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Factors Determining the Timing of Tracheostomy in Medical ICU of a Tertiary Referral Hospital

  • Park, Young-Sik;Lee, Jin-Woo;Lee, Sang-Min;Yim, Jae-Joon;Kim, Young-Whan;Han, Sung-Koo;Yoo, Chul-Gyu
    • Tuberculosis and Respiratory Diseases
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    • v.72 no.6
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    • pp.481-485
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    • 2012
  • Background: Tracheostomy is a common procedure for patients requiring prolonged mechanical ventilation. However, the timing of tracheostomy is quite variable. This study was performed to find out the factors determining the timing of tracheostomy in medical intensive care unit (ICU). Methods: Patients who were underwent tracheostomy between January 2008 and December 2009 in the medical ICU of Seoul National University Hospital were included in this retrospective study. Results: Among the 59 patients, 36 (61.0%) were male. Median Acute Physiology And Chronic Health Evaluation (APACHE) II scores and Sequential Organ Failure Assessment scores on the admission day were 28 and 7, respectively. The decision of tracheostomy was made on 13 days, and tracheostomy was performed on 15 days after endotracheal intubation. Of the 59 patients, 21 patients received tracheostomy before 2 weeks (group I) and 38 were underwent after 2 weeks (group II). In univariate analysis, days until the decision to perform tracheostomy (8 vs. 14.5, p<0.001), days before tracheostomy (10 vs. 18, p<0.001), time delay for tracheostomy (2.1 vs. 3.0, p<0.001), cardiopulmonary resuscitation (19.0% vs. 2.6%, p=0.049), existence of neurologic problem (38.1% vs. 7.9%, p=0.042), APACHE II scores (24 vs. 30, p=0.002), and $PaO_2/FiO_2$ <300 mm Hg (61.9% vs. 91.1%, p=0.011) were different between the two groups. In multivariate analysis, APACHE II scores${\geq}20$ (odds ratio [OR], 12.44; 95% confidence interval [CI], 1.14~136.19; p=0.039) and time delay for tracheostomy (OR, 1.97; 95% CI, 1.11~3.55; p=0.020) were significantly associated with tracheostomy after 2 weeks. Conclusion: APACHE II scores${\geq}20$ and time delay for tracheostomy were associated with tracheostomy after 2 weeks.

Clinical Comparison of Low-dose and High-dose Steroid in Pediatric Cardiac Surgery with Cardiopulmonary Bypass

  • Choi Seok-Cheol;Kim Song-Myung;Kim Yang-Weon
    • Biomedical Science Letters
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    • v.12 no.3
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    • pp.289-301
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    • 2006
  • Cardiopulmonary bypass (CPB) for cardiac surgery triggers the production and release of numerous chemotactic substances and cytokines, ensuing systemic inflammatory response that leads to postoperative major organ dysfunction. Traditionally, corticosteroids (steroid) have been administered to patients undergoing cardiac surgery to ward off these detrimental physiologic alterations. However, the majority of the studies have been performed on adult patients with high-dose steroid. We carried out a randomized, prospective, double-blind study to compare the efficacy of low-dose steroid with that of high-dose steroid and to determine the adequate dose of pretreated-steroid for prophylactic effects in pediatric cardiac surgery. Thirty pediatric patients scheduled for elective cardiac surgery were randomly assigned to two groups; fifteen patients received low-dose methylprednisolone (10mg/kg intravenously, n=15, low-dose group) and the others received high-dose methylprednisolone (30mg/kg intravenously, n=15, high-dose group) 1 hour prior to CPB. Arterial blood samples were taken before CPB (Pre-CPB), 10 minutes after start of CPB (CPB-10), and immediately after CPB-end (CPB-OFF) for measuring total leukocyte counts (T-WBC) and diff-counts, platelet counts, interleukin-6 (IL-6), myeloperoxidase (MPO), total antioxidant (TAO), neuron-specific enolase (NSE), troponin I (TNI), aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and blood urea nitrogen (BUN) levels. Other parameters such as volumes of urine output, pulmonary index $(PI,\;PaO_2/FiO_2)$, mechanical ventilating period, intensive care unit (ICU)-staying period, postoperative complications (fever, wound problem), postoperative 24 hrs and total volumes in blood loss, and hospitalized days were also assessed. All parameters were compared between two groups. There were no significant differences in T-WBC counts, monocyte fraction, platelet counts, TA levels, NSE levels, creatinine levels, BUN levels, the volumes of total urine output, PI, the incidences of fever and wound problem, postoperative 24hrs- and total-blood loss volumes and ICU-staying period between two groups (P>0.05). At CPB-OFF, neutrophil fraction, MPO level, TNI level, and AST level were higher in the high-dose group than in the low-dose group (P<0.05). IL-6 level at CPB-10 was higher in the high dose-group than in the low-dose group (P<0.05). Furthermore, mechanical ventilating periods and hospitalized days of the high-dose group were significantly longer than those of low-dose group (P<0.05). The high-dose group had significantly low lymphocyte fi-action at CPB-OFF compared with the low-dose group (P<0.001). These findings suggest that pretreatment of high-dose steroid is not superior to that of low-dose steroid regrading its potential benefits in pediatric cardiac surgery. Therefore, the conventional strategy of steroid treatment, high-dose pretreatment, should be modified in the cardiac surgery with CPB. However, further studies must be performed on the larger number of patients in as much as small number of patients in this study.

