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Original Articles
Pulmonary
Effect of prone positioning on gas exchange according to lung morphology in patients with acute respiratory distress syndrome
Na Young Kim, Si Mong Yoon, Jimyung Park, Jinwoo Lee, Sang-Min Lee, Hong Yeul Lee
Acute Crit Care. 2022;37(3):322-331.   Published online July 29, 2022
DOI: https://doi.org/10.4266/acc.2022.00367
  • 3,438 View
  • 228 Download
  • 1 Web of Science
  • 1 Crossref
AbstractAbstract PDFSupplementary Material
Background
There are limited data on the clinical effects of prone positioning according to lung morphology. We aimed to determine whether the gas exchange response to prone positioning differs according to lung morphology.
Methods
This retrospective study included adult patients with moderate-to-severe acute respiratory distress syndrome (ARDS). The lung morphology of ARDS was assessed by chest computed tomography scan and classified as “diffuse” or “focal.” The primary outcome was change in partial pressure of arterial oxygen to fraction of inspired oxygen (PaO2/FiO2) ratio after the first prone positioning session: first, using the entire cohort, and second, using subgroups of patients with diffuse ARDS matched 2 to 1 with patients with focal ARDS at baseline.
Results
Ninety-five patients were included (focal ARDS group, 23; diffuse ARDS group, 72). Before prone positioning, the focal ARDS group showed worse oxygenation than the diffuse ARDS group (median PaO2/FiO2 ratio, 79.9 mm Hg [interquartile range (IQR)], 67.7–112.6 vs. 104.0 mm Hg [IQR, 77.6–135.7]; P=0.042). During prone positioning, the focal ARDS group showed a greater improvement in the PaO2/FiO2 ratio than the diffuse ARDS group (median, 55.8 mm Hg [IQR, 11.1–109.2] vs. 42.8 mm Hg [IQR, 11.6–83.2]); however, the difference was not significant (P=0.705). Among the PaO2/FiO2-matched cohort, there was no significant difference in change in PaO2/FiO2 ratio after prone positioning between the groups (P=0.904).
Conclusions
In patients with moderate-to-severe ARDS, changes in PaO2/FiO2 ratio after prone positioning did not differ according to lung morphology. Therefore, prone positioning can be considered as soon as indicated, regardless of ARDS lung morphology.

Citations

Citations to this article as recorded by  
  • Subphenotypes of Acute Respiratory Distress Syndrome: Advancing Towards Precision Medicine
    Andrea R. Levine, Carolyn S. Calfee
    Tuberculosis and Respiratory Diseases.2024; 87(1): 1.     CrossRef
Pulmonary
Evaluation of Respiratory Dynamics in an Asymmetric Lung Compliance Model
So Hui Yun, Ho-Jin Lee, Yong-Hun Lee, Jong Cook Park
Korean J Crit Care Med. 2017;32(2):174-181.   Published online April 14, 2017
DOI: https://doi.org/10.4266/kjccm.2016.00738
  • 6,724 View
  • 95 Download
  • 2 Web of Science
  • 2 Crossref
AbstractAbstract PDF
Background
Unilateral lung hyperinflation develops in lungs with asymmetric compliance, which can lead to vital instability. The aim of this study was to investigate the respiratory dynamics and the effect of airway diameter on the distribution of tidal volume during mechanical ventilation in a lung model with asymmetric compliance.
Methods
Three groups of lung models were designed to simulate lungs with a symmetric and asymmetric compliance. The lung model was composed of two test lungs, lung1 and lung2. The static compliance of lung1 in C15, C60, and C120 groups was manipulated to be 15, 60, and 120 mL/cmH2O, respectively. Meanwhile, the static compliance of lung2 was fixed at 60 mL/cmH2O. Respiratory variables were measured above (proximal measurement) and below (distal measurement) the model trachea. The lung model was mechanically ventilated, and the airway internal diameter (ID) was changed from 3 to 8 mm in 1-mm increments.
Results
The mean ± standard deviation ratio of volumes distributed to each lung (VL1/VL2) in airway ID 3, 4, 5, 6, 7, and 8 were in order, 0.10 ± 0.05, 0.11 ± 0.03, 0.12 ± 0.02, 0.12 ± 0.02, 0.12 ± 0.02, and 0.12 ± 0.02 in the C15 group; 1.05 ± 0.16, 1.01 ± 0.09, 1.00 ± 0.07, 0.97 ± 0.09, 0.96 ± 0.06, and 0.97 ± 0.08 in the C60 group; and 1.46 ± 0.18, 3.06 ± 0.41, 3.72 ± 0.37, 3.78 ± 0.47, 3.77 ± 0.45, and 3.78 ± 0.60 in the C120 group. The positive end-expiratory pressure (PEEP) of lung1 was significantly increased at airway ID 3 mm (1.65 cmH2O) in the C15 group; at ID 3, 4, and 5 mm (2.21, 1.06, 0.95 cmH2O) in the C60 group; and ID 3, 4, and 5 mm (2.92, 1.84, 1.41 cmH2O) in the C120 group, compared to ID 8 mm (p < 0.05).
Conclusions
In the C15 and C120 groups, the tidal volume was unevenly distributed to both lungs in a positive relationship with lung compliance. In the C120 group, the uneven distribution of tidal volume was improved when the airway ID was equal to or less than 4 mm, but a significant increase of PEEP was observed.

