• Title/Summary/Keyword: Respiration diseases

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Unplanned Extubation in Patients with Mechanical Ventilation: Experience in the Medical Intensive Care Unit of a Single Tertiary Hospital

  • Lee, Tae Won;Hong, Jeong Woo;Yoo, Jung-Wan;Ju, Sunmi;Lee, Seung Hun;Lee, Seung Jun;Cho, Yu Ji;Jeong, Yi Yeong;Lee, Jong Deog;Kim, Ho Cheol
    • Tuberculosis and Respiratory Diseases
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    • v.78 no.4
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    • pp.336-340
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    • 2015
  • Background: Potentially harmful unplanned extubation (UE) may occur in patients on mechanical ventilation (MV) in an intensive care unit (ICU) setting. This study aimed to evaluate the clinical characteristics of UE and its impact on clinical outcomes in patients with MV in a medical ICU (MICU). Methods: We retrospectively evaluated MICU data prospectively collected between December 2011 and May 2014. Results: A total of 468 patients were admitted to the MICU, of whom 450 were on MV. Of the patients on MV, 30 (6.7%) experienced UE; 13 (43.3%) required reintubation after UE, whereas 17 (56.7%) did not require reintubation. Patients who required reintubation had a significantly longer MV duration and ICU stay than did those not requiring reintubation ($19.4{\pm}15.1days$ vs. $5.9{\pm}5.9days$ days and $18.1{\pm}14.2days$ vs. $7.1{\pm}6.5days$, respectively; p<0.05). In addition, mortality rate was significantly higher among patients requiring reintubation than among those not requiring reintubation (54.5% vs. 5.9%; p=0.007). These two groups of patients exhibited no significant differences, within 2 hours after UE, in the fraction of inspired oxygen, blood pressure, heart rate, respiratory rate, and pH. Conclusion: Although reintubation may not always be required in patients with UE, it is associated with a poor outcome after UE.

Usefulness of Vibration Response Imaging (VRI) for Pneumonia Patients (폐렴환자에서 진동 공명 영상 검사(VRI)의 유용성)

  • Park, Eu-Gene;Park, Jung-Hee;Hong, Mi-Jin;Kim, Won-Dong;Lee, Kye-Young;Kim, Sun-Jong;Kim, Hee-Joung;Ha, Kyoung-Won;Chon, Gyu-Rak;Kim, Hyun-Ai;Yoo, Kwang-Ha
    • Tuberculosis and Respiratory Diseases
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    • v.71 no.1
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    • pp.30-36
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    • 2011
  • Background: Pneumonia is commonly seen in outpatient clinics. it is widely known as the most common cause of death from infectious disease. Pneumonia has been diagnosed by its typical symptoms, chest X-ray and blood tests. However, both chest X-rays and blood tests have limitations in diagnosis. Thus primary care clinicians usually have been constrained due to a lack of adequate diagnostic tools. Vibration response imaging (VRI) is a newly emerging diagnostic modality, and its procedure is non-invasive, radiation-free, and easy to handle. This study was designed to evaluate the diagnostic usefulness of the VRI test among pneumonia patients and to consider its correlation with other conventional tests such as Chest X-ray, laboratory tests and clinical symptoms. Methods: VRI was performed in 46 patients diagnosed with pneumonia in Konkuk University Medical Center. VRI was assessed in a private and quiet room twice: before and after the treatment. Sensors for VRI were placed on a patient's back at regular intervals; they detected pulmonary vibration energy produced when respiration occurred and presented as specific images. Any modifications either in chest X-ray, C-reactive protein (CRP), white blood cell count (WBC) or body temperature were compared with changes in VRI image during a given time course. Results: VRI, chest X-ray and CRP scores were significantly improved after treatment. Correlation between VRI and other tests was not clearly indicated among all patients. But relatively severe pneumonia patients showed correlations between VRI and chest X-ray, as well as between VRI and CRP. Conclusion: This study demonstrates that VRI can be safely applied to patients with pneumonia.

