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남현승,조재화,최은영,장유진,최원일,황재준,문재영,이광하,김세원,강형구,심윤수,박태선,박승용,박성훈,Korean NIV Study Group 대한결핵및호흡기학회 2019 Tuberculosis and Respiratory Diseases Vol.82 No.3
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 2017to February 2018. Adult patients (age>18 years) who were admitted to the ICU and received NIV treatment for acuterespiratory failure were included. Results: A total of 156 patients treated with NIV were enrolled (mean age, 71.9±11.6 years). The most commonindications 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 majorityof patients (87.2%) used an oronasal mask. After the exclusion of 32 do-not-resuscitate patients, NIV success rate was68.5% (85/124); ICU and hospital mortality rates were 8.9% and 15.3%, respectively. However, the success rate was lowerin patients with de novo respiratory failure (27.3%) compared to that of patients with AHRF (72.8%) or post-extubationrespiratory 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 weresignificantly 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. Keywords: Intensive Care Units; Noninvasive Ventilation; Masks
Nonpulmonary risk factors of acute respiratory distress syndrome in patients with septic bacteraemia
남현승,장승훈,황용일,김주희,박지영,박성훈 대한내과학회 2019 The Korean Journal of Internal Medicine Vol.34 No.1
Background/Aims: The relationship between nonpulmonary organ failure and the development of acute respiratory distress syndrome (ARDS) in patients with sepsis has not been well studied. Methods: We retrospectively reviewed the medical records of patients with septic bacteremia admitted to the medical intensive care unit (ICU) of a tertiary academic hospital between January 2013 and December 2016. Results: The study enrolled 125 patients of median age 73.0 years. Urinary (n = 47), hepatobiliary (n = 30), and pulmonary infections (n = 28) were the most common causes of sepsis; the incidence of ARDS was 17.6%. The total number of nonpulmonary organ failures at the time of ICU admission was higher in patients with ARDS than in those without (p = 0.011), and the cardiovascular, central nervous system (CNS), and coagulation scores were significantly higher in ARDS patients. On multivariate analysis, apart from pneumonia sepsis, the CNS (odds ratio [OR], 1.917; 95% confidence interval [CI], 1.097 to 3.348) and coagulation scores (OR, 2.669; 95% CI, 1.438 to 4.954) were significantly associated with ARDS development. The 28-day and in-hospital mortality rates were higher in those with ARDS than in those without (63.6 vs. 8.7%, p < 0.001; 72.7% vs. 11.7%, p < 0.001), and ARDS development was found to be an independent risk factor for 28-day mortality. Conclusions: Apart from pneumonia, CNS dysfunction and coagulopathy were significantly associated with ARDS development, which was an independent risk factor for 28-day mortality.
A Case of Vibrio vulnificus Sepsis: A Potential Use of Extracorporeal Membrane Oxygenation
박선영,남현승,박성훈,박재용,하상욱,이선희,김형수 대한응급의학회 2017 大韓應急醫學會誌 Vol.28 No.1
Necrotizing fasciitis caused by Vibrio vulnificus can rapidly progress to septic shock and death. Hence, early surgical debridement of the involved tissue is vital. However, this can be a challenging task due to the coagulopathy and unstable conditions often associated with these patients. Herein, we present a patient with necrotizing fasciitis caused by V. vulnificus who received extracorporeal membrane oxygenation (ECMO) support for refractory hypotension. After initiating ECMO, his vital signs stabilized, and lactate, C-reactive protein, and procalcitonin levels continued to decrease. He underwent several rounds of surgical debridement and vacuum-assisted drainage on both lower legs. On ECMO day 15, he was successfully weaned off the device and his condition was uneventful for several days. However, on the 24th day of intensive care unit (ICU), he was again placed on ECMO due to clinical deterioration. On ICU day 32, he underwent bilateral below-knee amputations due to delayed wound healing. Unfortunately, he subsequently developed multi-organ failure and died. Nonetheless, this case is instructive regarding the potential use of ECMO. We suggest that ECMO could provide the necessary time for sepsis patients to undergo aggressive medical and surgical interventions.
조재화,김태희,남현승,최은영,장유진,최원일,황재준,문재영,이광하,김세원,강형구,심윤수,박태선,박승용,박성훈,( Korean Niv Study Group ) 대한결핵 및 호흡기학회 2018 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.126 No.-
Introduction: The use of sedative drugs may be an important therapeutic intervention in patients with high risks such as mask intolerance, delirium, and agitation. However, there is little data on sedation during NIV maintenance. The Korean noninvasive mechanical ventilation study group has prospectively collected NIV use data from ICUs. Objectives: We analyzed status and safety in the management of pain, sedation on NIV therapy in Korean ICU. Methods: The twenty ICUs intensivists among Korean nationwide hospitals were participated and collected data of NIV from June 2017 to April 2018. We analyzed using chi-square test and Fisher’s exact test on categorical variables and Mann-Whitney U test on continuous variables. Results: The 155 patients were included during those periods. We divided the intervention group (n=26) that who received management of sedation and control group (n=129). The PaCO2 and PF ratio before NIV and 30 minutes after NIV were not different between intervention and control group. There was no statistically significant difference in success rate of NIV weaning, complications, length of ICU stay, ICU and hospital survival rate. However, duration of NIV apply were shorter in intervention than in control (1.5 days versus 4 days, p=0.001). Conclusion: In the NIV patients, pain and sedation therapy might have no harmful effect on complications, NIV weaning success, and mortality compared to the control group. Pain and sedation might have reduced the duration of NIV. Thus control of pain, sedation during NIV might be safe with close monitoring.
KSUPRAMAX-O 선형의 규칙파 중 상대파고 계측에 대한 연구
박동민,권용주,김건우,남현승,황승현 대한조선학회 2023 大韓造船學會 論文集 Vol.60 No.5
This study focuses on measuring the relative wave elevation around the KSUPRAMAX-O ship and comparing it with numerical analysis results (potential and computational fluid dynamics). The relative wave elevation is a good indicator of the pressure distribution on the ship’s surface, which is affected by the ship’s motion, incident waves, and distributed waves. Prior to measuring the relative wave elevation, a comparative test was conducted on resistance type, capacitance type, and ultrasonic type wave probe to measure the relative wave elevation, and it was confirmed that the resistance type wave probe was suitable for measuring the relative wave elevation. A model test was performed at low speed and design speed using resistance type wave probe and compared with the results of numerical analysis result. As for the motion response, it was confirmed that the result of experiments and the result of the numerical analysis were in good agreement. The relative wave elevation showed a similar trend between the experiment and the computational fluid dynamics, but the potential analysis result showed a difference from the experiment in design speed.