• Tuberculosis and Respiratory Diseases
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• v.82 no.1
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• pp.81-85
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• 2019

Background: Bronchoscopy is a useful diagnostic and therapeutic tool. However, the clinical use of high-flow nasal cannula (HFNC) in adults with acute respiratory failure for diagnostic and invasive procedures has not been well evaluated. We present our experiences of well-tolerated diagnostic bronchoscopy as well as cases of improved saturation in hypoxaemic patients after a therapeutic bronchoscopic procedure. Methods: We retrospectively reviewed data of hypoxaemic patients who had undergone bronchoscopy for diagnostic or therapeutic purposes from October 2015 to February 2017. Results: Ten patients (44-75 years of age) were enrolled. The clinical purposes of bronchoscopy were for diagnosis in seven patients and for intervention in three patients. For the diagnoses, we performed bronchoalveolar lavage in six patients. One patient underwent endobronchial ultrasonography with transbronchial needle aspiration of a lymph node to investigate tumour involvement. Patients who underwent bronchoscopy for therapeutic interventions had endobronchial mass or blood clot removal with cryotherapy for bleeding control. The mean saturation ($SpO_2$) of pre-bronchoscopy in room air was 84.1%. The lowest and highest mean saturation with HFNC during the procedure was 95% and 99.4, respectively. The mean saturation in room air post-bronchoscopy was 87.4%, which was 3.3% higher than the mean room air $SpO_2$ pre-bronchoscopy. Seven patients with diagnostic bronchoscopy had no hypoxic event. Three patients with interventional bronchoscopy showed improvement in saturation after the procedure. Bronchoscopy was well tolerated in all 10 cases. Conclusion: This study suggests that the use of HFNC in hypoxaemic patients during diagnostic and therapeutic bronchoscopy procedures has clinical effectiveness.

• Journal of Chest Surgery
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• v.32 no.1
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• pp.38-42
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• 1999

Background: In neonatal respiratory distress syndrome patients, various types of pulmonary air leak contributes to elevate morbity and mortality. Although early surgical interventions can provide better results in several cases, whole clinical outcomes are poor. This study was designed to investigate the clinical aspects of pulmonary air leak in the neonatal respiratory distress syndrome patients and major contributing factors to mortality. Material and Method : We retrospectively evaluated 48 cases of pulmonary air leak in the neonatal respiratory distress syndrome patients from September 1994 to May 1997. Result: There were 15 cases of primary and 33 cases of secondary pulmonary air leakages. The prominent manifestations were pure interstitial emphysema in 19 cases(39.9%) and combined pneumothorax in 19 cases(39.9%). In clinical aspects, normal birth weight was dominant(83.4%), the onset occurred within 24 hours was in 28 cases(58.8%). The pulmonary diseases were meconium aspiration syndrome(25.2%) and hyaline membrane disease(33.2%). The overall hospital mortality was 25.2%, and the majority were hyaline membrane diseases. Conclusion: Although the overral mortality rate of these diseases were high, more detailed studies about immediate treatement, perinatal prevention, intensive care to geriatric problems were needed individually to improve outcomes.

• Journal of The Korean Society of Clinical Toxicology
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• v.5 no.1
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• pp.61-66
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• 2007

Trichloroethylene (TCE) is an unsaturated chlorinated hydrocarbon in the form of a colorless, volatile liquid, which is used as an industrial organic solvent for spot removal and for metal degreasing. In general, the primary complications of TCE poisoning result from involvement of the central nervous and respiratory systems, including aspiration pneumonia. A case is reported of a 54-year-old man who presented in a comatose state after accidental ingestion of 100 ml of TCE, and who recovered after conservative treatment and mechanical ventilation. We discuss this case and present a literature review.

• Tuberculosis and Respiratory Diseases
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• v.80 no.1
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• pp.45-51
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• 2017

Background: Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) is a minimally invasive diagnostic method for mediastinal and hilar lymphadenopathy. This study aimed to investigate the incidence of fever following EBUS-TBNA. Methods: A total of 684 patients who underwent EBUS-TBNA from May 2010 to July 2012 at Seoul National University Hospital were retrospectively reviewed. The patients were evaluated for fever by a physician every 6-8 hours during the first 24 hours following EBUS-TBNA. Fever was defined as an increase in axillary body temperature over $37.8^{\circ}C$. Results: Fever after EBUS-TBNA developed in 110 of 552 patients (20%). The median onset time and duration of fever was 7 hours (range, 0.5-32 hours) after EBUS-TBNA and 7 hours (range, 1-52 hours), respectively, and the median peak body temperature was $38.3^{\circ}C$ (range, $137.8-39.9^{\circ}C$). In most patients, fever subsided within 24 hours; however, six cases (1.1%) developed fever lasting longer than 24 hours. Infectious complications developed in three cases (0.54%) (pneumonia, 2; mediastinal abscess, 1), and all three patients had diabetes mellitus. The number or location of sampled lymph nodes and necrosis of lymph node were not associated with fever after EBUS-TBNA. Multiple logistic regression analysis did not reveal any risk factors for developing fever after EBUS-TBNA. Conclusion: Fever is relatively common after EBUS-TBNA, but is transient in most patients. However, clinicians should be aware of the possibility of infectious complications among patients with diabetes mellitus.