Chest CT Parameters to Predict the Major Adverse Events in Acute Submassive Pulmonary Embolism (신종인플루엔자 폐렴환자에서 임상적 악화와 연관된 초기 전산화 단층촬영 소견)

  • Ryoo, Seung-Mok;Kim, Won-Young;Lee, Choong-Wook;Sohn, Chang-Hwan;Seo, Dong-Woo;Lee, Yoon-Seon;Lee, Jae-Ho;Oh, Bum-Jin;Kim, Won;Lim, Kyoung-Soo
    • Tuberculosis and Respiratory Diseases
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    • v.69 no.2
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    • pp.103-107
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    • 2010
  • Background: The aim of the present study was to evaluate whether findings on initial chest computed tomography (CT) of influenza pneumonia can help predict clinical outcome. Methods: We reviewed all adult patients admitted to the Emergency Department (ED) with a confirmed diagnosis of novel influenza A H1N1 virus (2009 H1N1) pneumonia, who underwent chest CT upon admission between Aug 26, 2009 and Jan 31, 2010. Radiologic findings were characterized by type and pattern of opacities and zonal distribution. Clinical outcome measures were intensive care unit (ICU) admission, mechanical ventilation, and inhospital death. Results: Of 59 patients diagnosed with 2009 H1N1 pneumonia, 41 (69.5%) underwent chest CT on admission into ED. Nine (22%) of these patients developed adverse clinical outcomes requiring the following treatments: 9 (22.0%) ICU admissions, 5 (12.2%) mechanical ventilation, and 3 (7.3%) inhospital deaths. Counting the number of patients with more than 4 involved lobes, the sensitivity, specificity, positive predictive value, and negative predictive value for detection of adverse clinical outcome were 67%, 84%, 55% and 80%, respectively. Conclusion: Extensive involvement of both lungs (over 4 lobes) is related to ICU admission, mechanical ventilation, and inhospital death. Initial chest CT may help predict an adverse clinical outcome of patients with 2009 H1N1 influenza pneumonia.

Extended Use of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A Retrospective Multicenter Study

  • Kim, Won-Young;Park, SeungYong;Kim, Hwa Jung;Baek, Moon Seong;Chung, Chi Ryang;Park, So Hee;Kang, Byung Ju;Oh, Jin Young;Cho, Woo Hyun;Sim, Yun Su;Cho, Young-Jae;Park, Sunghoon;Kim, Jung-Hyun;Hong, Sang-Bum
    • Tuberculosis and Respiratory Diseases
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    • v.82 no.3
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    • pp.251-260
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    • 2019
  • Background: Beyond its current function as a rescue therapy in acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) may be applied in ARDS patients with less severe hypoxemia to facilitate lung protective ventilation. The purpose of this study was to evaluate the efficacy of extended ECMO use in ARDS patients. Methods: This study reviewed 223 adult patients who had been admitted to the intensive care units of 11 hospitals in Korea and subsequently treated using ECMO. Among them, the 62 who required ECMO for ARDS were analyzed. The patients were divided into two groups according to pre-ECMO arterial blood gas: an extended group (n=14) and a conventional group (n=48). Results: Baseline characteristics were not different between the groups. The median arterial carbon dioxide tension/fraction of inspired oxygen ($FiO_2$) ratio was higher (97 vs. 61, p<0.001) while the median $FiO_2$ was lower (0.8 vs. 1.0, p<0.001) in the extended compared to the conventional group. The 60-day mortality was 21% in the extended group and 54% in the conventional group (p=0.03). Multivariate analysis indicated that the extended use of ECMO was independently associated with reduced 60-day mortality (odds ratio, 0.10; 95% confidence interval, 0.02-0.64; p=0.02). Lower median peak inspiratory pressure and median dynamic driving pressure were observed in the extended group 24 hours after ECMO support. Conclusion: Extended indications of ECMO implementation coupled with protective ventilator settings may improve the clinical outcome of patients with ARDS.

