유방암의 접선 조사시 피폭 폐용적

오영택(Young Taek Oh),김주리(Juree Kim),강해진(Haejin Kang),손정혜(Jeong Hye Sohn),강승희(Seung Hee Kang),전미선(Mison Chun) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.2

목 적 : 유방암의 방사선 치료에서 가장 유의하여 할 사항 중의 하나인 방사선 폐렴 등의 폐합병증은 피폭 폐용적, 방사선량율, 방사선량 등의 영향을 받으며 그 중에서도 피폭 폐용적의 정도가 중요한 것으로 알려져 있다. 그러나 피폭 폐용적의 정량적인 측정 자료는 매우 드물며 피폭 폐용적의 정도를 예측할 수 있는 방법에 대한 보고도 제한적일 뿐만 아니라 대부분이 서양인을 대상으로 한 보고이다. 이에 본 저자들은 본원에서 치료받은 유방암 환자를 대상으로 접선조사시의 피폭 폐용적을 정량적으로 측정하고 간접적으로 피폭 폐용적을 예측할 수 있다고 제시되고 있는 여러 인자들의 유용성을 검증하고자 본 연구를 계획하였다. 재료 및 방법 :본 원 에 서 1995년 1월 부 터 1996년 8월 까지 접선 조사방식으로 방사선 치료를 시행 받은 유방암환자 중 치료 계획용 컴퓨터 단층 촬영을 시행한 25명을 대상으로 폐용적을 측정하였다 . 각각의 환자에서 피폭 폐용적을 예 측 할 수 있는 인자로서 1) 치료 계획 필름의 조사면 중심에서의 후방 접선으로부터 전방 흉벽의 뒷면까지의 수직선상거리인 Central Lung Distance (CLD), 2) 치료계획 필름의 후방 접선으로부터 전방 흉벽의 뒷면까지의 수직선중 가장 긴 수직선의 거리인 Maximum Lung Distance(MLD), 3) 치료 계획용 컴퓨터 단층 촬영 필름의 조사면 중심사진에서의 후방 접선으로부터 전방 흉벽의 뒷면까지의 거리인 Greatest Perpendicular Distance (GPD), 4) 치료계획 필름 상의 조사면의 세로길이(L)를 측정하였고 피폭 폐용적을 구하기 위하여 치료 계획상의 Dose Volume Histogram(DVH) 자료에서 양측 전체 폐용적(EV), 동측 전체 폐용적(IV) 및 피폭 폐용적(RV)을 측정하고, 서로간의 상관관계를 분석하였다. 결 과 : 총 25명 대상 환자의 연령은 23-67세로(중앙 연령 41세) 우측 유방암이 14예, 좌측 유방암이 11예 있었다. 전체 환자의 CLD는 평균 2.2cm(1.9-3.3cm), MLD는 평균 2.4cm(1.9-3.3 cm) 그리고 GPD는 평균 2.3cm(1.4-3.1cm)이었으며 L은 16-23cm이었다. CLD 와 L을 곱한 값은 평균 42.4cm2(32-76cm2), MLD와 L의 곱은 평균 45.3cm2(34.2 -75.9cm2)였으며, GPD와 L을 곱한 값은 42.5cm2(26.6-69cm2)였다. 전체 폐용적은 1356-4092cc로 평균 3052cc였으며 우측 폐는 584-2554cc 평균 1671cc였고 좌측 폐는 632-2252 cc로 평균 1379cc였다. 피폭 폐용적은 61-279cc(평균 170cc)로 양측 전체 폐용적에서 차지하는 비율은 (RV/EV)은 2.9-13%(평균 5.8%) 이고 동측 폐용적에서 차지하는 비율은(RV/IV) 4.9-29.6(평균 12.2%)였다. CLD, MLD, GPD, L, CLD*L, MLD*L, GPD*L 등의 변화에 따른 RV, RV/EV, RV/IV 등의 피폭 폐용적의 변화는 통계적으로 유의한 상관관계를 구할 수 없었으며 CLD가 3cm 이하인 24명의 환자에서 RV/EV는 10% 이내였다. 좌우 폐의 비교에서 RV/IV 이 좌측 유방암 환자에서 유의하게 높았으나 RV/EV은 유의한 차이를 나타내지 못하였다. 결 론 : 현재 사용하고 있는 접선 조사방식에서 CLD를 3cm 이내로 제한하는 경우 CLD 등의 변화폭이 작아서 피폭 폐용적과의 상관관계를 구할 수는 없으나 피폭 폐용적의 정도는 다른보고들을 고려할때 적절하였고 좌측 유방암 환자에서의 피폭 폐용적이 동측 전체 폐용적에서 차지하는 비율은 우측 유방암 환자에 비해 높았으나 양측 전체 폐용적에 대한 비율은 동일하였다. Purpose : Radiation pneumonitis is one of the complications caused by radiation therapy that includes a portion of the lung tissue. The severity of radiation induced pulmonary dysfunction depends on the irradiated lung volume, total dose, dose rate and underlying pulmonary function. It also depends on whether chemotherapy is done or not. The irradiated lung volume is the most important factor to predict the pulmonary dysfunction in breast cancer patients following radiation therapy. There are some data that show the irradiated lung volume measured from CT scans as a part of treatment planning with the tangential beams. But such data have not been reported in Korea. We planned to evaluate the irradiated lung volume quantitatively using CT scans for the breast tangential field and search for useful factors that could predict the irradiated lung volume. Materials and Methods : The lung volume was measured for 25 patients with breast cancer irradiated with tangential field from Jan.1995 to Aug.1996. Parameters that can predict the irradiated lung volume included; (1) the perpendicular distance from the posterior tangential edge to the posterior part of the anterior chest wall at the center of the field (CLD); (2) the maximum perpendicular distance from the posterior tangential field edge to the posterior part of the anterior chest wall (MLD); (3) the greatest perpendicular distance from the posterior tangential edge to the posterior part of anterior chest wall on CT image at the center of the longitudinal field (GPD); (4) the length of the longitudinal field (L). The irradiated lung volume(RV), the entire both lung volume(EV) and the ipsilateral lung volume(IV) were measured using dose volume histogram. The relationship between the irradiated lung volume and predictors was evaluated by regression analysis. Results : The RV is 61-279cc (mean 170cc), the RV/EV is 2.9-13.0% (mean 5.8%) and the RV/IV is 4.9-29.6% (mean 12.2%). The CLD, the MLD and the GPD are 1.9-3.3cm, 1.9-3.3cm and 1.4-3.1cm respectively. The significant relations between the irradiated lung volume such as RV, RV/EV, RV/IV and parameters such as CLD, MLD, GPD, L, CLD×L, MLD×L and GPD×L are not found with little variances in parameters. The RV/IV of the left breast irradiation is significantly larger than that of the right but the RV/EV s do not show the differences. There is no symptomatic radiation pneumonitis at least during 6 months follow up. Conclusion : The significant relationship between the irradiated lung volume and predictors is not found with little variation on parameters. The irradiated lung volume in the tangential field is less than 10% of entire lung volume when CLD is less than 3cm. The RV/IV of the left tangential field is larger than that of the right but there was no significant differences in RV/EVs. Symptomatic radiation pneumonitis has not occurred during minimum 6 months follow up.