• Tuberculosis and Respiratory Diseases
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• v.68 no.5
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• pp.267-272
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• 2010

Background: Pulmonary sarcoidosis often involves mediastinal or hilar lymph nodes in the lung parenchyma. Mediastinoscopy is the gold standard for diagnosis, but it is invasive and expensive. Transbronchial needle aspiration using conventional bronchoscope is less invasive than mediastinoscopy, but its diagnostic accuracy is in question due to the blind approach to targeting lymph nodes. Transbronchial needle aspiration (TBNA) via endobronchial ultrasound (EBUS) has high diagnostic value due to direct visualization of lymph nodes and to its relatively safeness. The purpose of this study was to assess the usefulness of EBUS-TBNA in the diagnosis of pulmonary sarcoidosis. Methods: Twenty-five patients with symptoms of sarcoidosis were enrolled into this study. Core tissue was obtained for a definitive diagnosis. Endobronchial biopsy, transbronchial lung biopsy, and bronchoalveolar lavage were performed to verify diagnosis. For patients without a confirmed diagnosis after the above procedures were performed, the additional procedures of mediastinoscopy or video-associated thoracoscopic surgery were performed to confirm a final diagnosis. Results: A total 25 EBUS procedures were done and 50 lymph nodes were aspirated. Thirty-three (37) out of 50 lymph nodes were consistent with non-caseating granuloma, confirming sarcoidosis as the final diagnosis. Sarcoidosis was the final diagnosis for all 25 patients, and 21 required EBUS-TBNA for a final diagnosis. There were no complications associated with the procedure. Conclusion: EBUS-TBNA is already a well-known procedure for diagnosing mediastinal or hilar lymphadenopathy. We used EBUS-TBNA for the diagnosis of pulmonary sarcoidosis and our results showed 84% diagnostic accuracy and no complications related to the procedure. EBUS-TBNA is a reliable and practical diagnostic modality in the diagnosis of pulmonary sarcoidosis.

• Tuberculosis and Respiratory Diseases
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• v.43 no.3
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• pp.339-347
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• 1996

Background : Transthoracic fine needle aspiration and biopsy(TNAB) has become a frequently used technique in the investigation of the intrathoracic lesions because of its safety, reliability, and accuracy. Method : Data on 125 patients who underwent TNAB from 1990 through 1994 were studied to determine the diagnostic sensitivity, accuracy and complications of this procedure as related to lesion type and location. Results : 1. The over-all diagnostic sensitivity of TNAB was 61.6%(77 of 125 patients). 2. The diagnostic yields were as high as 89.9% for malignant lesions, but a specific diagnosis of benign lesions were obtained only in 30% of benign lung lesions. 3. The correlation between results of TNAB cytology and of final histology was as high as 88.2%. 4. Lung lesions that were greater than 3cm in size had a higher proportion of correct diagnosis(73.3%) as compared with lesions 3cm or less in size(38.1%). But there was no significant difference between the central and peripheral lung lesions. 5. There were no serious complications to TNAB. In 12.8% of the procedures a pneumothorax developed, indicating a chest tube in 1.6% of the procedures. In 2 cases, minimal hemoptysis developed which did not require treatment. Conclusion : In our experience, TNAB represents a minor and safe procedure, which permits a direct approach to localized malignant lung lesions with a high degree of accuracy.

• Tuberculosis and Respiratory Diseases
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• v.56 no.4
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• pp.374-380
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• 2004

Although exophytic endobronchial lesions can readily be diagnosed by routine forceps biopsy through the fiberoptic bronchoscope, submucosal or peribronchial tumor can be difficult to diagnose. So we evaluated the diagnostic utility of transbronchial needle aspiration (TBNA) through the fiberoptic bronchoscope in patients presenting with endoscopic abnormalities suggestive of submucosal or peribronchial tumor. Patients and Methods : Retrospective review of 120 lung cancer patients who were found to have the lesions suggestive of peribronchial and submucosal tumor during fiberoptic bronchoscopy was performed from Jan. 1994 to Dec. 2002 at Severance Hospital, Yonsei University College of Medicine. Results : Forcep biopsy was positive in 63 cases (52.5%) and TBNA in 91 (75.8%), which was significantly better than forcep biopsy (p=0.001). The combination of forceps biopsy and TBNA was positive in 106 cases (88.3%), which was significantly better than forceps biopsy alone (p=0.0001). The difference of TBNA yield according to cell type or bronchoscopic appearance of lesion was not significant, but it showed the relatively better result in small cell carcinoma. Conclusions : We concluded that TBNA significantly increase the yield over forcep biopsy alone in the detection of submucosal or peribronchial bronchogenic carcinoma.

