• Tuberculosis and Respiratory Diseases
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• v.82 no.3
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• pp.242-250
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• 2019

Background: Data on noninvasive ventilation (NIV) use in intensive care units (ICUs) are very limited in South Korea. Methods: A prospective observational study was performed in 20 ICUs of university-affiliated hospitals from June 2017 to February 2018. Adult patients (age>18 years) who were admitted to the ICU and received NIV treatment for acute respiratory failure were included. Results: A total of 156 patients treated with NIV were enrolled (mean age, $71.9{\pm}11.6years$). The most common indications for NIV were acute hypercapnic respiratory failure (AHRF, n=89) and post-extubation respiratory failure (n=44). The main device for NIV was an invasive mechanical ventilator with an NIV module (61.5%), and the majority of patients (87.2%) used an oronasal mask. After the exclusion of 32 do-not-resuscitate patients, NIV success rate was 68.5% (85/124); ICU and hospital mortality rates were 8.9% and 15.3%, respectively. However, the success rate was lower in patients with de novo respiratory failure (27.3%) compared to that of patients with AHRF (72.8%) or post-extubation respiratory failure (75.0%). In multivariate analysis, immunocompromised state, de novo respiratory failure, post-NIV (2 hours) respiratory rate, NIV mode (i.e., non-pressure support ventilation mode), and the change of NIV device were significantly associated with a lower success rate of NIV. Conclusion: AHRF and post-extubation respiratory failure were the most common indications for NIV in Korean ICUs. Overall NIV success was achieved in 68.5% of patients, with the lowest rate in patients with de novo respiratory failure.

• Tuberculosis and Respiratory Diseases
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• v.49 no.3
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• pp.343-352
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• 2000

Backgrounds : Respiratory care for patients in intensive care units (ICUs) has been performed mainly by nurses in Korea. However, the current status of respiratory care in the Korea ICUs is not well known. Respiratory care and the methods of delivery in ICUs were surveyed. Method : A confidential questionnaire was distributed to the head nurses working the ICUs at 117 hospitals in Korea. One hundred hospitals returned the questionnaires, for a response rate of 85%. The hospitals were divided into three groups : Main university hospitals (MUH), university associated hospitals (UAH), and general hospitals (GH) Result : Eighteen units of 66 units in MUH and 35 units of 58 units in GH were organized as a general ICUs. The percentage of ICUs with full-time doctors was 47.1%. The nurses usually delivered respiratory care spending from 1 to 4 h during their 8 h of working time. Although the respondents felt that respiratory care should be delivered by trained respiratory therapists, these therapists were not found at the hospitals. Most of the units performed percussion, tracheal suctioning, and positional changes. However, vibration and IPPB were less frequently performed in GH. Among oxygen supply apparatus, venturi mask and T-piece were not frequently used in GH. GH applied a noninvasive ventilator mode less frequently than MUH and UAH. The percentage of Swan-Ganz catheter monitoring was only 21.4% in GH. Conclusion : Respiratory care for patients in the Korean ICUs was provided by nurses on the whole. In addition, there were many differences in the level of respiratory care according to the type of hospital. To overcome the current problems revealed, an effective in-hospital training program for the development of full-time respiratory care therapists should be established urgently in Korea.

• 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.

• Tuberculosis and Respiratory Diseases
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• v.71 no.4
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• pp.271-277
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• 2011

Background: A chronic obstructive pulmonary disease (COPD) assessment test (CAT) has recently been developed as a short and simple method for assessing the quality of life in COPD patients. The object of this study was to assess the usefulness of the Korean version of the CAT for assessing COPD patients in an outpatient clinic. Methods: The study included 60 COPD patients in a stable state from an outpatient clinic. The authors investigated the frequency of acute exacerbation during aprevious year through reviewing medical records. We evaluated the spirometry test, a 6-min walk distance test, and obtained the MMRC dyspnea scale, the Korean version of the CAT, and the BODE index at the time of visit. To assess the usefulness of the CAT, correlations between the CAT and other methods were evaluated. Results: The mean age of patients was $68.3{\pm}8.6$ years and 95% of patients were male. There was a significant correlation between the CAT score and $FEV_1%$ (r=-0.323, p=0.012), the frequency of acute exacerbation (r=0.292, p=0.024), the MMRC dyspnea scale (r=0.554, p<0.001), the BODE index (r=0.380, p=0.003), and 6 MWD (r=-0.372, p=0.004). The mean CAT score increased according to the GOLD stage (stage 1, $10.7{\pm}4.5$; stage 2, $13.1{\pm}7.9$; stage 3, $16.3{\pm}6.2$; stage 4, $16.5{\pm}14.8$; p=0.746). Conclusion: The CAT was shown to be useful for the assessment of COPD severity. Therefore, the CAT is an easily applied and simple method for assessing COPD severity in an outpatient clinic.

• Tuberculosis and Respiratory Diseases
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• v.55 no.4
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• pp.395-401
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• 2003

Fluoroquinolone is one of the first-line antibiotics recommended for treating community-acquired pneumonia. However, using fluroquinolones for presumptive community-acquired pneumonia can delay the diagnosis and the treatment of pulmonary tuberculosis because of its strong activity against mycobacteria. Here, we report a case of a 54-year-old female taking immunosuppressants after a renal transplant whose diagnosis of pulmonary tuberculosis was delayed as a result of the use of levofloxacin and amikacin under the original impression of community-acquired pneumonia. This case suggests that clinicians should consider the possibility of pulmonary tuberculosis in the case of a partial response of the pneumonia to flouroquinolones and/or aminoglycosides.

