Current status of pain and sedation therapy on noninvasive mechanical ventilation in Korean Intensive Care Units : a multi-center observational study

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.

Current Status of Noninvasive Ventilation Use in Korean Intensive Care Units: A Prospective Multicenter Observational Study

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

Utilization of pain and sedation therapy on noninvasive mechanical ventilation in Korean intensive care units: a multi-center prospective observational study

김태희,김정수,최은영,장유진,최원일,황재준,문재영,이광하,김세원,강형구,심윤수,박태선,박승용,박성훈,조재화,Korean NIV Study Group 대한중환자의학회 2020 Acute and Critical Care Vol.35 No.4

Background: The use of sedative drugs may be an important therapeutic intervention during noninvasive ventilation (NIV) in intensive care units (ICUs). The purpose of this study was to assess the current application of analgosedation in NIV and its impact on clinical outcomes in Korean ICUs. Methods: Twenty Korean ICUs participated in the study, and data was collected on NIV use during the period between June 2017 and February 2018. Demographic data from all adult patients, NIV clinical parameters, and hospital mortality were included. Results: A total of 155 patients treated with NIV in the ICUs were included, of whom 26 received pain and sedation therapy (sedation group) and 129 did not (control group). The primary cause of ICU admission was due to acute exacerbation of obstructed lung disease (45.7%) in the control group and pneumonia treatment (53.8%) in the sedation group. In addition, causes of NIV application included acute hypercapnic respiratory failure in the control group (62.8%) and post-extubation respiratory failure in the sedation group (57.7%). Arterial partial pressure of carbon dioxide (PaCO2) levels before and after 2 hours of NIV treatment were significantly decreased in both groups: from 61.9±23.8 mm Hg to 54.9±17.6 mm Hg in the control group (P<0.001) and from 54.9±15.1 mm Hg to 51.1±15.1 mm Hg in the sedation group (P=0.048). No significant differences were observed in the success rate of NIV weaning, complications, length of ICU stay, ICU survival rate, or hospital survival rate between the groups. Conclusions: In NIV patients, analgosedation therapy may have no harmful effects on complications, NIV weaning success, and mortality compared to the control group. Therefore, sedation during NIV may not be unsafe and can be used in patients for pain control when indicated.

The Next Korean War: Drawing Lessons From Israel`s Experience in the Middle East

( Niv Farago ) 한국국방연구원 2016 The Korean Journal of Defense Analysis Vol.28 No.1

What would an armed conflict between the two Koreas look like? The following analysis examines this question by drawing lessons from the history of military clashes between Israel and its Arab and Palestinian adversaries. Firstly, it suggests that an armed conflict on the Korean Peninsula would be limited in its scope. Although qualitatively inferior, the North Korean military could conduct a limited ground maneuver south to the DMZ by employing Egypt’s strategy in the 1973 Yom Kippur War. A South Korean counterattack would also be limited. Advancing too deep beyond the DMZ would provoke Pyongyang to go on a nuclear alert and encourage Chinese and American pressure on Seoul to pull back. A South Korean refusal to comply could invite foreign intervention, similar to the American intervention in the 1973 War. Secondly, this paper explores the challenge of guerrilla warfare (both above and below ground) that ROK forces are likely to encounter if they cross the DMZ. Israel’s experiences in the 2006 Lebanon War and in Operations Cast Lead (2008) and Protective Edge (2014) illustrate that in facing such a challenge, even an indisputably superior force may have to pay a heavy price in casualties. Given that North Korean nuclear deterrence would prevent ROK forces from implementing reunification war plans, South Korea should consider stopping its counterattack at the DMZ, rather than pursuing the enemy into a terra incognita of topographical and subterranean traps.

Government-Military Relations in Israel: Who’s the Boss? Lessons from the Six-Day War

( Niv Farago ) 한국국방연구원 2017 The Korean Journal of Defense Analysis Vol.29 No.4

In recent years, prominent voices in the Israeli academic and political arenas have increased their criticism of the Israeli Defense Force’s (IDF) dominant role in policy and decision-making processes in the country. The 1967 Six-Day War is perhaps the bedrock upon which IDF critics’ fears of a dominant military rest upon. They disapprove of the pressure that the military’s high command put on the government to go to war and argue that the IDF was overly dominant in determining its goals and strategic moves on the battlefield. The following analysis debunks the claims of IDF critics by presenting historical evidence that shows how political considerations overrode military calculations on the way to and during the war. It also highlights the vital contribution of the IDF’s high command to decision-making at significant crossroads. In this regard, the analysis uses organizational theory logic to question the suggestion of IDF critics to empower the National Security Council (NSC) so it could provide the government with alternative analyses and courses of action to those suggested by the IDF. Significantly, the analysis concludes that by empowering the NSC at the expense of the IDF, the government might invite confusion rather than clarity and efficiency to policy and decision-making processes, especially in times of crises and war―when quick decision and action are necessary.

Silk, Tea and Treasure: Maritime Trade in Eighteenth-Century Literature

( Niv Horesh ) 성균관대학교 동아시아학술원 2008 Sungkyun Journal of East Asian Studies Vol.8 No.2

Drawing on contemporaneous literary work, this essay explores how maritime trade reshaped popular concepts of currency and credit in China and Britain. In the eighteenth century, silver produced in Spanish America was carried on board galleons sailing from Acapulco to Manila, and was then transshipped to Southeast China by local seafarers and European traders. China`s monetary system had become by then fully bimetallic-copper coins and silver bullion maintained a parity whereby they were mutually convertible and universally accepted. The Chinese system was, in that sense, different from that prevalent in the West, where gold, paper instruments, and government regulation had begun to play a significant monetary role. If the eighteenth century was for China one of passive reliance on imported silver, it presaged in Britain a transition into nation-statehood and big government. The radiation of paper money from Britain to Continental Europe in the eighteenth century was one expression of an emergent credit economy that helps explain the starkly divergent development paths of China and Europe a century later.