Citations

Citations to this article as recorded by  
  • Proof-of-concept study of compartmentalized lung ventilation using system for asymmetric flow regulation (SAFR)
    Igor Barjaktarevic, Glen Meyerowitz, Onike Williams, I. Obi Emeruwa, Nir Hoftman
    Frontiers in Medical Technology.2023;[Epub]     CrossRef
  • Is It Essential to Consider Respiratory Dynamics?
    Youngjoon Kang
    The Korean Journal of Critical Care Medicine.2017; 32(2): 223.     CrossRef
Adequacy of Epinephrine Administration during Advanced Cardiovascular Life Support in terms of Dosing and Intervals between Doses
Seung Joon Lee, Byung Kook Lee, Kyung Woon Jeung, Hyoung Youn Lee, Tag Heo, Yong Il Min, Jong Geun Yun, Jae Hoon Lim
Korean J Crit Care Med. 2011;26(2):69-77.
DOI: https://doi.org/10.4266/kjccm.2011.26.2.69
  • 2,534 View
  • 26 Download
  • 1 Crossref
AbstractAbstract PDF
BACKGROUND
Consensus guidelines clearly define how epinephrine is administered during cardiopulmonary resuscitation (CPR). In South Korea, it is not known whether epinephrine is administered in accordance with the current advanced cardiovascular life support (ACLS) guidelines during actual practice. We sought to investigate adherence to ACLS guidelines during actual CPR in terms of the dose of epinephrine and the interval between doses.
METHODS
A retrospective review of medical records was performed on 394 adult cardiac arrest patients who received CPR at an emergency room. Data including the duration of CPR, the dose of epinephrine, and the interval between doses was collected from CPR records.
RESULTS
Standard-dose epinephrine (1 mg) was used in 166 of 394 patients (42.1%). In 58.8% of patients, the average between-dose interval was within the 3-5 min recommended in the guidelines, whereas it was shorter than 3 min in 31.4% of patients. As a whole, epinephrine was administered in accordance with the current ACLS guidelines in only 96 of 394 patients (24.4%). Logistic regression analysis revealed the duration of CPR to be an independent factor affecting the use of standard-dose epinephrine and the adequate between-dose interval.
CONCLUSIONS
Epinephrine was not administered according to the ACLS guideline in most patients. A national multi-center study is required to determine whether the poor adherence to the ACLS guideline is a widespread problem. In addition, efforts to improve adherence to the ACLS guideline are required.