Evaluation of Total Lung Volume and Density using Multi-Detector Computed Tomography in Normal Dogs

최호정,이기자,최수영,이정우,한우석,이인,권영항,이영원 한국임상수의학회 2011 한국임상수의학회지 Vol.28 No.5

This study was performed to quantitatively assess the normal lung volume and density according to the position by multi-detector computed tomography (MDCT) in dogs. Helical CT of the thorax was performed on 4 different positions with dorsal, left lateral, right lateral and ventral recumbency in 6 Pekingese and 6 Maltese dogs. During CT scanning, dogs were kept hyperventilated. Through the 3-dimensional reconstruction of CT images, the lung parameters were measured as the volume and density of the left, right including accessory lobe, and total lung. 3D images represented the different lung shape between Pekingese and Maltese dogs. Their difference of total lung volume and total lung density was not significant on the each position in both breeds. Right lung volume was significantly higher than left. The difference of left and right volume was 66.91 ± 25.1 ml. Linear relationship was shown between body weight and lung volume of ventral recumbency position. The dependent lung had higher density and lower volume than nondependent lung in both breed dogs. The volume of nondependent lung was not changed compared with the volume on ventral or dorsal recumbency. The total lung volume measured with MDCT is correlated with the lung density, and the lung density is useful to predict the normal total lung volume.

