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전경만,전익수,서지영,정만표,고원중,김호중,권오정,Dai-Hee Han,정명진 대한의학회 2007 Journal of Korean medical science Vol.22 No.3
This study was conducted to observe effects of two methods of setting positive endexpiratory pressure (PEEP) based on the pressure-volume (PV) curve. After lung injury was induced by oleic acid in six mongrel adult dogs, the inflation PV curve was traced and the lower inflection point (LIP) was measured. The ‘PEEPINF’ was defined as LIP+2 cmH2O. After recruitment maneuver to move the lung physiology to the deflation limb of PV curve, decremental PEEP was applied. The lowest level of PEEP that did not result in a significant drop in PaO2 was defined as the ‘PEEPDEF’. Arterial blood gases, lung mechanics, hemodynamics, and lung volumes (measured on computed tomography during end-expiratory pause) were measured at PEEP of 0 cmH2O, PEEPINF and PEEPDEF sequentially. The median PEEPINF was 13.4 cm H2O (interquartile range, 12.5-14.3) and median PEEPDEF was 12.0 cm H2O (10.0- 16.5) (p=0.813). PEEPDEF was associated with significantly higher PaO2 and lung volumes, and significantly lower shunt fraction and cardiac index when compared to PEEPINF (p<0.05). Setting the PEEP based on the deflation limb of the PV curve was useful in improving oxygenation and lung volumes in a canine lung injury model.
전경만 한국외교협회 2018 외교 Vol.126 No.0
한반도 평화체제는 북한이 1954년 이래 줄곧 주장해오는 평화협정 체결의 결과물로서 상정되고 있다. 북한이 핵개발과 핵무장 완성을 선언하면서 미 · 북 평화협정 체결을 집중적으로 요구하고 있어, 한국 정부도 당초의 정치군사적 신뢰구축을 선행조건으로 삼았으나 북핵문제 해결 목적에서 1990년대부터 비정상적 수순을 택해 평화체제 구축을 검토해오고 있다. 북한핵의 완전폐기를 검증하고 평화협정을 체결해 평화체제를 한반도에 구축함으로써 정전체제를 종식하자는 방안이다. 북한의 핵폐기 의사가 불확실한 가운데 평화체제 구축문제가 앞서 거론되어 한국안보는 물론 한반도 평화도 정전체제 당시보다 보장되지 못할 가능성을 배제해야 한다. 북한의 완전 핵폐기를 정치군사적 신뢰구축으로서 간주하는 경우, 착수할 한반도 평화체제 구축을 위해 체결당사자 범위, 남 · 북한 관계 설정, 경계선 획정, 한 · 미동맹과 주한미군 임무, 평화유지와 관리 방안 등, 평화협정 체결과 이를 위한 정전체제 종식 방법 등, 핵심과제들에 대한 세부방안을 면밀하게 준비하는 작업에 정책적 우선순위를 부여하는 일이 긴요하다.
Critical Care Management Following Lung Transplantation
전경만 대한흉부외과학회 2022 Journal of Chest Surgery (J Chest Surg) Vol.55 No.4
Postoperative critical care management for lung transplant recipients in the intensive care unit (ICU) has expanded in recent years due to its complexity and impact on clinical outcomes. The practical aspects of post-transplant critical care management, especially regarding ventilation and hemodynamic management during the early postoperative period in the ICU, are discussed in this brief review. Monitoring in the ICU provides information on the patient’s clinical status, diagnostic assessment of complications, and future management plans since lung transplantation involves unique pathophysiological conditions and risk factors for complications. After lung transplantation, the grafts should be appropriately ventilated with lung protective strategies to prevent ventilator-induced lung injury, as well as to promote graft function and maintain adequate gas exchange. Hypotension and varying degrees of pulmonary edema are common in the immediate postoperative lung transplantation setting. Ventricular dysfunction in lung transplant recipients should also be considered. Therefore, adequate volume and hemodynamic management with vasoactive agents based on their physiological effects and patient response are critical in the early postoperative lung transplantation period. Integrated management provided by a professional multidisciplinary team is essential for the critical care management of lung transplant recipients in the ICU.