Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation

심재겸,이상민,강형구,김경찬,김영삼,김윤성,리원연,박성훈,박소영,박주희,Sim Yun Su,이광하,이연주,이진화,이흥범,임채만,최원일,홍지영,송원준,서지영 대한중환자의학회 2024 Acute and Critical Care Vol.39 No.1

Background: Mechanical power (MP), which integrates ventilator variables affecting ventilator-induced lung injury, has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality.Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV=0.098 ∙ RR ∙ VT ∙ (ΔPinsp + PEEP). Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed. Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579).Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.

종격동 지방종증(Mediastinal lipomatosis) 1예

심재겸,김세중,민병주,김제형,신철 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.1

서론: 종격동 지방종증은 양성 질환으로 피막에 둘러싸이지 않은 지방 조직이 종격동 내에 축적되는 것으로 아직 국내 보고는 없다. 위험인 자로는 부신피질 스테로이드 복용, 쿠싱 증후군, 비만 등이 있다. 저자들은 흉부 불편감을 주소로 내원한 환자에서 종격동 지방종증 증례를 경험하였기에 보고하는 바이다. 증례: 30갑 년의 흡연력 있는 53세 남자가 내원 3주 전부터 발생한 흉부 불편감을 주소로 내원하였다. 신장 170 cm, 체중 70 kg, 체질량지수 24.2로 정상이었으며, 전립선비대증과 위궤양으로 약물 복용 중이었으나 스테로이드 복용력은 없었다. 이학 적 검진상 특이 소견 없었으며, 단순 흉부방사선과 흉부 전산화단층촬영에서 우측 전 종격동에 3.0 cm×1.9 cm 크기의 종양이 발견되었다. 종양은 불균질한 조영 증강을 보였고, 심장에 인접해있어 심막 침범이 의심되었다. 심전도 및 심장 초음파는 정상이었고, 복부 전산화단층촬 영 상 부신 등에 특이 소견 없었다. 림프암 등을 감별하기 위해 시행한 종양표지자 검사는 정상이었다. 진단 및 치료 목적으로 비디오 흉강경 하 절제술을 시행하였다. 수술 소견 상 늑강 내에 전반적인 유착이 있었고, 종양은 심장의 우심방에 유착되어 있었다. 비디오 흉강경 하 유착 박리술과 종양 절제술을 실시하였으며 수술 후 합병증은 없었다. 적출된 종양의 육안 소견상 피막에 싸이지 않은 노란색의 흐물흐물한 조직 이었으며 병리 소견 상 흉선 세포 없이 지방 세포와 소수의 혈관으로 이루어진 지방종증으로 최종 진단하였다. 고찰: 종격동 지방종증은 호흡곤란, 흉통을 일으키기도 하나 대부분 무증상이며 단순 흉부방사선 이상 소견으로 우연히 발견된다. 이 자체로는 악성화 가능성은 없지만 흉선종 및 림프암 등과 구별하기 위하여 조직 검사를 통한 정확한 진단을 내리는 것이 중요하다. 수술적 절제 후 재발은 드물어 예후는 양호하다. 종격동 종양이 발견되었을 때 흉선종, 림프종 등 흔한 질환들 이외에도, 감별 진단으로서 드물지만 지방종증에 대한 고려가 필요할 것으로 판단된다.

The Clinical Significance of Ventilator-Associated Event

심재겸,오지연,민경훈,허규영,이승룡,심재정,강경호 대한결핵 및 호흡기학회 2015 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.120 No.-

Introduction: The Centers for Disease Control and Prevention (CDC) proposed a new surveillance definition of ventilator-associated event (VAE). We investigated clinical characteristics of VAE. Method: We reviewed the medical records of patients who admitted to intensive care units (ICUs) from January 2013 to June 2014. Patients who were less than 18 or dependent on mechanical ventilation (MV) less than 2 calendar days were excluded. We checked the occurrence of VAE retrospectively and compared the groups with or without VAE. Result: Among 1031 episodes of MV, there were 92 ventilator-associated condition, 36 infection-related ventilator-associated complication, 11 possible ventilator associated pneumonia and 19 probable ventilator associated pneumonia. The median time to onset of VAE was 5 days. There was no significant difference in age, sex, Acute Physiology and Chronic Health Evaluation II score, and Charlson comorbidity index. We analyzed the primary causes of MV and classified them to 10 categories (central nervous system disorder, cardiovascular disorder, respiratory disease, severe sepsis or septic shock, gastrointestinal bleeding, renal disorder, trauma, post operative state, pulmonary edema and others). VAE was significantly higher in trauma and post operative patients. (p = 0.035 and p = 0.007). The VAE group was associated with longer MV day (5 days vs 12 days, p < 0.001), weaning failure (34.6% vs 75.0%, p < 0.001) and 30-day mortality (35.6% vs 74.2%, p < 0.001). Conclusion: The VAE was associated poor outcome.