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10% Pentastarch Versus 5% Albumin Solution for Volume Expansion Following Cariopulmonary Bypass in Patients Undergoing Open Heart Surgery (개심수술후 혈량 증가를 위한 10% Pentastarch와 5% Albumin 용액의 비교연구)

  • 장병철
    • Journal of Chest Surgery
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    • v.27 no.3
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    • pp.177-186
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    • 1994
  • Pentastarch is a hydroxyethyl starch similar to hetastarch, but lower average molecular weight and fewer hydroxyethyl groups which result in enhanced enzymatic hydrolysis and faster renal elimination.This report was performed to compare the clinical efficacy and safety of 10 % pentastarch[Pentaspan , group I] for plasma volume expansion after open heart surgery with that of 5% albumin[Plasmanate, group II]. There were no statistically significant differences between the group I [n=18] and group II [n:19] in the preoperative parameters [age, sex, body weight] and operative parameters[bypass time, aorta cross clamping time]. During the first 24 hours after arrival of the patient in the surgical intensive care unit, colloid solution [500--1000 ml] was infused to maintain left atrial pressure of more than 8 mmHg, or cardiac index of 2.0 L/min/M2 of more. In results, there were 3 complications of hypotension immediately after infusion of 5 % albumin solution and 2 among the 3 patients were excluded for the study. However there was no complication after infusion of 10 % pentastarch solution. Hemodynamic responses to infusion was similar for both groups, although in group I a greater increase in both left atrial pressure[mean 1.8 versus 0.7 mmHg, p< 0.05] and right atrial pressure [mean 2.2 versus 1.7 mmHg, p < 0.05] was observed during infusion of the first 500 ml. There were no significant differences in any of the measured respiratory parameters[PaO2, intrapulmonary shunt, and effective lung compliance]. Homodilution with colloid significantly reduced hemoglobin [mean 1.2 versus 0.8 gm/dl], and serum protein and albumin level[total protein;4.8$\pm$ 0.5 versus 5.2 $\pm$0.5 gm/dl, p < 0.05: albumin: 3.2 $\pm$0.4 versus 3.6 $\pm$0.6 gm/dl, p < 0.05] by 6:00 AM on 1 day postoperatively, however there were no significant differences on 7 day postoperatively. The mean serum colloid osmotic pressure and osmolarity was similar in both group.There were no abnormal findings of liver function and kidney function in all the patients. There were no significant between-group differences in bleeding time, platelets, prothrombin time, activated partial thromboplastin time and amount of chest tube output measured on 1st and 7th postoperative day. These findings demonstrated that 10% pentastarch is more effective and safe for plasma volume expension than 5 % albumin solution with no adverse effects on coagulation. Also 10 % pentastarch is less expensive than 5 % albumin and it would appeare to be a reasonable first choice for plasma volume expansion.

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The Clinical Analysis of Modified B-T Shunt Using 3 mm and 3.5 mm PTFE graft (3mm와 3.5mm PTFF graft를 이용한 변형 B-T 단락술의 임상적 분석)

