• Title/Summary/Keyword: mechanical ventilation

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Evaluation of Radon Concentration according to Mechanical Ventilation Systems in Apartments (공동주택 내의 기계환기 설비에 따른 라돈농도 평가)

  • Choi, Jiwon;Hong, Hyungjin;Lee, Jeongsub;Yoo, Juhee;Park, Boram;Kim, Gahyun;Yoon, Sungwon;Lee, Cheolmin
    • Journal of Environmental Health Sciences
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    • v.47 no.4
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    • pp.330-338
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    • 2021
  • Background: This study was conducted to provide background information for the proper management of radon contamination in apartments using mechanical ventilation facilities in residential environments. Objectives: To this end, this study compared and evaluated changes in radon concentrations based on different operating intensities of mechanical ventilation with or without natural ventilation. Methods: For the continuous measurement of radon concentrations, an RAD7 instrument was installed in four apartments equipped with a ventilation system. The measurements were done for comparison of ventilation types and different ventilation intensities ("high", "middle", "low"). Results: The results confirmed that both mechanical and natural ventilation sufficiently reduced the radon concentration in the apartments. In particular, mechanical ventilation at "high" intensity was the most effective. Natural ventilation combined with mechanical ventilation and then natural ventilation alone were the second and the third most effective, respectively. Conclusions: When using ventilation to reduce indoor radon concentrations, it is most effective to operate mechanical ventilation ("high") or natural ventilation and mechanical ventilation at the same time. In cases where mechanical ventilation is available alone, it is recommended to operate it at a minimum of "middle" intensity.

Mechanical Ventilation of the Children (소아의 기계적 환기요법)

  • Park, June Dong
    • Clinical and Experimental Pediatrics
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    • v.48 no.12
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    • pp.1310-1316
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    • 2005
  • Mechanical ventilation in children has some differences compared to in neonates or in adults. The indication of mechanical ventilation can be classified into two groups, hypercapnic respiratory failure and hypoxemic respiratory failure. The strategies of mechanical ventilation should be different in these two groups. In hypercapnic respiratory failure, volume target ventilation with constant flow is favorable and pressure target ventilation with constant pressure is preferred in hypoxemic respiratory failure. For oxygenation, fraction of inspired oxygen($FiO_2$) and mean airway pressure(MAP) can be adjusted. MAP is more important than FiO2. Positive end expiratory pressure(PEEP) is the most potent determinant of MAP. The optimal relationship of $FiO_2$ and PEEP is PEEP≒$FiO_2{\times}20$. For ventilation, minute volume of ventilation(MV) product of tidal volume(TV) and ventilation frequency is the most important factor. TV has an maximum value up to 15 mL/kg to avoid the volutrauma, so ventilation frequency is more important. The time constant(TC) in children is usually 0.15-0.2. Adequate inspiratory time is 3TC, and expiratory time should be more than 5TC. In some severe respiratory failure, to get 8TC for one cycle is impossible because of higher frequency. In such case, permissive hypercapnia can be considered. The strategy of mechanical ventilation should be adjusted gradually even in the same patient according to the status of the patient. Mechanical ventilators and ventilation modes are progressing with advances in engineering. But the most important thing in mechanical ventilation is profound understanding about the basic pulmonary mechanics and classic ventilation modes.

Traumatic Tricuspid Regurgitation as a Cause of Failure to Wean from Mechanical Ventilation

  • Jeon, Yang Bin;Park, Chul Hyun;Ma, Dae Sung
    • Journal of Trauma and Injury
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    • v.33 no.4
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    • pp.264-268
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    • 2020
  • A 55-year-old man underwent emergent sternotomy due to cardiac tamponade occurring just after an accidental fall from a 10-m height. Tricuspid valve regurgitation was found on echocardiography while he was on mechanical ventilation after the operation. The patient was weaned successfully from mechanical ventilation after tricuspid valve repair under cardiopulmonary bypass. Traumatic tricuspid valve regurgitation is a rare blunt chest injury and its symptoms occur late. Tricuspid regurgitation should be considered as a reason for failure to wean from mechanical ventilation after blunt cardiac trauma.

