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중환자실에서 기계적 환기를 시행받는 환자들의 기관내삽관 튜브의 기낭내압
이영주,윤장운,문봉기,이규완,박미미,이영석 아주대학교 1997 아주의학 Vol.2 No.2
Background and Objectives : High volume, low pressure (HVLP) cuffed tubes have been substituted for low volume, high pressure (LVHP) cuffed tubes in order to reduce complications created by the cuffed endotracheal tubes contact with the tracheal wall. Several physidans, however, prefer to use the LVHP cuff for habitual or economic reasons. Even so, careless cuff Inflation of the HVLP cuff could also induce complications. The purposes of this study were to see whether there are any differences between the usual intracuff pressure (UICP) and the Optimum intracuff pressure (OICP), to compare the OICP of three groups, and to study the correlation between the OICP and the peak inspiratory pressure (PIP) of three kinds of endotracheal tubes under mechanical Ventilation. Methods : 82 adult patients, upon admission of the ICU, were divided into 3 groups with different cuffed tube types according to the following: Portex Profile group (n=66), HVLP cuffed tube; Portex Regular group (n=11), LVHP cuffed tube; Rusch Red group (n=5), LVHP cuffed tube. We used the Portex cuff pressure manometer for Portex Profile group, the Hewlett-Packard pressure transducer for Portex Regular, and Rusch Red group to measure the intracuff pressure (ICP). The OICP was measured with the minimal leak technique (MLT). Intracuff pressure difference (ICPD) was calculated by subtracting OICP from UICP. Results : UICP and OICP of Portex Profile group were 33.12±22.25 ㎝H₂O, 22.02±12.5㎝H₂O, Portex Regular group, 70.09±30.88 ㎝H₂O, 69.45±30.41 ㎝H₂O and Rusch Red group, 378.40±38.60 ㎝H₂O, 337.60±74.45 ㎝H₂O. Significant difference was shown among the groups (p < 0.05). The significant difference of the PIP was not seen among the groups. Significant correlation between OICP and PIP (regression = 0.463, p < 0.01) was demonstrated only in Portex Profile group. ICPD of three groups were as high as 84 ㎝H₂O to as low as -56 ㎝H₂O. About 40% of the patients showed the allowable range. Conclusions : This study suggests that routine check-ups of ICP are needed when the patients are admitted to the ICU. The OICP of the HVLP cuffed tube is 1/3 -1/15 of the LVHP cuffed tube. Therefore, the routine use of the HVLP tube is highiy recommended. The OICP shows positive correlation with the PIP. This suggests to make every effort to reduce the PIP.
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이영주,박찬희,윤장운,이영숙 연세대학교의과대학 2004 Yonsei medical journal Vol.45 No.1
Procalcitonin (PCT) is a newly introduced marker of systemic inflammation and bacterial infection. A marked increase in circulating PCT level in critically ill patients has been related with the severity of illness and poor survival. The goal of this study was to compare the prognostic power of PCT and three other parameters, the arterial ketone body ratio (AKBR), the acute physiology, age, chronic health evaluation (APACHE) III score and the multiple organ dysfunction score (MODS), in the differentiation between survivors and nonsurvivors of systemic inflammatory response syndrome (SIRS). The study was performed in 95 patients over 16 years of age who met the criteria of SIRS. PCT and AKBR were assayed in arterial blood samples. The APACHE III score and MODS were recorded after the first 24 hours of surgical ICU (SICU) admission and then daily for two weeks or until either discharge or death. The patients were divided into two groups, survivors (n=71) and nonsurvivors (n=24), in accordance with the ICU outcome. They were also divided into three groups according to the trend of PCT level: declining, increasing or no change. Significant differences between survivors and nonsurvivors were found in APACHE III score and MODS throughout the study period, but in PCT value only up to the 7th day and in AKBR only up to the 3rd day. PCT values of the three groups were not significantly different on the first day between survivors and nonsurvivors. Receiver operating characteristic (ROC) curves for prediction of mortality by PCT, AKBR, APACHE III score and MODS were 0.690, 0.320, 0.915 and 0.913, respectively, on the admission day. In conclusion, PCT could have some use as a mortality predictor in SIRS patients but was less reliable than APACHE III score or MODS.
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기관내 삽관시 Esmolol 과 Labetalol 투여가 혈역학적 변화와 혈중 Catecholamine 치에
이상열,이영석,한정선,이영주,윤장운,허철령 대한마취과학회 1998 Korean Journal of Anesthesiology Vol.34 No.1
Background : Sympathetic blocking agent, esmolol(selective beta 1 blocker) or labetalol( alpha and beta blocker) would prevent the hypertension and tachycardia from endotracheal intubation. We have carried out the study to see the effects of esmolol or labetalol on the blood pressure, heart rate, rate pressure product and plasma catecolamines during the endotracheal intubation. Methods : Thirty-three ASA physical status 1 or 2 adult patients were allocated into three groups; Group I:control(n=10), Group II:esmolol(n=11) and Group III: labetalol(n=12). In Group I, 2 ml of normal saline, in Group II, 1 mg/kg of esmolol, and in Group III, 0.2 mg/kg of labetalol were given 3, 2 and 4 minutes before endotracheal intubation. Blood pressure and heart rate were measured after arrival at the operating room, before endotracheal intubation and after endotracheal intubation at 15, 60, 120, 180 and 300 seconds interval under the inhalation anesthesia (enflurane-N2O-O2). Rate-pressure product was calculated from the heart rate and systolic blood pressure(RPP = heart rate x systolic blood pressure). The plasma cathecolamines, dopamine, norepinephrine and epinephrine, were measured before intubation as a baseline value and 2 minute after intubation. Results : Systolic blood pressure, rate-pressure product and heart rate were significantly lower in esmolol and labetalol groups than in control group after intubation( P<0.05). Esmolol reduced the heart rate and the rate-pressure product than labetalol, but statistically there were no significance(P > 0.05). Plasma level of dopamine, norepinephrine and epinephrine showed higher values after intubation in all three groups( P<0.05). But there were no difference among groups(P>0.05). The side effects of esmolol and labetalol did not appear at all. Conclusion : 1 mg/kg of esmolol given 2 min before intubation or 0.2 mg/kg of labetalol given 4 min before intubation reduce increasing of blood pressure and heart rate, caused by adnergic response following endotracheal intubation, significantly. The reason is that esmolol and labetalol do not decrease release of catecholamines but attenuate responses of elevated catecholamines following endotracheal intubation. (Korean J Anesthesiol 1998; 34: 77∼85)
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