• Acute and Critical Care
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• 제33권4호
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• pp.222-229
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• 2018

Background: The diagnosis of pediatric acute respiratory distress syndrome (PARDS) is a pragmatic decision based on the degree of hypoxia at the time of onset. We aimed to determine whether reclassification using oxygenation metrics 24 hours after diagnosis could provide prognostic ability for outcomes in PARDS. Methods: Two hundred and eighty-eight pediatric patients admitted between January 1, 2010 and January 30, 2017, who met the inclusion criteria for PARDS were retrospectively analyzed. Reclassification based on data measured 24 hours after diagnosis was compared with the initial classification, and changes in pressure parameters and oxygenation were investigated for their prognostic value with respect to mortality. Results: PARDS severity varied widely in the first 24 hours; 52.4% of patients showed an improvement, 35.4% showed no change, and 12.2% either showed progression of PARDS or died. Multivariate analysis revealed that mortality risk significantly increased for the severe group, based on classification using metrics collected 24 hours after diagnosis (adjusted odds ratio, 26.84; 95% confidence interval [CI], 3.43 to 209.89; P=0.002). Compared to changes in pressure variables (peak inspiratory pressure and driving pressure), changes in oxygenation (arterial partial pressure of oxygen to fraction of inspired oxygen) over the first 24 hours showed statistically better discriminative power for mortality (area under the receiver operating characteristic curve, 0.701; 95% CI, 0.636 to 0.766; P<0.001). Conclusions: Implementation of reclassification based on oxygenation metrics 24 hours after diagnosis effectively stratified outcomes in PARDS. Progress within the first 24 hours was significantly associated with outcomes in PARDS, and oxygenation response was the most discernable surrogate metric for mortality.

• Journal of Veterinary Science
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• 제21권2호
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• pp.27.1-27.10
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• 2020

The efficacies of a supraglottic airway device (SGAD) and an endotracheal tube (ETT) in cats under general anesthesia with volume-controlled ventilation (VCV) were compared. Thirty healthy cats were randomly allocated for airway control using either an SGAD or an ETT. Five tidal volumes (6, 8, 10, 12, and 14 mL/kg) were randomly tested, and respiratory rates were adjusted to achieve a minute ventilation of 100 mL/kg/min. The dose of propofol necessary to insert the SGAD or ETT, the static respiratory pressure, leakage during VCV, and end tidal CO₂ (ETCO₂) were recorded. Dosages of propofol and static respiratory measurements for the SGAD and ETT groups were compared using a t-test. The distribution of leakages and hypercapnia (ETCO₂ > 45 mmHg) were compared using Fisher's exact test. A significance level of p < 0.05 was established. No significant difference in dose of propofol was observed between the SGAD and ETT groups (7.1 ± 1.0, 7.3 ± 1.7 mg/kg; p = 0.55). Static resistance pressure of the SGAD (22.0 ± 8.1 cmH₂O/L/sec) was significantly lower than that of the ETT (36.6 ± 12.9 cmH₂O/L/sec; p < 0.01). Of the 75 trials, leakage was more frequent when using an SGAD (8 events) than when using an ETT (1 event; p = 0.03). Hypercapnia occurred more frequently with SGAD (18 events) than with ETT (3 events; p < 0.01). Although intubation with an ETT is the gold standard in small animal anesthesia, the use of an SGAD can reduce airway resistance and the work of breathing. Nonetheless, SGAD had more dead space and the tidal volume for VCV needs adjustment.

• Nutrition Research and Practice
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• 제18권1호
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• pp.98-109
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• 2024

BACKGROUND/OBJECTIVES: The efficacy of Lab4 probiotic and vitamin C combination on the prevention of upper respiratory tract infections (URTIs) was investigated in two studies with children. Our objective was to pool dataset of 57 preschool children from the PROCHILD study (ISRCTN28722693) and the dataset of 50 preschool matched cohort from the PROCHILD-2 study (ISRCTN26587549) to evaluate the impact of probiotic/vitamin C combination on the prevention of upper respiratory tract symptoms and provide a more robust assessment of effect using detailed individual level data. SUBJECTS/METHODS: The children were supplemented daily for 6 months with either the multistrain probiotic (1.25×10¹⁰ cfu/tablet consisting of two strains of Lactobacillus acidophilus CUL21 and CUL60, Bifidobacterium bifidum CUL20 and Bifidobacterium animalis subsp. lactis CUL34) plus 50 mg vitamin C or a placebo. RESULTS: In the pooled analysis of the individual participant data (per protocol population), significant reductions were observed for the incidence (-25%; 95% confidence interval [CI], 0.66, 0.85; P < 0.0001) and duration (-14.9 days; 95% CI, -24.8, -5.1; P = 0.0030) of typical URTI symptoms in the active group compared with the placebo. The incidence rates of absenteeism from preschool (IR ratio, 0.75; 95% CI, 0.66, 0.86; P < 0.0001), paediatric visits (IR ratio, 0.56; 95% CI, 0.47; 0.68; P < 0.0001) and antibiotic usage (IR ratio, 0.53; 95% CI, 0.39, 0.71; P < 0.0001) were also significantly reduced. CONCLUSION: The pooled analysis findings of comparable preschool cohorts from two studies indicate that the supplementation with probiotic and vitamin C combination is beneficial in the prevention and management of URTI symptoms.