Clinical Characteristics of Patients with Acute Organophosphate Poisoning Requiring Prolonged Mechanical Ventilation (장기간 인공환기가 필요한 유기인계 중독환자의 연관인자 분석)

  • Shin, Hwang-Jin;Lee, Mi-Jin;Park, Kyu-Nam;Park, Joon-Seok;Park, Seong-Soo
    • Journal of The Korean Society of Clinical Toxicology
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    • v.6 no.1
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    • pp.32-36
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    • 2008
  • Purpose: The major complication of acute organophosphate (OP) poisoning is respiratory failure as a result of cholinergic toxicity. Many clinicians find it difficult to predict the optimal time to initiate mechanical ventilation (MV) weaning, and as a result have tended to provide a prolonged ventilator support period. The purpose of this study is to determine any clinical predictors based on patients characteristics and laboratory findings to assist in the optimal timing of mechanical ventilator weaning. Methods: We reviewed medical and intensive care records of 44 patients with acute OP poisoning who required mechanical ventilation admitted to medical intensive care unit between July 1998 and June 2007. Patient information regarding the poisoning, clinical data and demographic features, APACHE II score, laboratory data, and serial cholinesterase (chE) levels were collected. Base on the time period of MV, the patients were divided into two groups: early group (wean time < 7 days, n = 28) and delayed group (${\geq}$ 7 days, n = 16). Patients were assessed for any clinical characteristics and predictors associated with the MV weaning period. Results: During the study period, 44 patients were enrolled in this study. We obtained the sensitivity and specificity values of predictors in the late weaning group. APACHE II score and a reciprocal convert of hypoxic index but specificity (83.8%) is only APACHE II score. Also, the chE concentration (rho = -0.517, p = 0.026) and APACHE II score (rho = 0.827, p < 0.001) correlated with a longer mechanical ventilation duration. Conclusion: In patients with acute OP poisoning who required mechanical ventilation, the APACHE II scoring system on a point scale of less than 17 and decrements in cholinesterase levels on 1-3 days were good predictors of delayed MV weaning.

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Does the Mean Arterial Pressure Influence Mortality Rate in Patients with Acute Hypoxemic Respiratory Failure under Mechanical Ventilation?

  • Gjonbrataj, Juarda;Kim, Hyun Jung;Jung, Hye In;Choi, Won-Il
    • Tuberculosis and Respiratory Diseases
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    • v.78 no.2
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    • pp.85-91
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    • 2015
  • Background: In sepsis patients, target mean arterial pressures (MAPs) greater than 65 mm Hg are recommended. However, there is no such recommendation for patients receiving mechanical ventilation. We aimed to evaluate the influence of MAP over the first 24 hours after intensive care unit (ICU) admission on the mortality rate at 60 days post-admission in patients showing acute hypoxemic respiratory failure under mechanical ventilation. Methods: This prospective, multicenter study included 22 ICUs and compared the mortality and clinical outcomes in patients showing acute hypoxemic respiratory failure with high (75-90 mm Hg) and low (65-74.9 mm Hg) MAPs over the first 24 hours of admission to the ICU. Results: Of the 844 patients with acute hypoxemic respiratory failure, 338 had a sustained MAP of 65-90 mm Hg over the first 24 hours of admission to the ICU. At 60 days, the mortality rates in the low (26.2%) and high (24.5%) MAP groups were not significantly different. The ICU days, hospital days, and 60-day mortality rate did not differ between the groups. Conclusion: In the first 24 hours of ICU admission, MAP range between 65 and 90 mm Hg in patients with acute hypoxemic respiratory failure under mechanical ventilation may not cause significantly differences in 60-day mortality.

Risk Factors for Mechanical Ventilation in Patients with Scrub Typhus Admitted to Intensive Care Unit at a University Hospital

  • Moon, Kyoung Min;Han, Min Soo;Rim, Ch'ang Bum;Lee, Jun Ho;Kang, Min Seok;Kim, Ji Hye;Kim, Sang Il;Jung, Sun Young;Cho, Yongseon
    • Tuberculosis and Respiratory Diseases
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    • v.79 no.1
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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.

Association between Medical Costs and the ProVent Model in Patients Requiring Prolonged Mechanical Ventilation