Application of the CRISPR/Cas System for Point-of-care Diagnosis of Cattle Disease (현장에서 가축질병을 진단하기 위한 CRISPR/Cas 시스템의 활용)

  • Lee, Wonhee;Lee, Yoonseok
    • Journal of Life Science
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    • v.30 no.3
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    • pp.313-319
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    • 2020
  • Recently, cattle epidemic diseases are caused by a pathogen such as a virus or bacterium. Such diseases can spread through various pathways, such as feed intake, respiration, and contact between livestock. Diagnosis based on the ELISA (Enzyme-linked immunosorbent assay) and PCR (Polymerase chain reaction) methods has limitations because these traditional diagnostic methods are time consuming assays that require multiple steps and dedicated equipment. In this review, we propose the use of the CRISPR (Clustered Regularly Interspaced Short Palindromic Repeats) Cas system based on DNA and RNA levels for early point-of-care diagnosis in cattle. In the CRISPR/Cas system, Cas effectors are classified into two classes and six subtypes. The Cas effectors included in class 2 are typically Cas9 in type II, Cas12 in type V (Cas12a and Cas12b) and Cas13 in type VI (Cas13a and Cas13b). The CRISPR/Cas system uses reporter molecules that are attached to the ssDNA strands. When the Cas enzyme cuts the ssDNA, these reporters either fluoresce or change color, indicating the presence of a specific disease marker. There are several steps in the development of a CRISPR/Cas system. The first is to select the Cas enzyme depending on DNA or RNA from pathogens (viruses or bacteria). Based on that, the next step is to integrate the optimal amplification, transducing method, and signal reporter. The CRISPR/Cas system is a powerful diagnostic tool using a gene-editing method, which is faster, better, and cheaper than traditional methods. This system could be used for early diagnosis of epidemic cattle diseases and help to control their spread.

Clinical Characteristics and Prognostic Factors of Severe Community-Acquired Pneumonia (중증 지역사회획득 폐렴의 임상상 및 예후 예측인자에 관한 연구)

  • Oh, Heung-Kook;Seo, Ji-Young;Kim, Dong-Kyu;Choi, Jeong-Eun;Mo, Eun-Kyung;Park, Myung-Jae;Lee, Myung-Goo;Hyun, In-Gyu;Jung, Ki-Suck
    • Tuberculosis and Respiratory Diseases
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    • v.44 no.5
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    • pp.1072-1082
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    • 1997
  • Background : To characterize the clinical features and determine the prognostic factors of severe community-acquired pneumonia. This study is the first of its kind in Korea. Methods : Recruited were 40 patients diagnosed as severe community-acquired pneumonia in Hallym University Hospital from January 1, 1989 through July 31, 1996. Patients were analysed retrospectively for age, sex, underlying disease, respiration rate, hypoxemia, requirement of mechanical ventilation, involvement on chest radiograph, shock, and the serum concentration of BUN and albumin. All parameters were compared between survived and dead group. Results : Male to female ratio was 2.07 : 1. The mean age was $63.1{\pm}17.5$years(range 25~90years) with 65% of patients aged equal to or more than 60. The major underlying diseases were old pulmonary tuberculosis(12.5%), chronic obstructive pulmonary disease(7.5%), bronchial asthma(5%), bronchiectasis(2.5%), and diabetes mellitus(22.5%). Microbiologic diagnosis was made in 26 out of 40 patients(65%). The most common causative organism was S. pneumoniae(17.5%, 7/40) followed by S. aureus(15.0%, 6/40), K. Pneumoniae(12.5%, 5/40), M. tuberculosis(7.5%, 3/40), H. influenzae(2.5%, 1/40), coagulase negative staphylococcus(2.5%, 1/40), P. aeruginosa(2.5%. 1/40), E. cloaceae(2.5%, 1/40), and E. coli(2.5%, 1/40). M. pneumoniae was detected in no patient. The most frequent drugs administered in single or combination therapy were aminoglycosides(75%, 30/40), second- and third-generation cephalosporin(40%, 16/40 and 27.5%, 11/40), macrolides(27.5%, 11/40), and amoxicillin/clavulanic acid(22.5%, 9/40). Of the 40 patients, 14 died of severe community-acquired pneumonia(37.5%). Among them, seven patients (50%) expired within 72h of hospital arrival. According to multivariate analysis, mortality was significantly associated with requirement of mechanical ventilation, bilateral pulmonary involvement, and serum albumins$\leq$3.0g/dl. Conclusion : An understanding of the clinical characteristics and prognostic factors in severe community-acquired pneumonia identified in this study will optimize therapeutic approach in this disease and help decreasing its notorious mortality rate.