• Tuberculosis and Respiratory Diseases
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• v.64 no.6
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• pp.451-455
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• 2008

Pulmonary mucormycosis is an uncommon, serious opportunistic infection caused by fungi belonging to the order Mucorales and it occurs exclusively in debilitated or immuno-compromised hosts. It is known that the fungi can invade the blood vessels and cause serious ischemic necrosis and bleeding5. We experienced a fatal case of pulmonary mucormycosis in a diabetic 75-year-old man who developed a progressive necrotizing lesion despite administering proper and prompt medical and surgical treatment. We report here on this case along with a review of the relevant medical literature.

• Tuberculosis and Respiratory Diseases
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• v.63 no.2
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• pp.200-203
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• 2007

Adenocarcinoma presenting as a solitary mass with a cavity in chest computed tomogram is rare. A few reports have suggested an association between lung cancer and emphysema. We report a case of adenocarcinoma surrounding pulmonary emphysema that mimicked fungal pneumonia. This case highlights the need for cliniclians to be aware of the potential development of lung cancer in patients with emphysema.

• Tuberculosis and Respiratory Diseases
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• v.64 no.3
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• pp.210-214
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• 2008

Chemical pneumonitis is an occupational lung disease that's caused by the inhalation of chemical substances. Its severity depends on the characteristics of the substances, the exposure time and the susceptibility of the patients. Hydrogen sulfide is not only emitted naturally, but it also frequently found in industrial settings where it is either used as a reactant or it is a by-product of manufacturing or industrial processes. Inhalation of hydrogen sulfide causes various respiratory reactions from cough to acute respiratory failure, depending on the severity. Two pharmaceutical factory workers were admitted after being rescued from a waste water disposal site that contained hydrogen sulfide. In spite that they recovered their consciousness, they had excessive cough and mild dyspnea. The simple chest radiographs and high resolution computed tomography showed diffuse interstitial infiltrates, and hypoxemia was present. They were diagnosed as suffering from chemical pneumonitis caused by hydrogen sulfide. After conservative management that included oxygen therapy, their symptoms, hypoxemia and radiographic abnormalities were improved.

• The Journal of Korean Academic Society of Nursing Education
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• v.9 no.1
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• pp.17-29
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• 2003

This study investigated the degree of self-care practice to maintain the stable respiratory function and the required respiratory nursing needs upon the elderly with chronic obstructive pulmonary diseases. The research subjects were 115 elderly people over 60 years old, who were diagnosed to have chronic obstructive pulmonary diseases (the mixed type, chronic bronchitis, bronchial asthma, emphysema) and were hospitalized in 3 university hospitals in Busan or treated as outpatient, and the data was collected over the period between June 1, 2002 and September 30, 2002. In order to measure the respiratory self-care practice degree and nursing needs of the subjects, the instrument on the self-care practice and the instrument on nursing needs were developed by the researcher. The research results are as follows: 1. The mean of respiratory self-care practice degree by the subjects was 2.41 out of 4 for each clause, and the degree of practicing general management was the highest(2.70), and nutrition control(2.66), respiratory exercise(2.65), expectoration of sputum (2.63), oxygen therapy(2.60), environment control(2.50), and medication control(2.36) succeeded. 2. The degree of self-care practice had a significant difference depending on age(F=2.82, P=0.02), frequency of hospitalization(F=3.11, P=0.01), and diagnosed disease(F=15.66, P=0.00). 3. The subjects nursing needs of respiratory system were 3.07 on the average out of 4.00, and 'I want to know how to prevent the infection of respiratory system such as cold scored the highest 3.83, while the clauses like 'want to know how to face the respiratory disorder properly'(3.77) and 'want the specific explanation of the symptoms of my disease'(3.66) also had scored high points. 4. The nursing needs of the respiratory system had a significant difference depending on diagnosed disease such as mixed type of chronic obstructive pulmonary diseases, emphysema, bronchitis, and asthma (F=6.70, P=0.00). The research showed that the subjects degree of self-care practice of respiratory system was low on the whole, while the nursing needs for managing respiratory organ were relatively high. Therefore, specific education concerning the nursing of the disease and self-care upon the elderly having chronic obstructive pulmonary disease is necessary.

• Tuberculosis and Respiratory Diseases
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• v.67 no.6
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• pp.506-511
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• 2009

Background: The smoking prevalence in asthma patients are similar to those in the general population. Asthma and active cigarette smoking can interact to create more severe symptoms, an accelerated decline in lung function and impaired therapeutic responses. Accordingly, asthmatics with a history of smoking were examined to define the clinical characteristics and lung function of smoking asthmatics. Methods: The medical records of 142 asthmatics with a known smoking history were reviewed. The patients were divided into three groups according to their smoking history - current smokers, former smokers and non-smokers. The clinical characteristics, lung function, and annual declines of the forced expiratory volume in one second ($FEV_1$) were compared. Results: Fifty-three of the 142 patients (37%) were current smokers, 24 were former smokers (17%) and 65 were non-smokers (45%). The patients with a hospital admission history during the previous year included 16 current smokers (30%), 4 former smokers (17%) and 7 non-smokers (11%) (p=0.02). The mean $FEV_1$ (% predicted) was 76.8${\pm}$19.8%, 71.6${\pm}$21.1% and 87.9${\pm}$18.7% for current smokers, former smokers and non-smokers, respectively (p< 0.001). The $FEV_1$/forced vital capacity (FVC) (ratio, %) values were 63.6${\pm}$12.6%, 59.3${\pm}$14.9% and 72.1${\pm}$11.8% in current smokers, former smokers and non-smokers, respectively (p<0.001). The corresponding mean values for the individual $FEV_1$ slopes were not significant (p=0.33). Conclusion: Asthmatic smokers demonstrated higher hospital admission rates and lower lung function. These findings suggest that the smoking history is an important predictor of a poor clinical outcome in asthma patients.