국내 호흡치료의 필요성에 대한 보건・의료인 및 대학교수들의 인식도 조사

이재홍(JaeHong Lee),김은정(EunJeong Kim),최정희(JeongHee Choi) 대한치료과학회 2015 대한치료과학회지 Vol.7 No.1

Objective: The purpose of this study was to identify how healthcare professionals and university professors perceive the need for domestic respiratory therapy. Method: The subjects of this study included 100 healthcare professionals who worked for medical institutions and 100 university professors in healthcare-related departments. A survey questionnaire was used to collect their perceptions. This questionnaire consisted of questions regarding the subjects’ personal information and questions regarding the need for respiratory therapy. Results: Regarding the need for domestic respiratory therapy, 68% of all healthcare professionals were aware of respiratory therapy (or therapists), and 83% of all healthcare professionals responded that specialized therapists for respiratory diseases are necessary. In terms of the need for the establishment of educational institutions specializing in respiratory therapy, 46% of this group answered that it is highly necessary, and 41% answered that it is necessary. 81% of this group also agreed on the need for medical centers specializing in the treatment of respiratory diseases. In contrast, 47% of all professors in healthcare-related departments were aware of respiratory therapy (or therapists), and 68% of all professors responded that specialized therapists for respiratory diseases are necessary. 41% answered that the establishment of educational institutions specializing in respiratory therapy is necessary, and 10% answered that it is highly necessary. Regarding the need for the establishment of departments related to respiratory therapy, 29% of this group responded that it is necessary and 5% answered that it is highly necessary. Conclusion: The results of this study show that both healthcare professionals and university professors agree on the need for respiratory therapy. In addition, an educational system for respiratory therapy and specialized respiratory therapists are urgently required to improve the quality of domestic respiratory therapy.

Improvement in the Accuracy of Respiratory-gated Radiation Therapy Using a Respiratory Guiding System

강승희,김동수,김태호,서태석,윤제웅 한국물리학회 2013 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.62 No.1

The accuracy of respiratory-gated radiation therapy (RGRT) depends on the respiratory regularity because external respiratory signals are used for gating the radiation beam at particular phases. Many studies have applied a respiratory guiding system to improve the respiratory regularity. This study aims to evaluate the effect of an in-house-developed respiratory guiding system to improve the respiratory regularity for RGRT. To verify the effectiveness of this system, we acquired respiratory signals from five volunteers. The improvement in respiratory regularity was analyzed by comparing the standard deviations of the amplitudes and the periods between free and guided breathing. The reduction in residual motion at each phase was analyzed by comparing the standard deviations of sorted data within each corresponding phase bin as obtained from free and guided breathing. The results indicate that the respiratory guiding system improves the respiratory regularity, and that most of the volunteers showed significantly less average residual motion at each phase. The average residual motion measured at phases of 40, 50, and 60%, which showed lower variation than other phases, were, respectively, reduced by 41, 45, and 44% during guided breathing. The results show that the accuracy of RGRT can be improved by using the in-house-developed respiratory guiding system. Furthermore, this system should reduce artifacts caused by respiratory motion in 4D CT imaging.

What Can We Apply to Manage Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure?

Kim, Deog Kyeom,Lee, Jungsil,Park, Ju-Hee,Yoo, Kwang Ha The Korean Academy of Tuberculosis and Respiratory 2018 Tuberculosis and Respiratory Diseases Vol.81 No.2

Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.

What Can We Apply to Manage Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure?

김덕겸,이정실,박주희,유광하 대한결핵및호흡기학회 2018 Tuberculosis and Respiratory Diseases Vol.81 No.2

Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the longterm prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.

What Can We Apply to Manage Acute Exacerbation of Chronic Obstructive Pulmonary Disease with Acute Respiratory Failure?