• Clinical and Experimental Pediatrics
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• v.49 no.7
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• pp.763-768
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• 2006

Purpose : We investigated the risk of aspiration using the lipid-laden macrophage index(LLMI) from laryngeal lavages in infants with bronchiolitis. Methods : Laryngeal lavages from 22 infants with acute bronchiolitis caused by respiratory syncytial virus(RSV) were evaluated during the acute stage. Repeat studies were performed at 3 to 4 weeks after the initial study(remission stage). Lavage cell counts and differentials were determined. The amount of lipid per single macrophage was evaluated and the LLMI was determined by evaluating 100 cells. Comparisons between acute stage and remission stage were made. Twenty-four hour pH monitoring(pHm) was performed in 12 patients. Results : The total cell number was significantly higher in the acute stage compared with the remission stage(P<0.05). The LLMIs in the acute stage were significantly higher than those in the remission stage(P<0.05). The neutrophils percentage of laryngeal lavage correlated with the LLMI(r=0.69, P<0.001). Four children had positive pHm recordings(pH-positive infants) and eight had negative pHm recordings(pH-negative infants). The pH-positive infants had higher LLMI and higher neutrophils percentage than those of the pH-negative infants(P<0.05). Conclusion : These findings suggest that there is a transient increased risk of aspiration during bronchiolitis. The LLMI from laryngeal lavage may be a useful marker for pulmonary aspiration in infants with bronchiolitis.

• The Korean Journal of Nuclear Medicine Technology
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• v.17 no.1
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• pp.48-52
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• 2013

Purpose: Bed, living a long time is required in adult patients with brain lesions such as stroke, traumatic brain injury, and Parkinson's disease, causing pneumonia and respiratory diseases may be due to aspiration of food or saliva. In patients with recurrent pneumonia or pulmonary symptoms, there is a need to determine the possibility of pulmonary aspiration due to aspiration of saliva. Materials and Methods: Saliva due to aspiration pneumonia diagnosis in patients with brain lesions request for inspection to the Department of Nuclear Medicine, 10 patients (male 6, female 4) were included in this study. Patients were fasted before the test, $^{99m}Tc_{O4}$ 185 MBq (5 mCi) of less than 1 mL of solution was administered in the oral cavity. Administration and 20 minutes of dynamic imaging acquisition, and immediately after that the static images were acquired. Delayed scan after 2-4 hours if necessary. Results: Positivity rate of all 10 patients was 60%. In 4 patients showed positive reactions after the administration of oral cavity in a 20-minute dynamic imaging were able to confirm whether the aspiration. In the remaining 2 patients, four hours of additional delay tests were able to confirm whether the aspiration. Conclusion: Does not require changes in patient posture compared to the other checks that can be diagnosed with aspiration pneumonia. A simple test and takes less time. Therefore be useful in providing information for the diagnosis and treatment modality.

• Tuberculosis and Respiratory Diseases
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• v.84 no.4
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• pp.317-325
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• 2021

Background: Hospital-acquired pneumonia (HAP) and ventilator-associated pneumonia (VAP) are significant public health issues in the world, but the epidemiological data pertaining to HAP/VAP is limited in Korea. The objective of this study was to investigate the characteristics, management, and clinical outcomes of HAP/VAP in Korea. Methods: This study is a multicenter retrospective cohort study. In total, 206,372 adult patients, who were hospitalized at one of the 13 participating tertiary hospitals in Korea, were screened for eligibility during the six-month study period. Among them, we included patients who were diagnosed with HAP/VAP based on the Infectious Diseases Society of America (IDSA)/American Thoracic Society (ATS) definition for HAP/VAP. Results: Using the IDSA/ATS diagnostic criteria, 526 patients were identified as HAP/VAP patients. Among them, 27.9% were diagnosed at the intensive care unit (ICU). The cohort of patients had a median age of 71.0 (range from 62.0 to 79.0) years. Most of the patients had a high risk of aspiration (63.3%). The pathogen involved was identified in 211 patients (40.1%). Furthermore, multidrug resistant (MDR) pathogens were isolated in 138 patients; the most common MDR pathogen was Acinetobacter baumannii. During hospitalization, 107 patients with HAP (28.2%) had to be admitted to the ICU for additional care. The hospital mortality rate was 28.1% in the cohort of this study. Among the 378 patients who survived, 54.2% were discharged and sent back home, while 45.8% were transferred to other hospitals or facilities. Conclusion: This study found that the prevalence of HAP/VAP in adult hospitalized patients in Korea was 2.54/1,000 patients. In tertiary hospitals in Korea, patients with HAP/VAP were elderly and had a risk of aspiration, so they were often referred to step-down centers.