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국내 중환자실에서 72시간 이상 인공호흡기 치료를 받는 환자들의 진정제, 진통제 및 근이완제 사용 실태에 대한 전향적 다 기관 공동 조사연구
장항제,나승원,오범진,임채만,고윤석,홍상범,호흡부전연구회 대한중환자의학회 2009 Acute and Critical Care Vol.24 No.3
Background: To investigate the usage patterns of sedatives, analgesics and neuromuscular blocking agents (NMBAs) in patients requiring mechanical ventilation more than 72 hours in intensive care units (ICUs) of Korea. Methods: A total of 536 patients continuing mechanical ventilation more than 72 hours had been enrolled among the twenty-one ICUs of Korea from May 2003 to July 2003. Data about mechanical ventilation, the use of sedatives, analgesics, and NMBAs were prospectively collected for four weeks. We analyzed the patterns of using these drugs and effects on outcomes. Results: More than half of the patients (50.4%) received sedative drug alone. Most commonly used sedatives and analgesics were midazolam and morphine. NMBAs were administered in 41% of the patients. Volume controlled ventilation mode was associated with more frequent use of NMBAs. There were no significant differences in outcome variables among the usage patterns of sedatives, analgesics and NMBAs. Conclusions: Our investigation shows that analgesics were much less frequently used in the intensive care units of Korea compared with the use of sedatives. And the use of NMBAs were quite a common.
브러시리스 직류 전동기용 새로운 센서리스 드라이브 개발에 관한 연구
장항제,이용순,김종선,유지윤,이광운,여형기,박정배 전력전자학회 2001 전력전자학회 논문지 Vol.6 No.3
구형파 브러시리스 직류전동기를 구동시키기 위해서는 전동기의 회전자 위치에 대한 정보를 아는 것이 필수적이다. 본 논문에서는 회전자 위치를 검출하기 위해 일반적으로 사용되는 홀센서나 엔코더를 이용하지 않고, 각 상을 저항으로 Y결선하여 만들어지는 단자의 전압에 포함되어 있는 비여자상의 역기전력을 이용하여 전동기의 회전자 위치를 검출하는 구형파 브러시리스 직류전동기용 센서리스 드라이브 시스템을 제안한다. 이를 위해 3상 2여자 선단부 유니폴라 PWM을 수행할 결우에 대한 각상의 단자전압 분석을 수행하고, 분석된 단자전압 파형으로부터 회전자 위치를 검출하는 방법을 제안한다. 그리고 이를 실제로 간단한 회로로 구현하였다. 실험에 사용된 전동기는 100W급이며 Power MOSFET으호 인버터를 구성하였으며 87c196mc 컨트롤러를 사용하여 제어기를 구성하였다. This power proposes a new sensorless drive system for the trapezoidal brushless DC motor generally requiring mechanical position or speed sensor. For this an indirect rotor position sensing method from the back emf waveform of non-conducting phase is explained. Back emf waveform of non-conducting is obtained from analysing terminal voltage created by making Y-connection. And an experiment is implemented with a driving system which use 87c196mc microcontroller having a peripheral associated with 3-phase signals and inverter composed of Power MOSFET. The experimental results show the validity and practicality of the proposed sensorless drive.
다제내성 Acinetobacter baumannii에 의한 인공호흡기연관 페렴에서 Colistin 단독요법과 시험관 내 상승작용에 근거한 병합요법간의 효능 비교
장항제 ( Hang Jea Jang ),김미나 ( Mi Na Kim ),이광하 ( Kwang Ha Lee ),홍상범 ( Sang Bum Hong ),임채만 ( Chae Man Lim ),고윤석 ( Youn Suck Koh ) 대한결핵 및 호흡기학회 2009 Tuberculosis and Respiratory Diseases Vol.67 No.3
Background: Ventilator-associated pneumonia caused by multi-drug resistant Acinetobacter baumannii has been increasing and growing as a threat in intensive care units. Limited therapeutic options have forced clinicians to choose colistin with or without combination of other antibiotics. We tried to compare the effectiveness between colistin monotherapy and combination therapy based on in vitro synergistic tests. Methods: From January 2006 to December 2007 in medical ICU of a tertiary care hospital in Korea, We reviewed the medical records of patients treated with intravenous colistin due to ventilator-associated pneumonia caused by multi-drug resistant Acinetobacter baumannii. Results: A total of 41 patients were analyzed. 22 patients had been treated with colistin monotherapy and 19 patients with colistin and combination antibiotics that were found to have in vitro synergistic effects. Baseline characteristics were similar in both groups but the mean duration of colistin administration was significantly longer in the combination group (19.1±11.2 days vs. 12.3±6.8 days, p=0.042). There were no significant differences in outcome variables between the two groups. Conclusion: Combination treatment based on the in vitro antimicrobial synergy test did not show better outcomes compared with colistin monotherapy in VAP caused by multi-drug resistant A. baumannii.
한 내과계 중환자실에서 사망한 환자들의 심폐소생술 거절 현황
이광하,장항제,홍상범,임채만,고윤석 대한중환자의학회 2008 Acute and Critical Care Vol.23 No.2
Background: Do-not-resuscitate (DNR) in the event of a cardiac arrest is the most common and important discussion between a patient`s family and physicians among the end-of-life decision-making process. To observe the performance of a DNR order in critically ill patients, we analyzed the incidence of DNR orders, the changes in therapeutic levels after DNR orders, and the cases of violated DNR codes in patients who had died in a Korean medical intensive care unit (ICU) between 1 January 2006 and 30 June 2006. Methods: The charts of patients who had died in the medical ICU were retrospectively reviewed. Results: One hundred two patients were enrolled. The ICU and hospital lengths of stay of the patients were 12.4 ± 14.0 and 23.2 ± 21.1 days, respectively. Hematologic malignancy (24.5%) accounted for the most common premorbid diagnosis before ICU admission. Seventy-five patients (73.5%) had DNR orders. The DNR order was suggested by the physician in 96% of the patients. There was no significant difference in the clinical parameters and the performance of a DNR order. Eighty-four percent of the patients with a DNR order had received the order within 3 days death. The withholding of additional therapy or withdrawing of current therapy occurred in 57.3% of the patients. The DNR order was violated in 9 cases (12%). Conclusions: DNR orders are well-accepted by the patient`s family in the ICU. However, DNR orders are initiated when patient death is imminent.