( Deog Kyeom Kim ),( Jungsil Lee ),( Ju-hee Park ),( Kwang Ha Yoo ) 대한결핵 및 호흡기학회 2018 Tuberculosis and Respiratory Diseases Vol.81 No.2

Acute exacerbation(s) of chronic obstructive pulmonary disease (AECOPD) tend to be critical and debilitating events leading to poorer outcomes in relation to chronic obstructive pulmonary disease (COPD) treatment modalities, and contribute to a higher and earlier mortality rate in COPD patients. Besides pro-active preventative measures intended to obviate acquisition of AECOPD, early recovery from severe AECOPD is an important issue in determining the long-term prognosis of patients diagnosed with COPD. Updated GOLD guidelines and recently published American Thoracic Society/European Respiratory Society clinical recommendations emphasize the importance of use of pharmacologic treatment including bronchodilators, systemic steroids and/or antibiotics. As a non-pharmacologic strategy to combat the effects of AECOPD, noninvasive ventilation (NIV) is recommended as the treatment of choice as this therapy is thought to be most effective in reducing intubation risk in patients diagnosed with AECOPD with acute respiratory failure. Recently, a few adjunctive modalities, including NIV with helmet and helium-oxygen mixture, have been tried in cases of AECOPD with respiratory failure. As yet, insufficient documentation exists to permit recommendation of this therapy without qualification. Although there are too few findings, as yet, to allow for regular andr routine application of those modalities in AECOPD, there is anecdotal evidence to indicate both mechanical and physiological benefits connected with this therapy. High-flow nasal cannula oxygen therapy is another supportive strategy which serves to improve the symptoms of hypoxic respiratory failure. The therapy also produced improvement in ventilatory variables, and it may be successfully applied in cases of hypercapnic respiratory failure. Extracorporeal carbon dioxide removal has been successfully attempted in cases of adult respiratory distress syndrome, with protective hypercapnic ventilatory strategy. Nowadays, it is reported that it was also effective in reducing intubation in AECOPD with hypercapnic respiratory failure. Despite the apparent need for more supporting evidence, efforts to improve efficacy of NIV have continued unabated. It is anticipated that these efforts will, over time, serve toprogressively decrease the risk of intubation and invasive mechanical ventilation in cases of AECOPD with acute respiratory failure.

Changes in the Planning Target Volume and Liver Volume Dose Based on the Selected Respiratory Phase in Respiratory-gated Radiation Therapy for a Hepatocellular Carcinoma

김재승,임인철,강수만,구은회,백성민 한국물리학회 2013 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.63 No.9

The aim of this study was to quantitatively analyze the changes in the planning target volume(PTV) and liver volume dose based on the respiratory phase to identify the optimal respiratoryphase for respiratory-gated radiation therapy for a hepatocellular carcinoma (HCC). Based on thestandardized procedure for respiratory-gated radiation therapy, we performed a 4-dimensional computedtomography simulation for 0 ~ 90%, 30 ~ 70%, and 40 ~ 60% respiratory phases to assessthe respiratory stability (SR) and the defined PTVi for each respiratory phase i. A treatment planwas established, and the changes in the PTVi and dose volume of the liver were quantitativelyanalyzed. Most patients (91.5%) passed the respiratory stability test (SR = 0.111 ± 0.015). Withstandardized respiration training exercises, we were able to minimize the overall systematic errorcaused by irregular respiration. Furthermore, a quantitative analysis to identify the optimal respiratoryphase revealed that when a short respiratory phase (40 ~ 60%) was used, the changes inthe PTV were concentrated inside the center line; thus, we were able to obtain both a PTV marginaccounting for respiration and a uniform radiation dose within the PTV.

Development of Magnetometer based Portable Self-Respiratory Training System for Enhancing the Efficiency of Radiation Therapy

Yoonjin Oh,Dong Wook Kim,Su-Ho Lee,Young-Jin Jung 한국자기학회 2017 Journal of Magnetics Vol.22 No.4

As the demand for radiation therapy increases, an appropriate breathing training has been becoming a vital element to improve the accuracy and efficiency of radiation therapy. It is important for patients to maintain the constant respiratory cycle due to difficulties of identifying exact treatment site of respiratory organs, which move with every breath of patients (e.g. part of thorax or abdomen). In order to train the patient"s periodic breathing and evaluate patient’s respiratory cycle quantitatively, we have developed magnetometer based respiratory training system. Before subject experiment, mechanical simulation was performed to evaluate stability of the developed devices. The correlation between sensor module and subjects’ respiratory motion was confirmed in the mechanical simulation, and then the possibility of measuring respiratory cycle of patients by using the magnetometer was verified through subject experiment. So, it is found that the developed device improves efficiency of breath training based on visual bio-feedback, and then general use in clinical practice is expected.