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The Effect of Surfactant Therapy for Acute Lung Injury Induced by Intratracheal Endotoxin Instillation in Rats (기관내 내독소 투여로 유발된 흰쥐의 급성폐손상에서 surfactant의 치료효과)

  • Kang, Yun-Jung;Park, Yong-Bum;Jee, Hyun-Suk;Choi, Jae-Chol;Kim, Jae-Yeol;Park, In-Won;Choi, Byoung-Whui
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.4
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    • pp.487-499
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    • 2000
  • Background : Acute lung injury is an hypoxic respiratory failure resulting from damage to the alveolar-capillary membrane, which can be developed by a variety of systemic inflammatory diseases. In this study the therapeutic effects of intra-tracheal pulmonary surfactant instillation was evaluated in the intratracheal endotoxin induced acute lung injury model of a rat. Methods : Twenty Sprague-Dawley rats were divided into 4 groups, and normal saline (2 ml/kg, for group 1) or LPS (5 mg/kg, for group 2, 3, and 4) was instilled into the trachea respectively. Either normal saline (2 ml/kg, for group 1 & 2, 30 min later) or bovine surfactant (15 mg/kg, 30 min later for group 3, 5 hr later for group 5) was instilled into the trachea. The therapeutic effect of intratracheal surfactant therapy was evaluated with one chamber body plethysmography (respiratory frequency, tidal volume and enhanced pause), ABGA, BAL fluid analysis (cell count with differential, protein concentration) and pathologic examination of the lung. Results : Intratracheal endotoxin instillation increased the respiration rate decreased the tidal volume and int creased the Penh in all group of rats. Intratracheal instillation of surfactant decreased Penh, increased arterial oxygen tension, decreased protein concentration of BAL fluid and decreased lung inflammation at both times of administration (30 minute and 5 hour after endotoxin instillation). Conclusion : Intratracheal instillation of surfactant can be a beneficial therapeutic modality as discovered in the acute lung injury model of rats induced by intratracheal LPS intillation. It deserves to be evaluated for treatment of human acute lung injury.

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Effects of Depth and Duration of Flooding on Growth and Yield at Transplanting Stages in Tomato(Lycopersicon esculentum). (토마토(Lycopersicon esculentum)의 이식기(移植期) 침수(浸水) 처리(處理)에 따른 생육(生育) 반응(反應))

  • Guh, Ja-Ock;Roh, Sang-Eun;Kuk, Yong-In;Chon, Sang-Uk;Lee, Young-Man;Oh, Yun-Jin
    • Korean Journal of Environmental Agriculture
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    • v.16 no.1
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    • pp.7-13
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    • 1997
  • Tomatoes are flooded differently 0, 5, 10 and 15 ㎝, according to the developing stages such as transplanting stage under the condition of green house. Along with this, they are treated according to the time condition such as 6, 12, 24, 48 and 120 hours. The results obtained are summarized as follows. As the depth of flooding got deeper and the hours got longer, plant height, number of leaves, shoot and root decreased significantly. Flowering was possible for 24 hours in the flooding of 0 ㎝, for 6 hours in $5{\sim}10$ ㎝, but not possible after 6 hours in 15 ㎝. Without regard to the depth of flooding, adventitious root came into being before or after 48 hours of the treatment. Root activity diminished gradually as hours of treatment went by, but diminished rapidly over the depth of 5 ㎝. Chlorophyll content decreased similarly as in the case of root activity. Diffusion resistance of stomata cell increased as hours of treatment passed and depth increased. Photosynthesis and respiration diminished according as the hours and depth of treatment increased. Respiration diminished a little gradually but photosynthesis weakened greatly as the depth of treatment became greater and after 48 hours of treatment. Diseases occurred remarkably in proportion to the depth of treatment and the increase of hours. The possibility of preventing by means of insecticide treatment showed the same tendency as in the seedling stage. But its effect was not significant. After 120 hours yields could not be expected because tomatoes died without regard to the depth of flooding. Instead of the depth, numbers of fruits per plant decrease of individuals or variation of average weight of a fruit was recognized. Especially average weight increased in accordance with the increase of the depth. There was positive correlation between all the characters, such as plant height, number of leaves, fresh weight, chlorophyll content, root activity and yield traits, but negative correlation between these and epinastic curvature, diffusion resistance and adventitious root.

