• 성인간호학회지
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• 제28권5호
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• pp.595-606
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• 2016

Purpose: This study aimed to investigate the influencing factors on self care, respiratory difficulty, sleep impediment, anxiety and depression among patients with neuromuscular disease who are dependent on Home Mechanical Ventilator (HMV). Methods: 157 patients were recruited through hospital based home nursing care departments and HMV rental centers. Data were collected by questionnaires. The analytic methods were n(%)/$M{\pm}SD$, $x^2$/t-test or ANOVA and multiple linear regression. Results: Patients with Amyotrophic lateral sclerosis were more likely to utilize HMV, had shorter periods of morbidity and the most extended daily use of HMV. As for medical equipment, they had ambu-bag (87.2%) and oxygenator (15.4%). Reports of respiratory difficulty and sleep impediment were low. There were no significant difference. In contrast, reported anxiety and depression were high and showed significant difference between non invasive HMV and invasive HMV. Anxiety contributes to respiratory difficulty (t=3.62, p=.002), sleep impediment (t=2.06, p=.042), and depression (t=7.24, p<.001). However, home nursing care exerts a positive influence in reducing anxiety (t=-2.73, p=.008). Conclusion: Anxiety contributes to respiratory difficulty, sleep impediment, and depression. However, those who use home nursing care reported less anxiety. Home nursing care positively impacts patients dependent on HMV as a practical service and available resource.

• Journal of Yeungnam Medical Science
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• 제5권1호
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• pp.105-110
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• 1988

흡입전신마취시에 마취호흡기를 사용할 겨우 환자에게 가장 적절한 1회 호흡량을 흡입시킬수 있는 방법을 알아보기 위하여 전신마취환자 30명에서 흡입기압력 $10cmH_2O$가 되도록 용량조절마취호흡기의 1회 호흡량을 조절하고 호흡수를 분당 12회로 하여 기계조절양압호흡을 유지시켜 보았던 바 다음과 같은 결과를 얻었다. 1) PH : $7.39{\pm}0.01$로서 정상범위내 이었다. 2) $PaCO_2$ : $34{\pm}0.6mmHg$ 로서 약간의 과환기상태 이었다. 3) $PaO_2$ : $228.0{\pm}8.2mmHg$ 이었다. 4) Buffer base : $20.7{\pm}0.3mEq/{\ell}$로서 약간의 염기부족상태 이었다. 이상의 결과로 미루어 보아 전신마취시 충분한 근 이완상태에서 기계조절호흡을 시행하는 경우 1회 호흡량 조절은 흡기압력을 $10cmH_2O$로 유지함이 가장 바람직한 것으로 사료된다.

• Journal of Trauma and Injury
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• 제26권4호
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• pp.291-296
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• 2013

Purpose: Prolonged ventilation leads to a higher incidence of ventilator-associated pneumonia (VAP), resulting in weaning failure and increased medical costs. The aim of this study was to analyze clinical results and prognostic factors of VAP in patients with blunt chest trauma. Methods: From 2007 to 2011, one hundred patients undergoing mechanical ventilation for more than 48 hours were divided into two groups: a VAP-negative group, (32 patients, mean age; 53 years, M:F=25:7) and a VAP- positive group, (68 patients, mean age; 60 years, M:F=56:12). VAP was diagnosed using clinical symptoms, radiologic findings and microorganisms. The injury severity score (ISS), shock, combined injuries, computerized tomographic pulmonary findings, transfusion, chronic obstructive lung disease (COPD), ventilation time, stay in intensive care unit (ICU) and hospital stays, complications such as sepsis or disseminated intravascular coagulation (DIC) and microorganisms were analyzed. Chi square, t-test, Mann-Whitney U test and logistic regression analysies were used with SPSS 18 software. Results: Age, sex, ISS, shock and combined injuries showed no differences between the VAP - negative group and - positive group (p>0.05), but ventilation time, ICU and hospital stays, blood transfusion and complications such as sepsis or DIC showed significant differencies (p<0.05). Four patients(13%) showed no clinical symptoms eventhough blood cultures were positive. Regardless of VAP, mortality-related factors were shock (p=0.036), transfusion (p=0.042), COPD (p=0.029), mechanical ventilation time (p=0.011), ICU stay (p=0.032), and sepsis (p=0.000). Microorgnisms were MRSA(43%), pseudomonas(24%), acinetobacter(16%), streptococcus(9%), klebsiela(4%), staphillococus aureus(4%). However there was no difference in mortality between the two groups. Conclusion: VAP itself was not related with mortality. Consideration of mortality-related factors for VAP and its aggressive treatment play important roles in improving patient outcomes.