  • 정성호;윤태진;임한중;민경석;서동만;윤소영;김영휘;고재곤;박인숙
    • Journal of Chest Surgery
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    • v.33 no.9
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    • pp.716-722
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    • 2000
  • Background: Modified Blalock-Taussig shunt using 3mm or 3.5mm PTFE graft has been performed in patients with small body weight or in candidates for single ventricle palliation. However, there are few reports concerning clinical outcomes in terms of pulmonary artery growth and shunt patency rate after shunt operations using such a small graft. Material and Method: Twenty-five patients rate after shunt operations using 3 or 3.5 mm sized grafts from September 1996 to August 1999. We retrospectively assessed the pulmonary artery growth and the shunt patency rate by reviewing the pre-and post-operative pulmonary angiograms. The risk factors for late death and second shunt operations were also analyzed. To assess the presence of any correlation between body weight and selection of the graft size, regression analysis was done in 81 cases of shunt operations performed during the same period. Result: There were 1(4%) early death and 5(20%) late deaths. The survivors were followed up for an average of 7.34 months. The pulmonary artery index increased significantly from 129$\pm$66$\textrm{mm}^2$/$m^2$ to 213$\pm$114 $\textrm{mm}^2$/$m^2$(p=0.002). The shunt patency rate assessed at postoperative 2, 4, 6 and 8 months were 82.5%, 77%, 73% and 42% respectively with a marked decline between 6 and 8 months. Asplenia was a frequent finding for the patients with late death although the incidence failed to reach statistical significance(p=0.078). Pre-operative diagnosis of PA with VSD was found to be a statistically significant risk factor for a second shunt operation(p=0.01). Body weight(a) at operation and graft size(b) used in the shunt operations revealed strong correlation and could be expressed by the following formula; b=0.128a + 3.233. Conclusion: Adequate growth of pulmonary artery and satisfactory early patency rate could be obtained by modified Blalock-Taussing shunt using 3mm or 3.5mm graft. However, during 6 to 8 months after shunt operations, the patency rate fell sharply, which implicates that close observation and early intervention are mandatory in this period.

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Effect of Gamma Irradiation on the Overall Quality of a Commercial Plain-type Yogurt Products (안전성 향상을 위해 감마선 조사한 시판 플레인 요구르트의 품질 특성)

  • Kim, Hyun-Joo;Song, Hyun-Pa;Ham, Jun-Sang;Lee, Ju-Woon;Kim, Kee-Hyuk;Jo, Cheor-Un
    • Food Science of Animal Resources
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    • v.28 no.5
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    • pp.574-579
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    • 2008
  • To develop a yogurt for sensitive consumer such as infants, children or immuno-compromised patients using gamma irradiation, the effects of gamma irradiation on the microbiological, chemical, and sensory quality in a commercial plain yogurt were investigated. No viable coliform bacteria were detected in the sample and approximately a 6 decimal reduction was achieved in the number of total aerobic bacteria by irradiation at 5 kGy. The initial population of lactic acid bacteria observed in the commercial plain yogurt was 8.95 log CFU/g. Gamma irradiation significantly reduced the initial microbial level to 6.47 and 2.85 log CFU/g after irradiation at 1 and 3 kGy, respectively (p<0.05). However, irradiation dose up to 5 kGy could not completely eliminate the lactic acid bacteria in commercial plain yogurt. pH, color, lactose and lactic acid content, and sensory quality were not affected by irradiation treatment and storage. Our results suggest that irradiation can improve the microbial quality of commercial plain yogurt without impairing the physicochemical and sensory quality.

Opto-Electrochemical Sensing Device Based on Long-Period Grating Coated with Boron-Doped Diamond Thin Film

  • Bogdanowicz, Robert;Sobaszek, Michał;Ficek, Mateusz;Gnyba, Marcin;Ryl, Jacek;Siuzdak, Katarzyna;Bock, Wojtek J.;Smietana, Mateusz
    • Journal of the Optical Society of Korea
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    • v.19 no.6
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    • pp.705-710
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    • 2015
  • The fabrication process of thin boron-doped nanocrystalline diamond (B-NCD) microelectrodes on fused silica single mode optical fiber cladding has been investigated. The B-NCD films were deposited on the fibers using Microwave Plasma Assisted Chemical Vapor Deposition (MW PA CVD) at glass substrate temperature of 475 ℃. We have obtained homogenous, continuous and polycrystalline surface morphology with high sp3 content in B-NCD films and mean grain size in the range of 100-250 nm. The films deposited on the glass reference samples exhibit high refractive index (n=2.05 at λ=550 nm) and low extinction coefficient. Furthermore, cyclic voltammograms (CV) were recorded to determine the electrochemical window and reaction reversibility at the B-NCD fiber-based electrode. CV measurements in aqueous media consisting of 5 mM K3[Fe(CN)6] in 0.5 M Na2SO4 demonstrated a width of the electrochemical window up to 1.03 V and relatively fast kinetics expressed by a redox peak splitting below 500 mV. Moreover, thanks to high-n B-NCD overlay, the coated fibers can be also used for enhancing the sensitivity of long-period gratings (LPGs) induced in the fiber. The LPG is capable of measuring variations in refractive index of the surrounding liquid by tracing the shift in resonance appearing in the transmitted spectrum. Possible combined CV and LPG-based measurements are discussed in this work.