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Effects of Depth and Duration of Flooding on Growth and Yield at Different Growth Stage in Pepper(Capsicum annuum L.);I. Response to Flooding at Seedling Stage (고추(Capsicum annuum L.)의 생육단계별(生育段階別) 침수처리(浸水處理)에 따른 생육반응(生育反應);I. 유묘기(幼苗期) 반응(反應))

  • Guh, Ja-Ock;Kuk, Yong-In
    • Korean Journal of Environmental Agriculture
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    • v.15 no.3
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    • pp.325-334
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    • 1996
  • Pepper plants were flooded at 0, 5, 10 and 15cm at seedling stage under the condition of greenhouse. Treatment of flooding times are 6, 12, 24, 48 and 120 hours. The results obtained are summarized as follows. Plant height, number of leaves, shoot and root fresh weight were not recovered the flooding damages regardless of flooding time and depth. Pepper plant died in flooding depth of 5cm or more for over 48 hours. Plants in fallen leaves were found at more than 5cm depth and 6 hours of floodings. Photosynthesis and respiration rate decreased in the 5cm flooding depth or more for 24 hours. Chlorophyll content and root activity decreased for 12 hours or more at all the flooding depth. Also, diffusion resistance of stomata cell increased as increased flooding time and depth. Diseases occurred remarkably in proportion to the depth and hours of flooding treatment. It was not possible to control the desease by fungicide, also then was no effects of foliar spray of urea. Weight of fruit per plant not decrease by the 12 hours of 0cm and the 6 hours of 5cm flooding but decreased at deeper and longer flooding. Average weight of a fruit increased. The yield could not expected in the depth of 5cm or more for over 48 hours, There was significant positive correlation between all the investigated characteristics of growth and yield. There was, however, negative correlation between number of leaf and diffusion resistance of stomata.

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Pharmacological Effect of Decursin, Decursinol Angelate, and Decursinol Derived from Angelica gigas Nakai (참당귀(Angelica gigas Nakai) 유래 decursin, decursinol 그리고 decursinol angelate의 약리 효과)

  • Kang, Jae Seon
    • Journal of Life Science
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    • v.31 no.12
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    • pp.1128-1141
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    • 2021
  • 'Angelica' is one of the most traditionally consumed medicinal herbs around Northeast Asia including Korea for treatments of various diseases or health care purposes like hematopoiesis, blood circulation for women, sedative, analgesic, and a tonic medicine etc. Angelica gigas Nakai, a Korean native species of Angelica, is clearly different from the others in containing a high concentration of active ingredients like pyranocoumarines including decursin, decursinol, and decursinol angelate. These compounds have various kinds of positive effects such as anti-tumor activity including the precaution of neutropenia occurred during anticancer drug administration, improvements of metabolic disorders, menstrual irregularity, impairment of renal function, respiration improvement, cognition-enhancement, anti-inflammatory effect, anti-oxidative effect, enhancing fertility and so forth. Thus it implies incredible potentialities in future development for foods and drugs. However, certain purity-related qualities and/or overdose in food products can cause side effects like toxicities; therefore, their safety profiles should also be considered. This review focuses on the positive and negative effects of three pyranocoumarines in Angelica gigas Nakai and some possibilities and considerations for future food and drug products development.