• 가정∙방문간호학회지
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• 제24권2호
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• pp.121-132
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• 2017

Purpose: This study aimed to investigate the hospital nurses' knowledge, emergency coping ability and educational need about nursing care for patients applied the home mechanical ventilator (PaHMV) and to compare the variables between yes or not experienced on that. Methods: Participants were 91 hospital nurses who worked at the wards where PaHMV can be highly admitted such as respiratory internal medicine, rehabilitation medicine, neurology and emergency room. Data were collected by questionnaires. The analytic methods were $n(%)/M{\pm}SD$, t-test/ANOVA and $X^2-test/ANCOVA$. Results: Knowledge and emergency coping ability were low as $2.27{\pm}0.52$(4 points) and $78.72{\pm}8.06$(100 points) respectively. But educational need was high as $3.10{\pm}0.34$(4 points). Knowledge and emergency coping ability showed the significant differences between two groups (p<.001, p=.048), and the scores of experienced nurses were higher. But the educational need didn't show the significant difference (p=.974). Conclusion: These findings indicate that education on nursing care of PaHMV is needed for hospital nurse. So we have to develop the educational program on nursing care of PaHMV and then operate it with practice and site education.

• 한국산업보건학회지
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• 제16권4호
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• pp.364-374
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• 2006

Natural ventilation technique could be the substitute for or the complement to the local exhaust ventilation system in the sense of protecting work environment. Moreover, it has many strong points ; almost no mechanical parts, no energy use and no noise. If applied appropriately, it could have the very high ventilation rate and save a lot of energy expense. But, it depends on the outdoor environment, especially temperature and wind speed/direction. Predicting the capacity of natural ventilation is not an easy job because it comes from both buoyancy and wind effect. Another problem is too much flow through the ventilator especially in winter time due to too much difference between indoor and outdoor temperature. Thus some ventilators in industries are sealed by door or plastic sheet, resulting in bad work environment. Various types of dampers are used to control the flow rate through ventilators. The capabilities of flow control by damper has not been estimated. In addition, it was not tested whether the damper could obstruct the flow through ventilator when fully opened. To answer these questions, 4 types of dampers were tested by using computational fluid dynamics. 10 different configurations includes no damper, full open and half open. Flow rates were estimated and airflow fields were analysed to clarify the before-mentioned questions. The dual type damper was the best choice for controling the capability of ventilator. In addition, the upward grill type damper was the best for not obstructing the air flow when fully opened.

• 한국입자에어로졸학회지
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• 제16권4호
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• pp.73-94
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• 2020

Particulate infectious sources, including infectious viruses, can float in the air, causing airborne infections. To prevent indoor airborne infection, dilution control by ventilation and indoor air cleaners are frequently used. In this study, the risk of airborne infection by the operation of these two techniques was evaluated. In case of dilution control by ventilation, a high efficiency air filter was embedded at the inlet of supply air. In this study, infectious source reduction devices such as indoor air cleaner include all kinds of mechanical-filters, UV-photo catalysts and air ionizers through which air flow is forced by fans. Two mathematical models for influenza virus were applied in an infant care room where infants and young children are active, and the risk reduction efficiency was compared. As a result, in the case of individually operating the ventilator or the infectious source reduction device, the airborne infection risk reduction efficiencies were 55.2~61.2% and 53.8~59.9%, respectively. When both facilities were operated, it was found that the risk of airborne infection was reduced about 72.2~76.8%. Therefore, simultaneous operation of ventilation equipment and infectious source reduction device is the most effective method for safe environment that minimizes the risk of airborne infection of respiratory infectious diseases. In the case of a space where sufficient ventilation operation is difficult, it was found that the operation of an infectious source reduction device is important to prevent the spread of infectious diseases. This study is meaningful in that it provides an academic basis for strategies for preventing airborne infection of respiratory infectious diseases.