중등도 신생아 호흡 곤란 증후군에서 폐 표면 활성제 조기 투여 후 Nasal CPAP의 치료 효과

김은지,김혜숙,허만회,이상길,Kim, Eun Ji,Kim, Hae Sook,Hur, Man Hoe,Lee, Sang Geel 대한소아청소년과학회 2002 Clinical and Experimental Pediatrics (CEP) Vol.45 No.10

목 적 : 신생아 호흡 곤란 증후군에서 폐 표면 활성제의 조기 투여와 연성 환기, 고빈도 환기요법과 공격적 인공호흡기 이탈은 신생아 호흡 곤란 증후군 치료의 기본이다. 하지만, 침습적인 기도삽관에 의한 인공호흡기 치료보다 비침습적인 폐 표면 활성제의 조기투여와 nasal CPAP 병용치료의 적용 가능성을 확인하고자 본 연구를 시행하였다. 방 법 : 1999년 1월부터 2001년 8월까지 본원 출생아로서 중등도 신생아 호흡 곤란 증후군으로 진단된 환아 중 생후 2시간 이내 폐 표면 활성제의 조기 투여 후 nasal CPAP의 호기 말 양압을 5-6 cm $H_2O$로 설정하여 임상경과를 관찰한 14례를 연구군으로 하고, 인공호흡기 치료 후 5일 이내 조기이탈이 가능했던 15례를 대상으로 병력, 흉부 방사선 소견, SMR, 임상경과, 산소화 지수를 병력지를 이용하여 후향적으로 분석 하였다. 결 과 : 1) 대상아의 특징 : 평균 재태 연령은 연구군이 $32.3{\pm}1.7$주이고, 대조군은 31.3${\pm}1.5$주이었고, 평균 출생체중은 연구군이 $1,730{\pm}290gm$, 대조군이 $1,620{\pm}350gm$이었으며, 남녀 성비는 연구군이 10 : 4, 대조군이 6 : 9로 양군간에 유의한 차이가 없었다. 2) 양군에서 출생시 RDS의 정도 및 검사 소견의 비교 : 연구군에서 SMR은 $9.8{\pm}6.5$개, 대조군에서 $10.7{\pm}3.1$개, 흉부방사선 소견상 Bomsel grade 2 이상이 연구군에서 12례, 대조군에서 15례, 임상증상은 빈호흡이 연구군에서 11례, 대조군에서 9례, 흉부함몰은 연구군에서 10례, 대조군에서 8례, 신음호흡은 연구군에서 10례, 대조군에서 7례였고, 1분과 5분 Apgar 점수는 연구군이 각각 $6.9{\pm}1.3$, $8.4{\pm}0.8$, 대조군이 각각 $6.5{\pm}1.2$, $8.1{\pm}0.5$, 동맥혈 가스 분석상 pH, $PaCO_2$는 연구군이 각각 $7.3{\pm}0.1$, $51.3{\pm}14.1mmHg$, 대조군이 각각 $7.3{\pm}0.1$, $45.6{\pm}14.6mmHg$으로 신생아 호흡 곤란 증후군의 중등도 비교에서 양군은 유의한 차이가 없었다. 3) 양군에서 치료과정 중 동맥혈 가스 분석 및 호흡지표의 변화(생후 6-12시간 사이의 경과) : 호흡기치료과정 중 동맥혈 가스 분석 검사상 pH 및 $PaCO_2$의 평균치는 연구군에서 각각 $7.39{\pm}0.1$, $39.1{\pm}7.9$, 대조군에서 각각 $7.38{\pm}0.1$, $35.4{\pm}8.5$, 산소화 지수의 평균치는 연구군에서 $9.1{\pm}1.3$, 대조군에서 $8.34{\pm}1.7$로 양군에서 유의한 차이가 없었다. 4) 연구군에서 임상적 경과 및 CPAP 치료에 대한 반응도 : 연구군에서 임상적 경과가 악화되어 인공호흡기 치료가 필요했던 경우는 14례 중 2례(14.3%)이었고, 12례(85.7%)에서는 성공적으로 치료되어 인공호흡기 치료가 필요없었다. 실패한 2례 중 1례는 임상경과 중 호흡지표의 악화로 인공호흡기 치료로 전환된 경우이고 나머지 1례는 장치 후 6시간 이내에 제반증상의 악화로 보존적 인공호흡기 치료로 전환된 경우이다. 성공적으로 치료된 경우 지속적 양압 환기기간은 평균 5일이었고 평균 호기말 양압은 $5.4{\pm}0.5cm$ $H_2O$이었다. 5) 양군에서 합병증의 비교 : 동맥관 개존증은 대조군에서 2례(14.3%)있었고, 병기(stage) 3 이상의 미숙아 망막증은 연구군에서 1례, 대조군에서 3례 있었으며, 뇌실내 출혈은 연구군에서 3례, 대조군에서 2례 있었고, 뇌실주위백질연화증은 연구군에서 1례, 대조군에서 3례 있었으며, 공기 누출 Purpose : Early surfactant therapy with either gentle ventilation, high-frequency ventilation or aggressive weaning of mechanical ventilation are principles for the treatment of respiratory distress syndrome(RDS). We studied to determine the accessibility of noninvasive nasal continuous positive airway pressure(CPAP) rather than mechanical ventilation by invasive intubation after early surfactant therapy. Methods : The study group consisted of 14 infants who were born and diagnosed with moderate respiratory distress syndrome and received early surfactant therapy with nasal CPAP of PEEP 5-6 cm $H_2O$ within two hours after birth in the Fatima neonatal intensive care unit for two years from January 1999 to August 2001. The control group consisted of 15 infants who were diagnosed with the disease and could be weaned from mechanical ventilator within five days after birth during the same period. Results : The characteristics, the severity of clinical symptoms and laboratory findings in the two groups at birth showed no significant difference. Neither did the interim analysis of laboratory data in two groups. Of 14 infants in the study group who received nasal CPAP after early surfactant therapy, only two infants showed weaning failure with this therapy. In the response cases, duration of CPAP was five days and mean airway pressure was $5.4{\pm}0.5cm$ $H_2O$. Two had the complication of CPAP with abdominal distension. Final complications and outcomes in the two groups showed no signifcant difference(P>0.05). Conclusion : The clinical courses in the two groups showed no significant difference. Therefore, we suggest that early surfactant therapy with noninvasive nasal CPAP is a simple and safe method rather than aggressive weaning after invasive mechanical ventilation in moderate respiratory distress syndrome.