폐용적과 폐기능 환기장애에 대한 유의성 평가

김지율,예수영 한국방사선학회 2023 한국방사선학회 논문지 Vol.17 No.5

To In this study, we sought to evaluate related factors affecting lung volume and their significance in pulmonary function and ventilation disorders. As experimental subjects, 206 normal adult men and women who underwent a low-dose chest CT scan and a spirometry test were selected at the same time. The experimental method was to measure lung volume using lung CT images obtained through a low-dose chest CT scan using deep learning-based AVIEW. Measurements were made using the LCS automatic diagnosis program. In addition, the results of measuring lung function were obtained using a spirometer, and gender and BMI were selected as related factors that affect lung volume, and significance was evaluated through an independent sample T-test with lung volume. As a result of the experiment, it was confirmed that in evaluating lung volume according to gender, all lung volumes of men were larger than all lung volumes of women. he result of an independent samples T-test using the respective average values ​​for gender and lung volume showed that all lung volumes were larger in men than in women, which was significant (p<0.001). And in the evaluation of lung volume according to BMI index, it was confirmed that all lung volumes of adults with a BMI index of 24 or higher were larger than all lung volumes of adults with a BMI index of less than 24. However, the independent samples T-test using the respective average values ​​for BMI index and lung volume did not show a significant result that all lung volumes were larger in BMI index 24 or higher than in BMI index less than 24 (p<0.055). In the evaluation of lung volume according to the presence or absence of pulmonary ventilation impairment, it was confirmed that all lung volumes of adults with normal pulmonary function ventilation were larger than all lung volumes of adults with pulmonary ventilation impairment. And as a result of the independent sample T-test using the respective average values ​​for the presence or absence of pulmonary ventilation disorder and lung volume, the result was significant that all lung volumes were larger in adults with normal pulmonary function ventilation than in adults with pulmonary function ventilation disorder (p <0.001). Lung volume and spirometry test results are the most important indicators in evaluating lung health, and using these two indicators together to evaluate lung function is the most accurate evaluation method. Therefore, it is expected that this study will be used as basic data by presenting the average lung volume for adults with normal ventilation and adults with impaired lung function and ventilation in similar future studies on lung volume and vital capacity testing.

폐쇄용적(Closing volume)증가가 일측성 폐질환자의 체위에 따른 동맥혈 산소분압 변동에 미치는 영향

김용태,임채만,진재용,고윤석,김우성,김원동 울산대학교 의과대학 1992 울산의대학술지 Vol.1 No.1

일측성 폐질환자에서 건측 폐 하위시 환측 폐 하위시 보다 동맥혈 산소량이 높게 유지 된다는 것은 잘 알려져 있다. 이는 일반적으로 중력에 의해 하부폐에 환기, 관류가 더 많이 일어나기 때문이다. 한편 유아에서는 흉곽벽이 단단하지 못하고 폐에 대한 견인력이 약하여 흉막강 압력이 덜 음압인 것으로 알려져 있다. 따라서 유아에서는 하부폐의 기도폐쇄가 쉽게 일어나며 일측성 폐질환에서, 건측폐 하위시 보다 오히려 환측폐 하위시 동맥혈 산소분압이 더 높다고 알려져 있다. 이에 저자들은 일측성 폐질환을 가진 성인에서도 폐쇄용적이 증가된 경우 건측 폐를 상부로 하였을 때에 건측 폐를 하부로 하였을 때 보다 동맥혈 산소분압이 더 높을 수 있다고 가정하였다. 39명의 일측성 폐질환 환자를 대상으로 즉, 체위별, 정와위, 우와위에서 동맥혈 가스분석을 시 행하였으며 이중 18명의 환자에서 폐활량 측정법의 측정치 및 폐쇄용적을 측정비교하였다. 1. 건측 폐 하위시 동맥혈 산소분압이 높았던 군(A군)에서 건측 폐 하위 와위시 평균 Pao₂는 88.5±15.1mmHg, 환측 하위 와위시 평균 Pao₂는 78.6±13.3이었다.(P<0.001) 2. 한측 폐 하위시 동맥혈 산소분압이 높았던 군(B군)에서 건측 폐 하위 와위시 평균 Pao₂는 79.4±5.3, 환측 하위 와위시 평균 Pao₂는 87.9±6.2이었다.(P<0.001) 3. A군에서 평균 FVC는 78.2±14.8, FEV1은 61.5±21.3%, FEF25-75%는 57.9±23.4%이었고 B군에서는 평균 FVC는 63.7±28.6%, FEV1은 59.2±26.2%, FEF25-75%는 67.5±26.2% 이었다. 4. A군에서 CV은 87.8±13.6%, B군에서는 CV은 121±18.8%으로서 양군 사이에 유의한 차이가 있었다.(P<0.05). 이상의 결과로서 폐쇄용적이 증가한 환자에서 일측성 폐질환의 경우 동맥혈 산소분압이 환측 폐 하위시 건측 폐 하위시 보다 높을 수 있음을 관찰하였다. In unilateral lung disease, it is well known that good lung dependent position has higher Pao₂than bad lung dependent lateral decubitus position. Usually the lung base is more perfused and more ventilated than the apex because of gravity and lung weight. But infants have the floppier chest wall than adults and the resting pleural pressure in infants is more positive than that of adult. In infants, peripheral airways on dependent lung regions may be easily closed and therefore infants have large closing volume. In fact, it is well known that infants have higher Pao₂at bad lung dependent position than at good lung dependent position in unilateral lung disease. We assumed that in adult if closing volume is increased, bad lung dependent position could have higher Pao₂ than good lung dependent position. In 39 patients with unilateral parenchymal lung disease, we analysed changes of blood gas status in various body position(supine, right and left decubitus). Spirometry and closing volume were measured in 18 patients. The results are as follows. 1) In patients with higher Pao₂ at good lung dependent position, mean Pao₂was 88.5±15.1 mmHg at good lung dependent position and 78.6±13.3 mmHg at bad lung dependent position(P<0.001). 2) In patients with higher Pao₂at bad lung dependent position, mean Pao₂was 79.4±5.3 mmHg at good lung dependent position and 87.9±6.2 mmHg at bad lung dependent position(P<0.01). 3) Closing volumes were significantly different between patients with higher Pao₂at good lung dependent position and patients with higher Pao₂ at bad lung dependent position(87.8%±13.6% vs, 121±18.8%, p<0.05). From these results, we observed that patients with increased closing volume could have higher Pao₂at bad lung dependent position than at good lung dependent position.

