Extended Use of Extracorporeal Membrane Oxygenation for Acute Respiratory Distress Syndrome: A Retrospective Multicenter Study

김원영,박승용,김화정,백문성,정치량,박소희,강병주,오진영,조우현,심윤수,조영재,박성훈,김정현,홍상범 대한결핵및호흡기학회 2019 Tuberculosis and Respiratory Diseases Vol.82 No.3

Background: Beyond its current function as a rescue therapy in acute respiratory distress syndrome (ARDS), extracorporeal membrane oxygenation (ECMO) may be applied in ARDS patients with less severe hypoxemia to facilitate lung protective ventilation. The purpose of this study was to evaluate the efficacy of extended ECMO use in ARDS patients. Methods: This study reviewed 223 adult patients who had been admitted to the intensive care units of 11 hospitals in Korea and subsequently treated using ECMO. Among them, the 62 who required ECMO for ARDS were analyzed. The patients were divided into two groups according to pre-ECMO arterial blood gas: an extended group (n=14) and a conventional group (n=48). Results: Baseline characteristics were not different between the groups. The median arterial carbon dioxide tension/ fraction of inspired oxygen (FiO2) ratio was higher (97 vs. 61, p<0.001) while the median FiO2 was lower (0.8 vs. 1.0, p<0.001) in the extended compared to the conventional group. The 60-day mortality was 21% in the extended group and 54% in the conventional group (p=0.03). Multivariate analysis indicated that the extended use of ECMO was independently associated with reduced 60-day mortality (odds ratio, 0.10; 95% confidence interval, 0.02–0.64; p=0.02). Lower median peak inspiratory pressure and median dynamic driving pressure were observed in the extended group 24 hours after ECMO support. Conclusion: Extended indications of ECMO implementation coupled with protective ventilator settings may improve the clinical outcome of patients with ARDS.

종모돈 관리 포인트

김원영,Kim, Won-Yeong 대한양돈협회 1987 養豚 Vol.9 No.6

급성 하벽심근경색증 환자에서 우심실경색을 찾아내기 위한 표준 12유도 심전도기준들과 80-유도 체표지도 (Body surface mapping)의 진단정확도 비교

김원영,김원,오범진,오세현,임경수 대한응급의학회 2004 大韓應急醫學會誌 Vol.15 No.3

P u r p o s e: Right ventricular (RV) infarction is associated with increased morbidity and mortality in patients with acute inferior wall myocardial infarction (MI). A 12-lead electrocardiogram (ECG) has a poor tendency to identify RV involvement. Our objective was to evaluate the diagnostic accuracy of 80-lead body surface mapping (BSM) for RV infarction and to compare diagnostic accuracy of 12-lead ECG criteria and 80-lead BSM for RV infarction in patients with acute inferior wall MI. M e t h o d s: Between September 2002 and January 2003, 96 patients visited to our emergency center with AMI. All standard initial 12-lead ECG and 80-lead BSM were examined and compared with angiographic and echocardiographic findings. R e s u l t s: Thirty-one patients were confirmed as inferior wall MI. With the use of exclusion criteria, sixteen patients included in this study. RV infarction accompanied in 5 patients of these 16 patients. BSM showed a high sensitivity (60%), specificity (82%), high positive and negative predictive values (60%, and 82%, respectively), and high diagnostic accuracy (75%) in diagnosing RV infarction in patients with acute inferior wall MI. BSM showed increase in the sensitivity for RV infarction from 40% to 60% when compared with the 12-lead ECG. C o n c l u s i o n: The 80-lead BSM is a more useful test in diagnosing RV infarction in patients with acute inferior wall MI.