Clincial characteristics of pulmonary sarcomatoid carcinoma

심재겸,오지연,민경훈,허규영,이승헌,이승룡,김제형,심재정,강경호 대한결핵 및 호흡기학회 2015 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.120 No.-

Introduction: Pulmonary sarcomatoid carcinoma (PSC) is poorly differentiated non small cell lung cancer with spindle cell or giant cell. There is insufficient data regarding them. Method: We reviewed the medical records of patients diagnosed with PSC from January 2009 to February 2015. We analyzed the clinical features, treatment response and prognosis. Result: We investigated 23 patients with median age of 66 years. 20 patients were male. Initial presentation included respiratory symptom (11), cancer-related pain (5), constitutional symptom (2). 5 patients were presented with abnormal chest image. 14 patients were current or ex-smokers. 12 patients had primary lesion on right upper lobe, 5 on left upper lobe, 3 on right and left lower lobes. 18 patients were in stage IV at the time of diagnosis. Epidermal growth factor receptor (EGFR) mutation test was conducted in 11 patients and 2 were positive. The primary treatment was palliative chemotherapy (11), curative surgery (5), curative radiation therapy (1) and best supportive care (6). Platinum-based doublet regimen was selected as first line in 8 patients. 2 patients with EGFR mutation were treated with tyrosine kinase inhibitor. We assessed the best response of first line therapy and found that 2 and 3 patients showed partial response and stable disease. The overall survival of all patients were 508 days and the progression free survival of patients with first line chemotherapy was 53 days. Conclusion: PSC patients had fair prognsois.However, response to chemotherapy was unfavorable.

Pulmonary Sarcoidosis Induced by Adalimumab: A Case Report and Literature Review

심재겸,강경호,이승룡,심재정 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.1

Not available

종격동 지방종증(Mediastinal Lipomatosis) 1예

심재겸,김세중,민병주,김제형,신철 대한내과학회 2011 대한내과학회 추계학술대회 Vol.2011 No.-

Two Cases of Diagnosis and Removal of Endobronchial Hamartoma by Cryotherapy via Flexible Bronchoscopy

심재겸,최종현,오지연,조재영,문을선,민혜숙,이병현,박민선,허규영,이승용,심재정,강경호,민경훈 대한결핵및호흡기학회 2014 Tuberculosis and Respiratory Diseases Vol.76 No.3

Although endobronchial hamartoma is a rare benign tumor, most patients with endobronchial hamartoma have respiratory symptoms such as obstructive pneumonia, hemoptysis, cough, or dyspnea due to bronchial obstruction. It can cause irreversible post-obstructive pulmonary destruction, thus early diagnosis and treatment is very important. Recently, there have been cases of neodymium-doped yttrium aluminum garnet (Nd:YAG) laser and electrocautery procedures for bronchoscopic treatment of malignant or benign central airway obstruction with comparable therapeutic efficacy and few complications. Bronchoscopic cryotherapy is a newly developed technique for management of central airway obstruction. Moreover, it provides diagnostic methods with improving diagnostic yield and safety. We report two cases of endobronchial hamartoma, each diagnosed and definitively treated with bronchoscopic techniques. Endobronchial biopsy and removal was successfully performed by cryotherapy via flexible bronchoscopy without notable complications. Follow-up bronchoscopic examinations excluded residual or recurrent disease.

A Case of IgG4-related Disease Presenting as Massive Pleural Effusion and Thrombophlebitis

심재겸,최종현,오지연,이은정,이승현,민경훈,이승헌,이은주,허규영,이승룡,이상엽,김제형,신철,심재정,인광호,강경호 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

IgG4-related disease is a newly recognized fibroinflammatory condition characterized by tumefactive lesions, a dense lym-phoplasmacytic infiltrate rich in IgG4-positive plasma cells, storiform fibrosis, and, often but not always, elevated serum IgG4 concentrations. The disease can either be localized to one or two organs, or be present with diffuse multi-organ disease. In the thorax, lesions associated with IgG4-related disease have been described in the lung parenchyma, airways and pleura, as well as the mediastinum. We report a case of IgG4-related disease presenting as massive pleural effusion and thrombophlebitis. A 48-year-old man was admitted to our hospital complaining of fever, chills, sweating, and dyspnea. He has a history of admission for evaluation and management of suggested deep neck infection with small amount of left pleural effusion. On physical examination, he showed generalized edematous appearance with venous engorgement of neck and upper chest. Chest X-ray and Chest CT showed thrombophlebitis at left innominate vein, subclavian vein and left internal jugular vein and enlarged lymph node at left neck and axillar area with both pleural effusion and ascites. Pleural fluid analysis showed lymphocyte predominant exudates nature. Pleural biopsy showed chronic inflammation with lymphoplasmacytic infiltration and fibrosis. The ratio of IgG4-positive to IgG-positive plasma cells in specimen was 23%. Serum IgG4 level was 248 mg/dL. He showed symptomatic and radiographic improvement after systemic steroid therapy with anticoagulation.