Effects of Intraoperative Ventilation Strategy on Perioperative Atelectasis Assessed by Lung Ultrasonography in Patients Undergoing Open Abdominal Surgery: a Prospective Randomized Controlled Study

조수영,오혜원,최민희,이현정,우재희 대한의학회 2020 Journal of Korean medical science Vol.35 No.39

Background: Protective mechanical ventilation using low tidal volume has been introduced to surgical patients to reduce the incidence of postoperative pulmonary complications. We investigated the effects of protective ventilation (PV) techniques on anesthesia-induced atelectasis identified via lung ultrasonography in patients undergoing abdominal surgery. Methods: A total of 42 adult patients who were scheduled for open abdominal surgery with an expected duration > 2 hours were included in the study. Patients were randomized to receive either conventional ventilation (CV; tidal volume of 9–10 mL/kg predicted body weight [PBW] with no positive end-expiratory pressure [PEEP]) or PV (tidal volume of 6–8 mL/kg PBW and 5 cmH2O PEEP) via pressure-controlled ventilation with volume guaranteed. Lung ultrasonography was performed at four predefined time points to assess perioperative atelectasis by dividing each hemithorax into six quadrants based on a modified lung ultrasound (LUS) scoring system. Results: The tidal volume delivered to patients was 9.65 ± 1.65 mL/kg PBW in the CV group and 6.31 ± 0.62 mL/kg PBW in the PV group. Ventilation using low tidal volume led to similar LUS scores in all lung areas and at all time points compared to ventilation using high tidal volume. There was no significant difference between the groups in the number of patients requiring recruitment maneuvers at the end of surgery. Conclusion: Ventilation with low tidal volume combined with 5 cmH2O PEEP did not cause further loss of aeration compared to ventilation with high tidal volume. Low tidal volume ventilation can be used in patients without lung injury based on lung assessment by bedside lung ultrasonography.

Predictive Value of Preoperative Volume-Based 18F-2-Fluoro-2-Deoxy-D-Glucose Positron Emission Tomography/Computed Tomography Parameters in Patients with Resectable Lung Adenocarcinoma