• Pediatric Infection and Vaccine
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• 제12권1호
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• pp.67-74
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• 2005

목 적 : 최근 신생아학의 발달과 신생아 집중 치료의 발달로 기관내 삽관 후 인공 환기요법 치료가 빈번하게 이루어져 호흡곤란증이 있는 신생아의 사망률은 감소된 반면 이에 따른 여러 합병증이 병발할 가능성이 높아지게 되었다. 이에 저자들은 인공 환기요법을 사용한 신생아에서 VAP의 발생빈도와 위험요인 및 주된 균주에 대해 알아보았다. 방 법 : 2000년 1월 1일부터 2003년 6월 30일까지 한림대학교 강남성심병원 신생아 집중치료실에 입원하여 인공 환기요법을 사용한 신생아 50명을 대상으로 하여 입원 기록지를 후향적으로 분석하였다. VAP의 진단은 기관내 삽관 당시에는 폐렴이 보이지 않으나 기관내 삽관 후 최소 48시간 경과 후 흉부 방사선상 새롭게 침윤이 발생한 경우로 정의하였다. 상기 조건에 만족하는 환아 13명을 VAP군으로, 만족하지 않는 환아 37명을 대조군으로 분류하였다. 결 과 : 인공 환기요법을 사용했던 환아 50명 중 VAP의 발생빈도는 26.0%(13명)였다. 동맥관 개존증과 뇌실내 출혈이 VAP 발생과 연관이 있었고 재태연령, 출생체중, 1분 및 5분 Apgar 점수 및 호흡곤란 증후군, 기관지폐 이형성증, 미숙아 망막증, 패혈증, 급성 신부전, 폐출혈, 공기 누출 증후군 등과는 연관이 없었다. 본 연구에서는 총 12균주가 동정되었는데 MR-CNS 4례(33.3%), E. cloacae 3례(25.0%), P. aeruginosa 2례(16.7%), MRSA 1례(8.3%), Acinetobacter baumanii 1례(8.3%), K. pneumoniae 1례(8.3%)로 MR-CNS가 가장 많았다. 결 론 : 본원 신생아 집중치료실에서 인공 환기요법 치료 후 발생한 폐렴의 빈도는 26.0%이며 MR-CNS가 가장 많이 배양되였다. 기관삽관 말단의 배양은 VAP의 정확한 진단을 위해서는 적절치 않을 수 있으나 신생아에게 필요한 침습적이지 않고 정확한 방법에 대한 연구가 필요하다고 생각된다.

• 대한설비공학회:학술대회논문집
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• 대한설비공학회 2006년도 동계학술발표대회 논문집
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• pp.28-28
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• 2006

• 대한기관식도과학회지
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• 제6권2호
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• pp.177-180
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• 2000

Backgrounds： Patients with respiratory failure may require prolonged mechanical ventilation. The purpose of this study was to determine the optimal time for tracheostomy and complications of tracheostomy. Methods : All medical records of 27 patients who underwent tracheostomy in department of thoracic & cardiovascular surgery at Yondong Severance hospital between January 1, 1990 and December 31, 1998, were reviewed. Variables analyzed include underlying disease, primary indication of tracheostomy, interval from 1st intubation to tracheostomy, duration from tracheostomy to weaning ventilator, duration of decannulation, and complication. There were 18 men and 9 women. Mean age at the time of the tracheostomy was 54 years (rage, 11 to 64 yeras). Results : Underlying diseases included lung cancer in 14 patients (51.9%), trauma in 8 patients (29.6%), and TE fistula in 2 patients. The indication for tracheostomy were as follows: prolonged mechanical ventilation in 13 patients, purpose of bronchial toilet in 9 patients, and tracheal stenosis in 5 patients. The mean interval between the first intubation and tracheostomy was 8.1 days. The mean duration from tracheostomy to weaning ventilator was 10.1 days. Conclusions : Timing of tracheostomy Is very important. Tracheostomy may benefit patients because it can accelerate the process of weaning and thus lead to a reduction in the duration of ventilation, length of hospitalization, and cost.

• 가정∙방문간호학회지
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• 제23권1호
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• pp.25-33
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• 2016

Purpose: This study aimed to survey caregivers of patients with Neuromuscular Rare and Incurable Disease (NRID) using invasive home mechanical ventilator (HMV), in order to compare the incident rate of pneumonia by tracheal suction procedures used. Method: Participants were 99 family caregivers of NRID patients using HMV. Participants were given a questionnaire consisting of 12 demographic items, 10 items about disease and HMV related characteristics, 11 items about tracheal suction procedures, and 2 items about the incidence of pneumonia. Data were analyzed using chi-square tests and t-tests. Results: The items that predicted the incidence of pneumonia were "change of irrigation saline every suction" (p=.047), "use of aseptic catheter every suction" (p=.004), and "instillation of normal saline before suction" (p=.027). In addition, these items were 47.4%, 51.4%, and 38.8% respectively. Conclusion: Family members caring for NRID patients with invasive HMV should be educated about tracheal suction, especially the necessity of changing irrigation saline after every suction, using the aseptic catheter for every suction, and instillation of normal saline before suction. Medical personnel such as home care nurses should periodically check tracheal suction procedures, and re-educate family caregivers when necessary.