  • Roh, Jiyeon;Shin, Myung-Jun;Jeong, Eun Suk;Lee, Kwangha
    • Tuberculosis and Respiratory Diseases
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    • v.82 no.2
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    • pp.166-172
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    • 2019
  • Background: The purpose of this study was to determine whether components of the ProVent model can predict the high medical costs in Korean patients requiring at least 21 days of mechanical ventilation (prolonged mechanical ventilation [PMV]). Methods: Retrospective data from 302 patients (61.6% male; median age, 63.0 years) who had received PMV in the past 5 years were analyzed. To determine the relationship between medical cost per patient and components of the ProVent model, we collected the following data on day 21 of mechanical ventilation (MV): age, blood platelet count, requirement for hemodialysis, and requirement for vasopressors. Results: The mortality rate in the intensive care unit (ICU) was 31.5%. The average medical costs per patient during ICU and total hospital (ICU and general ward) stay were 35,105 and 41,110 US dollars (USD), respectively. The following components of the ProVent model were associated with higher medical costs during ICU stay: age <50 years (average 42,731 USD vs. 33,710 USD, p=0.001), thrombocytopenia on day 21 of MV (36,237 USD vs. 34,783 USD, p=0.009), and requirement for hemodialysis on day 21 of MV (57,864 USD vs. 33,509 USD, p<0.001). As the number of these three components increased, a positive correlation was found betweeen medical costs and ICU stay based on the Pearson's correlation coefficient (${\gamma}$) (${\gamma}=0.367$, p<0.001). Conclusion: The ProVent model can be used to predict high medical costs in PMV patients during ICU stay. The highest medical costs were for patients who required hemodialysis on day 21 of MV.

Effects of Two Music Therapy Methods on Agitation and Anxiety among Patients Weaning off Mechanical Ventilation: A Pilot Study

  • Park, Jong Yoen;Park, Soohyun
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.26 no.2
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    • pp.136-143
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    • 2019
  • Purpose: The feasibility and differential effects of two music therapy methods (interventions with preferred music vs. classical relaxation music) were done to examine the effects on agitation and anxiety in patients weaning off mechanical ventilation. Methods: This pilot study was conducted using a crossover design. Six patients listened to preferred music choices and classical relaxation music. Anxiety scores were measured using the Richmond Agitation Sedation Scale (RASS), State-Trait Anxiety Inventory (STAI), and visual analog scale (VAS). Results: Patients showed a significant decrease in agitation and anxiety after both the preferred and classical relaxation music interventions. The difference in the effects of preferred music and that of classical relaxation music was not significant. As for feasibility, patients exhibited a change in agitated behaviors after the music interventions by not trying to take off medical devices and quietly listening to the music, and by smiling and moving lips along with the lyrics while listening. Conclusion: Music interventions which centered on either patients' preferences or classical relaxation music to enhance relaxation, helped reduce agitation and anxiety during the mechanical ventilation weaning process.

Monitoring and Interpretation of Mechanical Ventilator Waveform in the Neuro-Intensive Care Unit (신경계 중환자실에서 기계호흡 그래프 파형 감시와 분석)

  • Park, Jin
    • Journal of Neurocritical Care
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    • v.11 no.2
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    • pp.63-70
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    • 2018
  • Management of mechanical ventilation is essential for patients with neuro-critical illnesses who may also have impairment of airways, lungs, respiratory muscles, and respiratory drive. However, balancing the approach to mechanical ventilation in the intensive care unit (ICU) with the need to prevent additional lung and brain injury, is challenging to intensivists. Lung protective ventilation strategies should be modified and applied to neuro-critically ill patients to maintain normocapnia and proper positive end expiratory pressure in the setting of neurological closed monitoring. Understanding the various parameters and graphic waveforms of the mechanical ventilator can provide information about the respiratory target, including appropriate tidal volume, airway pressure, and synchrony between patient and ventilator, especially in patients with neurological dysfunction due to irregularity of spontaneous respiration. Several types of asynchrony occur during mechanical ventilation, including trigger, flow, and termination asynchrony. This review aims to present the basic interpretation of mechanical ventilator waveforms and utilization of waveforms in various clinical situations in the neuro-ICU.

A Case Report of Acquired Nonmalignant Tracheoesophageal Fistula (후천성 비종양성 기관식도루;수술 치험1례)

  • 윤정섭
    • Journal of Chest Surgery
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    • v.25 no.8
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    • pp.800-805
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    • 1992
  • Acquired, nonmalignant tracheoesophageal fistula is an uncommom and difficult problem to manage. The most commom cause is a complication of endotracheal or tracheostomy tubes. Most are diagnosed while patients still require mechanical ventilation. The principle of treatment is two stage operation. First, new tracheostomy tube is placed so that the baloon is below the fistula, and gastrostomy and feeding jejunostomy are made for the drainage and feeding. Finally after weaning from the mechanical ventilation, tracheal resection and reconstruction are made, and the esophageal defect is closed in two layers and a viable strap muscle interposed into the two suture site to prevent recurrence. Recently, we experienced a case of acquired nonmalignant tracheoesophageal fistula which was developed during mechanical ventilation. She was successfully treated with the above two stage operation.

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