경 비는 통계적으로 의미 있게 낮았다(P<0.05). 총 CT 점수(r=0.799, P<0.0001)와 기관지-폐동맥 직경 비(r=0.576, P<0.0001)는 임상적 기관지폐이형성증의 중증도와 통계적으로 의미 있는 직선의 상관관계를 보였다. 결 론 : 산소치료를 받았던 극소저출생 체중아를 대상으로 신생아기에 촬영한 폐 HRCT 소견은 폐 실질 내의 변화를 잘 반영하고, 기관지폐이형성증의 임상적 중증도와 의미 있는 상관관계를 보였다.