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남지명(Ji-Myung Nam),정준모(Joonmo Choung) 대한조선학회 2011 대한조선학회 학술대회자료집 Vol.2011 No.11
This paper provides prediction of ultimate longitudinal strengths of VLCC hull girders with probabilistic damage extents based on IMO Guideline. The various probability levels are taken into account for the damage extent estimation. The ultimate strengths have been calculated using in-house software UMADS (Ultimate Moment Analysis of Damaged Ships) which is based on simplified method. In the cases of grounding accident, the residual longitudinal strengths can be expressed as a function of nondimensional damage area, meanwhile it is proved that there are not clear relations between the residual strength and the damage area. It is inferred that this is due to asymmetry of damaged hull girder section.
Residual ultimate strength of a very large crude carrier considering probabilistic damage extents
정준모,남지명,Gökhan Tansel Tayyar 대한조선학회 2014 International Journal of Naval Architecture and Oc Vol.6 No.1
This paper provides the prediction of ultimate longitudinal strengths of the hull girders of a very large crude carrier considering probabilistic damage extent due to collision and grounding accidents based on IMO Guidelines (2003). The probabilistic density functions of damage extent are expressed as a function of non-dimensional damage variables. The accumulated probabilistic levels of 10%, 30%, 50%, and 70% are taken into account for the estimation of damage extent. The ultimate strengths have been calculated using the in-house software called Ultimate Moment Analysis of Damaged Ships which is based on the progressive collapse method, with a new convergence criterion of force vector equilibrium. Damage indices are provided for several probable heeling angles from 0˚ (sagging) to 180˚ (hogging) due to collision- and grounding-induced structural failures and consequent flooding of compartments. This paper proves from the residual strength analyses that the second moment of area of a damage section can be a reliable index for the estimation of the residual ultimate strength. A simple polynomial formula is also proposed based on minimum residual ultimate strengths.
P-22 Impact of limb weakness on re-intubation after planned extubation in medical patients
정병호,남지명,고명균,정치량,서지영,전경만 대한결핵 및 호흡기학회 2017 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.124 No.-
Objectives: The objective of this cohort study was to evaluate the association between limb muscle weakness assessed by Medical Research Council (MRC) scale on the day of the planned extubation and re-intubation rate in a medical intensive care unit (ICU). Methods: We retrospectively analyzed all consecutive medical ICU patients who were mechanically ventilated for more than 24 hours and were weaned according to the protocol between January 2012 and December 2013. Results: Of 377 consecutive patients, 58 (15.4%) patients required re-intubation within the 48 hours following planned extubation. MRC scale of four limbs was lower in patients with re-intubation (median 14 points, IQR 10-16 points) than those without re-intubation (median 16 points, IQR 12-18 points; P = 0.005). In addition, re-intubation rates decreased significantly with increasing quartiles of MRC scales (P for trend < 0.001). In multivariable analysis, MRC scale was independently associated with re-intubation (adjusted OR 0.911, 95% CI 0.835-0.994, P = 0.037 for increasing one point of MRC scale). In addition, MRC scale ≤ 10 points for four limbs had an adjusted OR of 2.276 (95% CI 1.074-4.825, P = 0.032) to the probability of re-intubation within 48 h after planned extubation after adjusting for potential confounding factors. Conclusions: Limb muscle weakness assessed on the day of extubation was found to be independently associated with higher re-intubation rate within 48 h following planned extubation in the medical ICU having a protocol-based weaning program.
Validation of a new WIND classification compared to ICC classification for weaning outcome
정병호,이경윤,남지명,고명균,나수진,서지영,전경만 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-
Background: Although the WIND (Weaning according to a New Definition) classification based on duration of ventilation after the first separation attempt has been proposed, this new classification has not been tested in clinical practice. The objective of this cohort study was to evaluate the clinical relevance of WIND classification compared to the International Consensus Conference (ICC) classification. Methods: All consecutive medical ICU patients who were mechanically ventilated for >24 h were prospectively registered. Patients were classified into simple, difficult, or prolonged weaning according to ICC classification and Groups 1, 2, 3, or no weaning (NW) according to WIND classification. Results: During the study period, a total of 1,600 patients were eligible. These patients were classified by the WIND classification (NW=580 [36%], Group 1=617 [39%], Group 2=186 [12%], and Group 3=217 [14%]). However, only 735 (46%) patients were classified by ICC classification (simple=503 [68%], difficult=145 [20%], and prolonged=87 [12%]). Clinical outcomes were significantly different across weaning groups by ICC and WIND classifications. However, there were no differences in successful weaning rate (97% vs 95%) or hospital mortality (22% vs 26%) between simple and difficult weaning groups by the ICC. Conversely, there were significant differences in successful weaning rate (99% vs 77%) and hospital mortality (21% vs 34%) between Group 1 and Group 2 by WIND. Conclusions: The WIND could be a better tool for predicting weaning outcomes than the ICC.
F-122 : 기계환기 이탈 분류에 따른 환자들의 임상적 특성
정병호,고명균,남지명,정치량,서지영,전경만 대한결핵 및 호흡기학회 2013 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.116 No.-
배경: 기계환기 이탈은 기계환기에서 첫 이탈시도 후 발관까지 걸리는 시간과 이탈시도 횟수에 따라 단순이탈(simple weaning), 곤란이탈 (difficult weaning), 지연이탈(prolonged weaning)로 분류할 수 있으나 국내 내과계 중환자실에서의 기계환기 이탈에 대한 자료는 부족한 실정이다. 본 연구는 국내 일개 병원의 내과계 중환자실에서 기계환기 이탈 결과를 새로운 분류법에 따라 분류하고 임상결과를 비교하고자 하였다. 방법: 2010년 7월부터 2012년 12월까지 삼성서울병원 내과 중환자실에 입실하여 24시간 이상 기계환기를 받은 환자를 대상으로 기계환기 이탈을 위한 프로토콜을 적용하여 이탈 결과를 전향적으로 수집한 후 후향적으로 분석하였다. 결과: 연구기간 동안 기계환기 적용 후 기계환기 이탈을 시도한 환자는 총 555/1199(46%)명이었고, 첫 번째 이탈 시도에서 어려움 없이 발관까지 성공한 단순이탈은 370명(67%), 첫 번째 이탈 시도에서 실패 후 이탈 성공까지 2회 이하의 이탈시도 또는 7일 이하의 시간이 필요한 곤란이탈은 116명(21%), 첫 번째 이탈 시도에서 실패 후 이탈 성공까지 3회 이상의 이탈시도 또는 8일 이상의 시간이 필요한 지연이탈 은 69명(12%)이었다. 기계환기 후 첫 이탈 시도까지 걸린 시간은 평균 4.0±3.5일이었고 단순이탈(3.7±3.3일)에 비해 곤란이탈(4.1±2.8일), 지연이탈(5.4±4.9일)에서 유의하게 길었다. 단순, 곤란, 지연이탈 각각의 중환자실 체류기간은 중앙값(사분위수) 5 (3-9)일, 9 (6-13)일, 20 (14-31)일, 병원 재원기간은 23 (14-43)일, 29 (20-50)일, 35 (25-62)일, 중환자실 사망률은 4%, 4%, 42%, 병원사망률은 21%, 26%, 61%로 지연이탈에서 나쁜 예후를 보였다. 결론: 내과계 중환자실에서 24시간 이상 기계환기를 적용한 환자 중 67%에서 단순이탈을 보였다. 하지만 지연 이탈의 경우 단순이탈 및 곤란이탈에 비해 높은 사망률이 관찰되었다.