Lipids and Fatty Acid Composition of Garlic (Allium sativum Linnaeus) (마늘의 지방질(脂肪質) 및 지방산(脂肪酸) 조성에 관한 연구)

  • Yang, Kyu-Yeol;Shin, Hyo-Sun
    • Korean Journal of Food Science and Technology
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    • v.14 no.4
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    • pp.388-393
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    • 1982
  • Lipids extracted from two garlic samples (Allium sativum Linnaeus) were studied. Total lipid content of the samples ranged from 310 to 342mg/100g of fresh garlic. These lipids were shown to consist of $36.4{\sim}43.5%$ neutral lipids, $20.3{\sim}24.3%$ glycolipids, and $36.2{\sim}39.3%$ phospholipids. Among the neutral lipids, triglycerides were predominant $(80.5{\sim}83.6%)$ with smaller amounts of free sterols, free fatty acids, and sterol esters being present. 1, 2-Diacylglycerol acetates, 1, 3-diacylglycerol acetates and cholesterol acetates were also tentatively identified. Esterified steryl glycosides and steryl glycosides were major sugar-containing lipids, but monogalactosyl diglycerides, cerebrosides, digalactosyl diglycerides and sulfolipids were relatively minor components. Of the phospholipids, phosphatidyl cholines and serines, and phosphatidyl ethanolamines were the major components, comprising over 85% of this class. Phosphatidic acid and phosphatidyl inositols were also present. The major fatty acids in the total and three lipid classes were linoleic, palmitic, oleic and linolenic acid.

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Catalytic CVD-Kinetics of Pyrolytic Carbon and SiC on the Stainless Steel Stent (Stainless Steel Stent에 Pyrolytic Carbon과 SiC의 촉매적 CVD-Kinetic연구)

  • 이보성;이무용
    • Proceedings of the KAIS Fall Conference
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    • 2000.10a
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    • pp.30-33
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    • 2000
  • 최근 국내에서도 관 동맥 질환 환자의 수가 급증하고 있으며, 관 동맥 질환의 치료 방법인 관 동맥 성형 술은 관 동맥 stent의 도입에 의하여 보편화되어 국내에서 년간 5000개 이상의 stent가 시술되고 있다. 그러나 stent는 고가(1,200천원/개)로 전량 수입에 의존하고 있으며, 시술 후 사망까지 이를 수 있는 혈전에 의한 급성 페쇠와 재 협착이 문제점이다. 이를 위한 한가지 방법이 생체 적합성이 뛰어난 복합 stent의 개발인데 SiC나 Carbon을 coating한 stent는 시술 후 혈전 형성을 억제하는 것으로 알려져 있다. 특히 가장 순수한 Pyrolytic carbon은 hemocompatibility가 탁월하고 기밀 성이기 때문에 본 연구에서 그의 CVB-Kinetics를 연구코저 하는 것이다. methane으로부터 pyrolytic carbon의 CVD는 온도에 따라서 다양한 구조를 가지며 따라서 그의 mechanism도 다양하다는 것은 잘 알려져 있다. 더구나 광간(균질)반응과 표면(불균질)반응의 정량적 관계에 따라서도 다르다는 것도 확인되었다. 그러나 stainless steel 316L로 만든 stent는 12 - 15 %의 Ni과 2%의 Mo을 함유해서 금속성을 잃지 않는 저온(600℃)에서도 pyrolytic carbon의 속매적 CVD가 가능함을 그리고 SiC의 코팅에 적합한 buffer layer 역할을 함을 확인하였다. 그리하여 본 연구는 반응기 설계에 필요한 저온 촉매적 pyrolytic carbon의 CVD-kinetics의 연구결로 그의 mechanism과 함께 rate law 식을 유도, 확인하였으며 600℃, 90kPa에서 P/sub ch4//P/sub H2/=5:1과 체류시간 1.8 sec가 최적임을 발견하였다. 이때 석출속도 11.2 g-mol/g-cat.h 혹은 두께속도로 73 nm/sec를 나타내었다.메타놀-물 (1 : 1) 유출액에서 $(0.80\;{\mu}g)$ 검출되었다. 하면 morey eel내장에서 얻은 독물질도 DEAE-셀루로즈에서 ST-1 과 ST-2로 나누어지며, 이 ST-1의 TLC, HPLC 및 알루미나 컬럼상의 거동이 파랑비늘돔에서 얻은 ST-1의 그것과 같으므로 scaritoxin으로 보고한 ST-1은 ciguatoxin의 형태인 less polar cigutoxin (LPCTX) 으로 생각된다.에서 각각 대조구의 57, 413 및 315% 증진되었다. 거품의 열안정성은 15분 whipping시, pH 4.0(대조구, 30.2%) 및 5.0(대조구, 23.7%)에서 각각 $0{\sim}38.0$$0{\sim}57.0%$이었고 pH 7.0(대조구, 39.6%) 및 8.0(대조구, 43.6%)에서 각각 $0{\sim}59.4$$36.6{\sim}58.4%$이었으며 sodium alginate 첨가시가 가장 양호하였다. 전체적으로 보아 거품안정성이 높은 것은 열안정성도 높은 경향이며, 표면장력이 낮으면 거품형성능이 높아지고, 비점도가 높으면 거품안정성 및 열안정성이 높아지는 경향이 있었다.protocol.eractions between application agents that are developed using different languages. Dynamic agent invocation is accomplished by Java Native Interface(JNI) that links two heterogeneous methods, and by KQML language interface that facilitates the communications between heterogeneous agents. This scheme of dyna