중등도 신생아 호흡 곤란 증후군에서 폐 표면 활성제 조기 투여 후 Nasal CPAP의 치료 효과

김은지,김혜숙,허만회,이상길 대한소아과학회 2002 小兒科 Vol.45 No.10

응급구조학과 학생들의 호흡보조요법 경험, 지식이 수행자신감에 미치는 영향요인

엄동춘,김아정,Uhm, Dong-Choon,Kim, A-Jung 한국응급구조학회 2018 한국응급구조학회지 Vol.22 No.2

Purpose: This study was conducted to identify the factors influencing performance confidence by knowledge and experience of respiratory-assistant therapy in paramedic students. Methods: A descriptive survey study used a convenience sample comprising 387 students from September 15 to October 31, 2016. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and regression analysis. Results: Knowledge was statistically significant by college(3-year), acquired certification, and observation experience in respiratory-assistant therapy. Performance confidence was statistically significant by sex, academic grade($3.0{\leq}$), acquired certification, and observation and performance experience in respiratory-assistant therapy. There was a significant correlation between knowledge and acquired certification, clinical practice, and major satisfaction. There was a significant correlation between performance confidence and acquired certification, clinical practice, major satisfaction, and knowledge. Regression analysis revealed that performance confidence accounted for 22.9% of the variance by academic grade(3.0~3.99), acquired certification, and major satisfaction. Conclusion: For paramedic students in clinical practice and in-school classes, it is important to improve performance confidence by combining training instruction with experience and education of respiratory-assistant therapy.