• Tuberculosis and Respiratory Diseases
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• 제74권6호
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• pp.256-263
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• 2013

Background: Health status measure is not only important for clinical research studies but also for clinical practices of chronic obstructive pulmonary disease (COPD) patients. The objective of this study is to evaluate the validity of the Korean Version of COPD Assessment Test (CAT) in primary care clinics as well as in referral hospitals. Methods: Smokers or ex-smokers, aged 40 years or older, with a smoking history of >10 pack-years; and a COPD diagnosis in the past 6 months or more, were recruited from 4 primary care clinics and 2 referral hospitals. Demographic, medical, and spirometry data was collected from patients who completed the CAT and St. George Respiratory Questionnaire (SGRQ), and had their dyspnea been assessed. The primary endpoint was the correlation between of the Korean version of CAT with SGRQ in patients with COPD. Results: A total 100 patients were enrolled. The mean age and smoking amounts were $69.2{\pm}8.4$ years and $40.6{\pm}22.3$ pack-years, respectively. Sixty-seven percent of the patients reported at least one exacerbation in the past year. The mean CAT score was $16.9{\pm}8.0$. The internal consistency assessed by Cronbach's alpha was 0.85. The CAT score was positively correlated with the SGRQ score (r=0.76, p<0.0001) and each component of SGRQ: symptoms, activity and impacts; r=0.68, r=0.61, and r=0.72, respectively (all p<0.0001). These positive correlations were preserved in the different groups (r=0.86, p<0.0001 in primary care clinic group; r=0.69, p<0.0001 in hospital group). The CAT score was also positively correlated to the Medical Research Council dyspnoea scale (r=0.46, p<0.0001). Conclusion: The Korean version of CAT had good internal consistency and showed good correlations with SGRQ. It can be used for assessing the impacts of COPD on the patient's health including primary care setting.

• Tuberculosis and Respiratory Diseases
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• 제69권3호
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• pp.171-176
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• 2010

Background: The object of this study was to assess the validity and reliability of the Korean versions of chronic obstructive pulmonary disease assessment test (CAT) and Dyspnea-12 Questionnaire for patients with chronic pulmonary obstructive disease (COPD). Methods: For the 127 COPD patients, we obtained the Korean versions of the 3 questionnaires being tested: St George's Respiratory Questionnaire (SGRQ), CAT, and Dyspnea-12 with spirometric measurements. To assess the validity of CAT and Dyspnea-12, their correlation with SGRQ was evaluated. To assess the reliability of CAT and Dyspnea-12, Cronbach's alpha coefficient was evaluated. Results: The mean age of patient participants was $68.6{\pm}7.5$ years; 97.6% were male. The SGRQ score was correlated with the scores of the Korean version of CAT (r=0.71, p<0.0001) and Dyspnea-12 (r=0.73, p<0.0001). The Cronbach's alpha coefficient for the CAT and Dyspnea-12 were 0.77 and 0.78, respectively. Conclusion: The Korean versions of CAT and Dyspnea-12 were shown to be valid and reliable for the Korean COPD patients.