Citations

Citations to this article as recorded by  
  • Reply to letter “Improving ROSC with high dose of epinephrine. Are we really?”
    Kyung Woon Jeung, Hyun Ho Ryu, Kyung Hwan Song, Byung Kook Lee, Hyoung Youn Lee, Tag Heo, Yong Il Min
    Resuscitation.2012; 83(3): e73.     CrossRef
Physician Compliance with Tube Feeding Protocol Improves Nutritional and Clinical Outcomes in Acute Lung Injury Patients
Sungwon Na, Hosun Lee, Shin Ok Koh, Ai Soon Park, A Reum Han
Korean J Crit Care Med. 2010;25(3):136-143.
DOI: https://doi.org/10.4266/kjccm.2010.25.3.136
  • 2,702 View
  • 20 Download
  • 2 Crossref
AbstractAbstract PDF
BACKGROUND
Nutrition delivery is frequently interrupted or delayed by physicians' ordering patterns. We conducted this study to investigate the effect of physician compliance with tube feeding (TF) protocol on the nutritional and clinical outcomes in acute lung injury (ALI) patients.
METHODS
After implementing a TF protocol, 71 ALI patients with mechanical ventilation (MV) for > or = 7 days were observed. A dietician assessed the nutritional status of the patients and established individualized nutrition plans according to the protocol. If the physicians followed the dietician's recommendation within 48 hours, the patients were classified under the compliant group (Group 1).
RESULTS
Forty patients (56.3%) were classified into Group 1. Prealbumin was comparable in both groups at ICU admission but higher in Group 1 at the time of discharge from the ICU (228 +/- 81 vs 157 +/- 77 mg/dl, p = 0.025). Nitrogen balance was only improved in Group 1. The time to reach calorie goal was shorter and non-feeding days were reduced in Group 1. The proportion of parenteral nutrition to nutritional support days was lower and delivered calories on the 4th and 7th day of TF were higher in Group 1 (p < 0.001). ICU mortality/stay and hospital mortality failed to show differences but hospital stay was prolonged in the noncompliant group (Group 2) (p = 0.023). Arterial oxygen tension and PaO2/FiO2 were maintained during the 1st week of ICU stay in Group 1 but were decreased in Group 2.
CONCLUSIONS
Physicians' compliance with the TF protocol contributed to the likelihood of nutritional improvement and a shorter hospital stay in ALI patients with prolonged MV.