The Overlap Syndrome of Asthma and COPD: Its Prevalence and Clinical Characteristics

심재겸,민경훈,허규영,심재정,강경호 대한결핵 및 호흡기학회 2012 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.114 No.-

Background: Although asthma and COPD have been accepted as different diseases, many elderly patients show clinical features of both asthma and COPD, so called "overlap syndrome". The purpose of our study was to examine the prevalence and clinical characteristics of the overlap syndrome (OS). Methods: We conducted a retrospective survey of patients above 40 years who had visited our hospital from January 2005 to June 2009 because of obstructive lung disease. Patients with structural lung disease were excluded and patients with short follow-up duration were excluded. Based on lung function profile, we classified subjects into COPD and OS groups, and analyzed their prevalence, demographics and lung function. Results: 2,105 subjects were included. 240 (11.4%) and 630 (29.9%) were found to have OS and COPD, respectively. The mean age was similar in both group (66.40 years vs 67.67 years, P=0.553) but age of symptom onset was earlier in OS group than COPD group (38.42 years vs 58.17 years, P<0.001). OS group showed lower baseline postbronchodilator FEV1 than COPD group (50.88% vs 57.65%, P=0.04). After additional treatment with tiotropium, OS and COPD groups showed significant improvement of postbronchodilator FEV1 (5.50%, P=0.012; 7.68%, P=.0.000). Conclusion: Certain proportion of aged patients have overlap syndrome. Although their symptom develops earlier and baseline lung function is worse, intensive treatment can improve lung function.

국민을 위한 노래: 해방 이후 국민가요운동의 전개와 국민 주체의 음악적 구상

심재겸(Jaekyom Shim) 한국대중음악학회 2016 대중음악 Vol.- No.18

1945년 해방 이후 유행가는 우파와 좌파의 모든 지식인에게 비판을 받았 다. 일제 시기부터 즐겨 불리던 유행가가 가진 저속함과 퇴폐성이 대중을 타락하게 하고 바람직한 국민 주체의 형성을 가로막는다는 이유였다. 따라서 지식인들과 정부는 가요정화운동을 통해 당대의 유행가를 규제하고자 하였 다. 그리고 기존의 유행가를 대체할 수 있는 건전한 가요를 보급해 대중을좀 더 바람직한 방향으로 이끌고자 하였다. 이러한 배경에서 정부 수립 이후 우파 음악가들은 국민가요운동과 국민개창운동을 전개하기 시작하였다. 하지만 1950년대 한국의 상황에서 유행가를 규제한다는 것은 쉬운 일이 아니었다. 공공 기관의 조직적 허술함도 그 원인 중 하나였지만 무엇보다 문화에 대한 자유주의적 경향 아래 강압적인 금지와 통제는 예민한 문제였다. 따라서 국민가요운동 지도자들은 유행가 규제보다 건전한 국민가요를 적극적으로 보급해 기존의 퇴폐적인 유행가들을 대체하려고 하였다. 대중에게 널리 불리기 위해 서는 대중성을 갖출 필요가 있었다. 1950년대가 지나가는 동안, 국민가요의 원활한 보급을 위해 정부는 때로는 적극적으로 운동에 가담하였지만 때로는 무관심하기도 하였다. 게다가 국민개창운동추진회의 국민가요는 대중에게 인기를 얻지 못하였다. 이와 같은 상황에서 국민개창운동을 정부 차원에서 주도 하기로 한 박정희 정권에 대해 우파 음악가들의 기대는 컸다. 하지만 우파 음악가들의 기대에도 불구하고 1960년대 정부 주도의 국민개창운동은 지속 적으로 시행되지 못하였다. 1970년 정부는 우파 음악가들의 국민가요가 대중 성이 없다고 판단하며 유행가 작곡가와 가수들에게 이를 위임한 후, 이는 건전가요라고 불리게 된다. This paper examines the discursive and institutional practices of ‘Song for the Nation,’ which was made to evoke national consciousness and work ethic of the people, to elucidate how the national subjectivity of postcolonial Koreans was reconstructed in the early part of the Cold War period. After Korea’s liberation in 1945, popular music became problematized by intellectuals as one of the most urgent topics in the process of nationalization of the masses, who passed through the Japanese colonialism. Through the regulation of popular music, the Korean state sought to produce ‘wholesome’ modern national subjects free of the corrupting desires and mindsets of ‘premodern’ Koreans. In particular, this paper examines the activities of rightist classical musicians. In the 1950s, ‘Song for the Nation Campaign,’ led by the rightist musicians, sought to drive out ‘degenerate’ music and provide ‘wholesome’ music to the people. In examining writings of campaign participants and songs made by the elite composers, I highlight the production and reconstruction of discursive and institutional musical practices with global references in 1950s.