• Proceedings of the Korean Society for Emotion and Sensibility Conference
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• 한국감성과학회 2000년도 추계학술대회 논문집
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• pp.81-87
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• 2000

Beat-to-beat changes in heart period (heart period variability, HPV) are mediated by fluctuations in autonomic activity. Spectral analysis is used to quantify such fluctuations in the range of 0.15-0.40 Hz (high frequency, HF), which are influenced primarily by parasympathetic factors. These fluctuations are often referred to as RSA (respiratory sinus arrhythmia), the physiological phenomenon extracted by spectral analysis and other methods including histograms of heart rate ( HR), deviations of HR etc. Respiratory sinus arrhythmia indexing with peak-to-valley method suggested by Grossman et at., (1981) yields a simple range statistic and is quantified on breath-by-breath basis, thus being quite sensitive and less dependent on recording time as compared to spectral analysis. It is strongly recommended to use at least 1 min epoch to asses HF component of HPV and at least 2 min fer low frequency (LF) of HPV and even 5 min far valid clinical assessment. Peak-to-valley statistic is limited to RSA index only, but has its pragmatic advantages. Most important is possibility of its application far relatively small epoch analysis. We used short periods (20,30, 40 sec only) and off-line analysis of RSA using ECG and respiration curve this method of assessment and proved that this method is more practically effective. The RSA index was not so far dependent on respiration pattern differences and reflected actual vagal control of HR and were accompanied by low HR under some high stress conditions and in an aversive affective visual stimulation experiments. Another factor that might modulate cardiac chronotropic response is the interaction of sympathetic and parasympathetic inputs on sino-atrial (SA) node level, because responses to vagal influences are known to be proportional to ongoing sympathetic activity, that is so called accentuated antagonism. Since sympathetic outflow (increment of influences on SA) under negative emotions or stress was high in almost all physiological responses, vagal effects on HR could be therefore potentiated, leading to masking of output cardiac response seen in HPV, In the case of moderate sympathetic activation, on the other hand, autonomic interactions in cardiac control appear to be minimal. Thus RSA index appears to be an effective alternative method to assess and measure spectral HPV.

• Tuberculosis and Respiratory Diseases
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• 제79권1호
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• pp.31-36
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• 2016

Background: The purpose of this study was to evaluate the risk factors for mechanical ventilation in the patients with scrub typhus admitted to intensive care unit (ICU) at a university hospital. Methods: We retrospectively selected and analyzed clinical data from the medical records of 70 patients (32 men, 38 women) admitted to the ICU with scrub typhus between 2004 and 2014. The patients had a mean${\pm}$standard deviation age of $71.2{\pm}11.1years$ and were evaluated in two groups: those who had been treated with mechanical ventilation (the MV group, n=19) and those who had not (the non-MV group, n=51). Mean ages of the MV group and the non-MV group were $71.2{\pm}8.3years$ and $71.2{\pm}11.1years$, respectively. Results: Significant differences between the two groups were observed with respect to acute respiratory failure (p=0.008), Acute Physiology and Chronic Health Evaluation (APACHE) II score (p=0.015), Sequential Organ Failure Assessment (SOFA) score (p=0.013), death (p=0.014), and ICU duration (p<0.01). Multivariate analysis indicated that the following factors were significantly associated with mechanical ventilation: acute respiratory failure (p=0.011), SOFA score (p=0.005), APACHE II score (p=0.011), platelet count (p=0.009), and lactate dehydrogenase (LDH) (p=0.011). Conclusion: Thus, five factors-acute respiratory failure, SOFA score, APACHE II score, platelet count, and LDH-can be the meaningful indicators for mechanical ventilation for the patients with scrub typhus admitted to ICU.

• Journal of Korean Academy of Fundamentals of Nursing
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• 제7권2호
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• pp.256-270
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• 2000

Invasive hemodynamic monitoring has become a valuable assessment parameters in critical care nursing in patients undergoing open heart surgery patients. During cardiac surgery, the Swan Ganz catheter is placed in the pulmonary artery. Critical care nurses routinely obtain cardiac output, cardiac index, and pulmonary arterial pressure in these patients. Traditionally, patients are positioned flat and supine for cardiac output measurement. Numerous studies have dealt with the effects of changing position on the hemodynamic variables. However, there are a few studies dealing with patients who undergo cardiac surgery in Korea. Thus, the purpose of this study was to determine the effects of changing position on cardiac output, PAP, CVP, BP, HR and discomfort in patients after cardiac surgery. A sample of 21 adults who had CABG and/or valve replacement with Swan Ganz catheters in place was studied. The data were collected in the cardiac ICU of a university hospital in Seoul during the period from July 28, 1999 to August 30. 1999. In this study, the independent variable is patient position in the supine, 30 degree, and 45 degree angles. Dependent variables are C.O., C.I., CVP, PAP, MAP, HR and patients' perceived discomforts. Subject discomfort was measured subjectively by visual analogue scale. Other hemodynamic data where collected by the thermodilution method and by direct measurement. The data were analyzed by percentile, t-test, ANOVA, Linear regression analysis using SPSS-/WIN program. The results are as follows : 1) Changes in cardiac output were absent in different angle positions, 0, 30. 45 degrees(F=.070, P=.932). Changes in cardiac index were absent in different angle positions, 0. 30, 45 degrees(P>.05). 2) Changes in central venous pressure were absent in different angle positions, 0, 30, 45 degree(P>.05). 3) PAP had no change in different angle 0, 30, 45 degree positions; systolic PAP(P>.05), diastolic PAP(P>.05). 4) Changes in systolic blood pressure were absent in different angle positions, 0, 30, 45 degree(P>.05). 5) Changes in heart rates were absent in different angle positions, 0, 30, 45 degree(P>.05). 6) Patients' perceived discomfort was absent in different angle positions, 0, 30, 45 degree(p<.05). In conclusion, critical care nurses can measure C.O., C.I., PAP, BP, & CVP in cardiac surgery patients at 30 degree or 45 degree positions. This can improve the patients' comfort.