Silk, Tea and Treasure: Maritime Trade in Eighteenth-Century Literature

Horesh, Niv 성균관대학교 동아시아학술원 2008 Sungkyun Journal of East Asian Studies Vol.8 No.2

Drawing on contemporaneous literary work, this essay explores how maritime trade reshaped popular concepts of currency and credit in China and Britain. In the eighteenth century, silver produced in Spanish America was carried on board galleons sailing from Acapulco to Manila, and was then transshipped to Southeast China by local seafarers and European traders. China's monetary System had become by then fully bimetallic-copper coins and silver bullion maintained a parity whereby they were mutually convertible and universally accepted. The Chinese system was, in that sense, different from that prevalent in the West, where gold, paper instruments, and government regulation had begun to play a significant monetary role. if the eighteenth century was for China one of passive reliance on imported silver, it presaged in Britain a transition into nation-statehood and big government. The radiation of paper money from Britain to Continental Europe in the eighteenth century was one expression of an emergent credit economy that helps explain the starkly divergent development paths of China and Europe a century later.

The Civil War in Syria in View of the Iranian Challenge in the Middle East: An Israeli Perspective

Farago Niv 한국국방연구원 2019 The Korean Journal of Defense Analysis Vol.31 No.3

This article examines the civil war in Syria and Iran’s military buildup in that country through the lens of senior Israeli politicians, military ofcers, and security pundits. Most of them agree that the Netanyahu government’s policy of striking Iran–linked targets in Syria hard while encouraging Europe to impose, like the United States, debilitating sanctions on Iran has severely damaged the ayatollahs’ plans. By interrupting Iranian efforts to establish a Hezbollah-like force in Syria and equip it with precision-guided missiles, Israeli policy has also decreased, some pundits believe, the likelihood of regional war. However, this article suggests that although Israel’s policy has hindered Iranian entrenchment in Syria, the danger of regional war has increased. Debilitating sanctions could cause Iran to discard the 2015 nuclear deal, thereby provoking an Israeli strike on its nuclear installations, and increasingly bolder strikes in Syria may spur the ayatollahs to retaliate harshly. Reliant upon Iran to secure Assad’s victory, but determined to deny the ayatollahs control over Syria, Russia is allowing Israeli strikes to continue as it rehabilitates Assad’s forces and rearms them with advanced weaponry. This weaponry, including S-300 defense systems that threaten Israeli planes, could embolden Syria to attempt recapturing the Golan Heights in the future.

Scanning tunneling microscopy of gate tunable topological insulator Bi2Se3thin films

Zhang, Tong,Levy, Niv,Ha, Jeonghoon,Kuk, Young,Stroscio, Joseph A. American Physical Society 2013 Physical review. B, Condensed matter and materials Vol.87 No.11

Comparison of Clinical Characteristics of Patients With Gastroesophageal Reflux Disease Who Failed Proton Pump Inhibitor Therapy Versus Those Who Fully Responded

( Ram Dickman ),( Mona Boaz ),( Shoshanna Aizic ),( Zaza Beniashvili ),( Ronnie Fass ),( Yaron Niv ) 대한소화기기능성질환·운동학회(구 대한소화관운동학회) 2011 Journal of Neurogastroenterology and Motility (JNM Vol.17 No.4

Background/Aims Refractory gastroesophageal reflux disease (GERD) is very common, affecting up to 40% of the patients receiving proton pump inhibitor (PPI) therapy. However, there is not much information about the clinical characteristics of these patients. The aim of the study is to compare the clinical characteristics of PPI responders vs non-responders. Methods Consecutive GERD patients receiving PPI once or twice daily were evaluated by a questionnaire and a personal interview regarding their demographics, habits, clinical characteristics and endoscopic findings. The patients were divided into 3 groups: Patients who fully responded to PPI once daily (Group A, n = 111), patients who failed PPI once daily (Group B, n = 78) and patients who failed PPI twice daily (Group C, n = 56). Results A total of 245 patients (59.3% females, 52 ± 17.2 years of age) were included in this study. Cross-group differences (A vs B vs C) were detected for hiatal hernia (33% vs 51% vs 52%, P = 0.011); erosive esophagitis (19% vs 51% vs 30%, P < 0.0001); cough (24% vs 44% vs 43%, P = 0.007); sleep disturbances (19% vs 30% vs 38%, P = 0.033); chest symptoms (21% vs 35% vs 41%, P = 0.010); Helicobacter pylori status (25% vs 33% vs 48%, P < 0.0001), disease duration (1.6 ± 0.8 vs 1.9 ± 1.0 vs 2.0 ± 1.1 years, P = 0.007), performed lifestyle interventions (68.5% vs 46.7% vs 69.6%, P = 0.043) and compliance (84% vs 55% vs 46%, P < 0.0001). Conclusions PPI failure (either once or twice daily) appears to be significantly associated with atypical GERD symptoms, disease duration and severity, H. pylori status, obesity, performed lifestyle interventions and compliance as compared with PPI responders. (J Neurogastroenterol Motil 2011;17:387-394)