Isolation of Egg-Contaminating Bacteria and Evaluation of Bacterial Radiation Sensitivity (계란 오염 세균의 분리 및 분리 균주의 감마선 감수성 평가)

  • Kim, Dong-Ho;Yun, Hye-Jeong;Song, Hyun-Pa;Lim, Byung-Lak;Jo, Cheo-Run
    • Food Science and Preservation
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    • v.15 no.5
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    • pp.774-781
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    • 2008
  • was performed and Staphylococcus sciuri, Bacillus cereus, Escherichia coli, Proteus mirabilis, and Enterococcus faecalis were identified. No Salmonella strain, a typical contaminant of eggs, was found. The radiation sensitivities of isolated bacteria and Salmonella typhimurium, in an inoculated model system, were expressed in $D_{10}$ values. The ranges of $D_{10}$ values shown by S. typhimurium, S. sciuri, B. cereus, E. coli, P. mirabilis, and E. faecalis were 0.365-0.399 kGy, 0.418-0.471 kGy, 1.075-1.119 kGy, 0.280-0.304 kGy, 1.132-1.330 kGy, and 0.993-1.290 kGy, respectively. The growth of all six test bacteria in eggs (inoculated at $10^6-10^7\;CFU/g$) during 3 days of post-irradiation storage at ambient conditions ($25^{\circ}C$) was recorded. S. typhimurium was eliminated by irradiation at 3 kGy, and E. coli and S. sciuri were eliminated by irradiation at 5 kGy. The viable cell counts of B. cereus, P. mirabilis, and E. faecalis in eggs showed 4-6 log reductions after irradiation with 5 kGy.

Episode Analysis of the Habit and Phase Changes of Snow Crystals in the Wintertime Yeongdong Region (겨울철 영동지역 눈 결정 습성과 성상 변화 에피소드 분석)

  • Young-Gil Choi;Byung-Gon Kim;Ji-Yun Kim;Tae-Yeon Kim;Jin-Heon Han;GyuWon Lee;Kwonil Kim;Ki-Hoon Kim;Byung-Hwan Lim
    • Atmosphere
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    • v.34 no.2
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    • pp.139-151
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    • 2024
  • The Yeongdong region has suffered from severe snowstorms and the relevant damage such as traffic accidents on slippery roads, and the collapse of greenhouses and temporary buildings. While a lot of research on snowfall has been conducted, the detailed study of snow crystals' phase and habit through intensive observations and the relevant microphysical analysis is still lacking. Therefore, a snowflake camera, PARSIVEL, and intensive radiosonde soundings were utilized to investigate phase and habit changes in solid precipitation. Two remarkable episodes of phase and habit changes were selected such as 19 March 2022 and 15 February 2023. Both events occurred in the synoptic condition of the High in the north and the Low passing by the south, which was accompanied by rapid temperature cooling below 2.5 km. During the events of a short period between 3 to 6 hours, the temperature at 850 hPa decreased by about 4 to 6℃. This cooling led to a change in the main habit of snow particles from riming to aggregate, identified with both MASC and PARSIVEL. Meanwhile, the LDAPS model analyses do not successively represent the rapid cooling and short-term variations of solid precipitation, probably by virtue of overestimating low-level equivalent potential temperature during these periods. The underlying causes of these the low-level temperature variations within 6 hours, still remain unclear. It might be associated with mesoscale orographic phenomenon due to the mountains and East Sea effects, which certainly needs an intensive and comprehensive observation campaign.