• Tuberculosis and Respiratory Diseases
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• 제46권3호
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• pp.386-393
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• 1999

Objective : Cardiopulmonary exercise testing in patients with heart and lung problems is used to assess functional capacity, evaluate responses to medical treatment, plan for exercise therapy, assess progression of disease process, and determine prognosis. Particularly in the patients with lung cancer, the exercise pulmonary function test gives significant physiologic assessment of the lung resection candidate. Common exercise modalities are running and cycling. Until now, the comparison of two tests mainly has been done in normal person and patients with cardiac diseases. This study is designed to compare the treadmill and bicycle exercise pulmonary function test in patients with respiratory diseases. Methods : Twenty one patients underwent a progressively incremental exercise test to the symptom-limited stage with the treadmill (Vmax29 Sensor Medics, USA) and the bicycle(model No. 2,900 Sensor Medics, USA) with 7 days apart between the two tests. Measurements were made of the metabolic, cardiorespiratory parameters, blood gases, and symptoms. Results : The results of the treadmill exercise showed significant elevation in the $VO_2$max, VEmax, and anaerobic threshold compared to those of bicycle exercise. In contrast, the results of the breathing and heart rate reserve showed the reverse. Conclusion : These results suggest that the type of exercise should be taken into consideration when interpreting exercise test in patients with respiratory diseases.

• Safety and Health at Work
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• 제1권2호
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• pp.183-191
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• 2010

Objectives: The objective of this study is to investigate the distribution patterns and exposure concentrations of bioaerosols in industries suspected to have high levels of bioaerosol exposure. Methods: We selected 11 plants including 3 livestock feed plants (LF industry), 3 metal working fluids handling plants (MWFs industry), and 5 sawmills and measured total airborne bacteria, fungi, endotoxins, as well as dust. Airborne bacteria and fungi were measured with one stage impactor, six stage cascade impactor, and gelatin filters. Endotoxins were measured with polycarbonate filters. Results: The geometric means (GM) of the airborne concentrations of bacteria, fungi, and endotoxins were 1,864, $2,252\;CFU/m^3$, and $31.5\;EU/m^3$, respectively at the sawmills, followed by the LF industry (535, $585\;CFU/m^3$, and $22.0\;EU/m^3$) and MWFs industry (258, $331\;CFU/m^3$, and $8.7\;EU/m^3$). These concentrations by industry type were significantly statistically different (p < 0.01). The ratio of indoor to outdoor concentration was 6.2, 1.9, 3.2, and 3.2 for bacteria, fungi, endotoxins, and dust in the LF industry, 5.0, 0.9, 2.3, and 12.5 in the MWFs industry, and 3.7, 4.1, 3.3, and 9.7 in sawmills. The respiratory fractions of bioaerosols were differentiated by bioaerosol types and industry types: the respiratory fraction of bacteria in the LF industry, MWF industry, and sawmills was 59.4%, 72.0%, and 57.7%, respectively, and that of fungi was 77.3%, 89.5%, and 83.7% in the same order. Conclusion: We found that bioaerosol concentration was the highest in sawmills, followed by LF industry facilities and MWFs industry facilities. The indoor/outdoor ratio of microorganisms was larger than 1 and respiratory fraction of microorganisms was more than 50% of the total microorganism concentrations which might penetrate respiratory tract easily. All these findings suggest that bioaerosol in the surveyed industries should be controlled to prevent worker respiratory diseases.