P-25 Predicting mortality in patients with tuberculous destroyed lung on mechanical ventilation

김원영,조은정,엄중섭,목정하,김미현,김기욱,박혜경,이민기,이광하 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-

Background: Given the poor prognosis of tuberculous destroyed lung (TDL) necessitating mechanical ventilation, it is important to identify patients who might benefit from such treatment. The aim of this study was to develop a mortality prediction model for patients with TDL requiring mechanical ventilation. Methods: Consecutive TDL patients who received mechanical ventilation and were admitted to the medical ICU of the Pusan National University Hospital were reviewed. Binary logistic regression was used to identify factors predicting ICU mortality. The TDL-Vent score was calculated as the sum of simplified regression weights (SRW), and its predictive ability was compared to Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores. Results: A total of 125 patients were included; 36 (29%) of these died during a stay in the ICU. Multivariate analysis identified age ≥ 65 years (SRW 1), vasopressor use (SRW 1), and PaO2/FiO2 ratio < 180 (SRW 1) for inclusion in the TDL-Vent score. The area under the receiver operating characteristic curve of the TDL-Vent score was 0.72 (95% confidence interval, 0.63-0.80) and was larger than those of APACHE II (0.63; 95% confidence interval, 0.54-0.72) and SOFA (0.62; 95% confidence interval, 0.53-0.71) scores. The cutoff value for predicting ICU mortality based on maximum Youden’s index was ≥ 2. Conclusions: The TDL-Vent score is a simple model that may be useful for predicting ICU mortality among patients with TDL requiring mechanical ventilation.

소장점막의 허혈-재관류 손상에 대한 Capsaicin의 보호효과

김원영,임경수,박형섭 대한응급의학회 2002 대한응급의학회지 Vol.13 No.2

Purpose: Capsaicin, a major ingredient of hot peppers, has a stimulatory effect of the neurons. Ingested capscaicin causes pain and even damages the mucosa with a large dose. On the other hand, it protects the gastric mucosa against many ulcerogenic agents or conditions. In this study, we investigated the effect of oral capsaicin on the ischemia-reperfusion damage of the intestinal mucosa in rats. The involvement of stress proteins such as HSP-70 and HSP-72 in the action of capsaicin was also investigated. Methods: Male Sprague-Dawley rats were given oral capsaicin (20 mg/kg/day) for a designated period. Ischemia of the small intestine was inflicted by clamping the superior mesenteric arteries for 30 minutes under anesthesia. After the ischemic period, the clamp was released and the animal was kept for 1,5, or 24 hours. Then, the intestinal structure was observed under the microscope, and the levels of the heart-shock proteins were determined by using a Western blot. Results and Conclusion: Oral capsaicin protected the mucosa of the small intestine against the ischemia/reperfusion injury. Capsaicin also increased and expedited the ischemia/reperfusion-induced expression of the heat-shock proteins, HSP-70 and 72, in the intestine. The possible linkage between the two events is discussed.

野球競技에서 Base Running에 關한 硏究 : 打者走者 二壘進壘의 效果的인 Course選擇을 中心으로

金元永,金鼎柱,金尙國 경희대학교 체육과학연구소 1985 體育學論文集 Vol.13 No.-

To investigate the time, the distance and the number of steps along different courses of 'base-running,' some players of amateur base-ball teams were made objects of this investigation and the conclusion reached is as follows: 1.The necessary times for running are 8"00 along A Course, 7"92 along B Course and 7"80 along C Course respectively. C Course turns out to require the minimum of time. 2.The numbers of steps are 34.7 paces along A Course, 34.6 paces along B Course and 34.8 paces along C Course respectively. 3.The distance are 55.85m along A Course, 55.54m along B Course and 56.34m along C Course respectively. C Course turns out to be the longest. 4.The angle of the change of direction from first base to second base is 50˚ along each course. But C Course, whose angle of advance from uome base to first base is little and that from first base to second base is great, turns out to be one along which the runner can run in the least time. (Fig. 1 Refer to the angle of the change of direction along each course.) Along C Course, the runner can minimize, when he changes his direction, the centrifugal force caused by acceleration, and make the best of the acceleration. Therefore, C Course is the most desireable.