Citations

Citations to this article as recorded by  
  • Nutritional Assessment of ICU Inpatients with Tube Feeding
    Yu-Jin Kim, Jung-Sook Seo
    Journal of the Korean Dietetic Association.2015; 21(1): 11.     CrossRef
  • Identifying Barriers to Implementing Nutrition Recommendations
    Nancy Stamp, Anne M. Davis
    Topics in Clinical Nutrition.2013; 28(3): 249.     CrossRef
Collagen Synthesis in an in Vivo Rat Model of Ventilator-induced Lung Injury
Won Il Choi
Korean J Crit Care Med. 2006;21(2):109-115.
  • 1,350 View
  • 14 Download
AbstractAbstract PDF
BACKGROUND
Experimentally, maintaining high pressure or high volume ventilation in animal models produces an acute lung injury, however, there was little information on remodeling. We investigated the collagen synthesis in a rat model of ventilator-induced lung injury.
METHODS
Rats were ventilated with room air at 85 breaths/minute for 2 hours either tidal volume 7 ml/kg or 20 ml/kg (V(T)7 or V(T)20, respectively). After 2 hours of ventilation, rats were placed in the chamber for 24 hours. Lung collagen was evaluated by immunohistochemistry (n=5) and collagen was quantitated by collagen assay (n=5). Static compliance (Csta) of the whole lung as obtained from the pressure volume curves.
RESULTS
Type I collagen was an increase in expression in the interstitium with large V(T) (20 ml/ kg) ventilation after 2 hours of mechanical ventilation (MV), and further increased expression after 24 hours of recovery period. Static lung compliance was significantly (p<0.05) decreased in the V(T)20 compared with V(T)7 (0.221+/-0.05 vs 0.305+/-0.06 ml/cm H2O) after 2 hours of MV. There was a further decrease in lung compliance after 24 hours of recovery period (0.144+/-0.07 vs 0.221+/-0.05, p<0.05) in the V(T)20.
CONCLUSIONS
Large tidal volume ventilation causes an increase in type 1 collagen expression with reduction of lung compliance.
Effects of Ventilation Modes and Levels of PEEP on Respiratory Mechanics during Controlled Ventilation under General Anesthesia
Jong Cook Park, Sang Hyun Park, Hyun Jun Kwag, Soo Young Park
Korean J Crit Care Med. 2006;21(2):89-94.
  • 1,576 View
  • 17 Download
AbstractAbstract PDF
BACKGROUND
Application of PEEP increases lung volume and improves oxygenation. High PEEP levels may cause alveolar overdistension or barotrauma. It was hypothesized that there will be an effect of level of PEEP on respiratory resistance and an effect of ventilatory mode on respiratory compliance. This study aimed to investigate the effects of ventilation modes and levels of PEEP on respiratory mechanics during controlled ventilation under general anesthesia.
METHODS
In 14 mechanically ventilated patients without cardiopulmonary symptoms and signs, we measured the respiratory mechanics using the inspiration interrupter technique during a constant flow. Dynamic and static compliance, airway resistance, visco-elastic tissue and total respiratory system resistance were calculated at 0, 5, 10, 15, and 20 cmH2O of positive end-expiratory pressure (PEEP) in VCV mode, VCV with inspiratory pause mode, and PCV mode, respectively.
RESULTS
The dynamic compliance of the PCV mode was higher than that of the VCV mode. The highest static compliance was at 10 cmH2O PEEP. At 20 cmH2O PEEP, pulmonary compliance was decreased and the tissue resistance was increased.
CONCLUSIONS
These results suggest that the respiratory mechanics including respiratory resistance should be monitored for applying PEEP. Further studies on clinical condition such as acute lung injury and ARDS were needed.
Comparison of Auto-PEEP Levels Measured by End-expiratory Port Occlusion Method and Trapped Lung Volume
Jang Won Sohn, Chae Man Lim, Younsuck Koh
Korean J Crit Care Med. 2005;20(2):131-135.
  • 1,617 View
  • 17 Download
AbstractAbstract PDF
BACKGROUND
There are several METHODS: for auto-PEEP measurement during mechanical ventilation. The end-expiratory port occlusion (EEPO) method is simple and easy. Theoretically, auto- PEEP level can be also calculated by using trapped lung volume and static compliance. However, the relationship between measured auto-PEEP by EEPO method and the calculated auto-PEEP has not been studied. The purpose of this study is to observe the relationship between the measured and the calculated auto-PEEP. METHODS: 15 patients with auto-PEEP during mechanical ventilation were included. Auto-PEEP was measured by EEPO method, and calculated by using a formula; trapped lung volume/static compliance. All of the patients were paralyzed during the study. If the measured auto-PEEP is higher than calculated auto-PEEP, this patient was included in `high group'; in the opposite case, `low group'. We compared respiratory mechanics between these two groups. RESULTS: Measured auto-PEEP was 9.60+/-2.82 cmH2O, and calculated auto-PEEP was 9.78+/-2.90 cmH2O. There was statistically significant relationship between measured and calculated auto-PEEP (r=0.81, p<0.01). There was no difference on respiratory mechanics between `high group' and `low group'. CONCLUSIONS: The auto-PEEP obtained by calculation with trapped lung volume and static compliance showed a good correlation with that of using EEPO method in the paralyzed patients.
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