Comparable efficacy of tigecycline versus colistin therapy for multidrug-resistant and extensively drug-resistant Acinetotbacter baumannii pneumonia in critically ill patients

김원영,문재영,허진원,임채만,고윤석,정용필,홍상범 대한결핵 및 호흡기학회 2015 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.120 No.-

Background: Tigecycline may be an alternative therapy of treating pneumonia caused by multidrug-resistant and extensively drug-resistant Acinetobacter baumannii (MDR/XDRAB). The aim of this study was to compare the efficacy of tigecycline-based therapy with colistin-based therapy in patients with MDR/XDRAB pneumonia. Methods: Between January 2009 and December 2010, patients in the intensive care unit who were diagnosed with MDR/XDRAB pneumonia and treated with either tigecycline or colistin mono-/combination therapy were reviewed. Results: A total of 70 patients were included in our analysis. Among them, 30 patients received tigecycline-based therapy, and 40 patients received colistin-based therapy. Baseline characteristics were similar in the two groups. The 30-day mortality was 33% in the tigecycline group and 30% in the colistin group (P = 0.77). Colistin-based therapy was significantly associated with developing nephrotoxicity (P = 0.009). Microbiological failure, clinical failure, and mortality rates were numerically lower in the combination therapy than in the monotherapy. Multivariate analysis indicated that monotherapy was independently associated with increased clinical failure (aOR, 4.35; 95% CI, 1.05 to 18.02; P = 0.04). Conclusions: Our results suggest that tigecycline-based therapy was tolerable and the clinical outcome was comparable to that of colistin-based therapy for patients with MDR/XDRAB pneumonia. In addition, combination therapy may be more useful than monotherapy in treatment of MDR/XDRAB pneumonia.

산사태 위험도 산정시스템 및 피해저감기술 개발

김원영 한국지반공학회 2008 지반 : 한국지반공학회지 Vol.24 No.6

나의 목회 신학

김원영 장로회신대학교 2004 敎會와 神學 Vol.58 No.-

필자는 그때 한국교회의 성장을 깊이 통찰하면서 낙관만 하고 앉아 있을 수 없다는 생각하였다. 한국교회의 급속한 성장이 지닌 문제점이 많다고 보았기 때문이다. 교회가 어두운 사회 속에서 소금과 빛의 사명을 바로 감당하지 못하고 있다고 보았고, 교회의 분쟁과 교파분열이 사회의 지탄의 대상이 되기도 하고, 기복 적인 신앙으로 교회나 출석하며 형식만 갖추고 있는 신앙인의 불신앙 적 요소가 바로 큰 문제점이라고 보았기 때문이다. 또한 군소 교단의 신학교 난립으로 인한 한국교회의 교역자 자질문제도 심각한 문제라고 보았기 때문이다. 또한 군소 교단의 신학교 난립으로 인한 한국교회의 교역자 자질문제도 심각한 문제라고 보았기 때문이다. 그런데 오늘날 현실적으로 한국교회에 나타나고 있는 안타까운 징조가 무엇인가? 교인수의 감소이다. 예배당이 곳곳에 세워지면서 교인들의 수평이동은 빈번해지고 잇지만 교인 성장은 답보 내지는 퇴보하고 있는 실정이다. 그리고 사회적인 큰 사건이 터질 때마다 교회의 중직 자들이 연루되어 있는 것이다.

범하수체 기능저하증을 동반한 일차성 중추성 림프종의 1예

김원영,김원,조규종,홍정석,이미우,장성은,오세현,임경수 대한응급의학회 2001 대한응급의학회지 Vol.12 No.4

A primary central nervous system lymphoma(PCNSL) is defined as a lymphoma limited to the cranial-spinal axis without systemic involvement. PCNSLs were formerly very rare, only 0.5∼ 1.2% of all intracranial neoplasms, and were usually associated with acquired immuno-deficiency syndrome(AIDS) and other immune-compromised states. Recently, there has been a clear rise in the incidence of this disease among normal individuals. We describe a 77-year-old female with hyponatremia who presented with a confused mental state. Computed tomography(CT) of the brain demonstrated a suprasellar mass with enhancement. We evaluated the basic hormonal studies and the magnetic resonance imaging(MRI). A ventricular biopsy was done, and the result was a diffuse, large, B-cell-type malignant lymphoma. She presented panhypopituitarism and partial central diabetes insipidus. She received chemotheraphy and was discharged in an improved condition. We report a case of panhypopituitarism due to PCNSL and give a review of the literature.