최선주,권혜령,조희영,박기수,이성호,정재호,권현우,김성은 대한핵의학회 2018 핵의학 분자영상 Vol.52 No.6

Purpose This study aimed to investigate the prognostic value of metabolic tumor volume (MTV) and total lesion glycolysis(TLG), which are volume-based PET parameters, using 18F-2-fluoro-2-deoxy-D-glucose positron emission tomography/computed tomography (18F-FDG PET/CT) in patients with surgically resectable lung adenocarcinoma. Methods We retrospectively evaluated 149 patients with lung adenocarcinoma who underwent 18F-FDG PET/CT beforesurgical resection. Maximum standardized uptake value (SUVmax), MTV, and TLG of the primary tumor with thresholdvalue of SUVmax 30, 40, and 50% were calculated, respectively. To compare the predictive performance of volumebasedPET parameters, recurrence-free survival was assessed using the Kaplan-Meier method. Results The study included 70 males and 79 females with an average age of 65.8 years. The median follow-up time was45.4 months. Recurrence was observed in 53 patients (35.6%). The mean ± SD SUVmax, MTV30%, and TLG30% of theentire cohort were 4.79 ± 2.94, 19.45 ± 24.85, and 56.43 ± 101.88, respectively. The cut-off values of MTV30% andTLG30% for recurrence were 11.07 ad 30.56, respectively. The 1-year recurrence-free survival (RFS) rate was 96.5%in low-MTV30% patients compared with 86.2% in high-MTV30% patients (p = 0.018) and 96.0% in low-TLG30% patientscompared with 88.5% in high-TLG30% patients (p < 0.001). On univariate and multivariate analysis, TLG30% (HR, 2.828,p < 0.001; HR, 2.738, p < 0.001, respectively) was an independent prognostic factor for predicting recurrence-freesurvival (RFS). Conclusion TLG30% value was observed to be a significant prognostic factor for RFS in patients with lung adenocarcinomatreated by surgical resection.

생체외 돼지 폐를 이용한 인공 폐결절의 부피측정: 반자동 부피측정 프로그램과 영상의학과 의사의 수동측정간의 비교 연구

전주현,김진환,김성수,전호상,이현주,박노혁,조규성 대한영상의학회 2010 대한영상의학회지 Vol.62 No.5

Purpose: With the advent of MSCT, the detection rate of small pulmonary nodules is markedly greater. However, there is no definite diagnostic clue to differentiate between malignant and benign nodules, except for the interval growth in small nodule less than 1 cm in diameter. We evaluated the accuracy of computeraided volumetry (CAV) and compared it with 4 radiologists’ measurement. Materials and Methods: Fifteen artificial nodules that were embedded in the ex vivo porcine lung were scanned by MSCT. The diameters and volumes of nodules were independently measured three times, at 5-day intervals, and by four radiologists as well as by CAV. We evaluated the accuracy of the measurements on the basis of the true diameter and volume of the nodules. Using a paired t-test and a Bland-Altman plot, we evaluated whether there was a statistically significant difference between the radiologists’ measurements and the CAV. Results: The accuracy of the manual measurements by radiologists revealed a statistically significant difference from the true diameter and volume of the artificial nodules (p<0.01). Conversely, the accuracy of CAV did not show a statistically significant difference with the true nodule diameter and volume (p>0.01)Conclusion: The results of this study suggest that CAV is an accurate and useful tool to evaluate the volume of pulmonary nodules and can eventually be used to differentiate malignant and benign nodules as well as evaluate the therapeutic response of lung cancer. 목적: 다채널전산화단층촬영을 이용한 폐암 검진이 증가함에 따라 직경 1 cm 미만의 소폐결절의 발견이 증가하고 있지만, 소폐결절에서 악성과 양성을 감별하기 어렵기 때문에 추적검사로 그 크기 변화를 관찰하는 것이 중요하다. 이 연구에서는 인공 결절을 이용하여, 컴퓨터 프로그램을 이용한 체적 진단(computer-aided volumetry, CAV) 결과와 영상의학과 의사의 수동측정 결과의 정확도와 재현성을 비교 연구하였다. 대상과 방법: 공기로 팽창하고 고정한 돼지의 폐에 직경이 3 mm, 5 mm, 8 mm, 10 mm, 12 mm인 15개의 인공 결절을 삽입하여 다채널전산화단층촬영으로 촬영한 뒤 4명의 영상의학과 의사와 CAV가 측정한 직경과 부피를 비교하였다. 측정 재현성을 비교하고 상기 바이아스(bias)를 줄이고자 5일 간격으로 각 3번씩 측정하였고, 통계학적 분석을 위해 Paired T-test와 Bland-Altman plot을 사용하였다. 결과: 영상의학과 의사가 측정한 결절의 직경과, 체적 결과는 참값과 통계학적으로 유의하게 차이가 있는 것으로 나타났지만(p < 0.01), CAV가 측정한 값은 참값과 유의한 차이가 없는 것으로 나타났다. 결론: CAV가 부피 측정에 있어 정확도와 재현성이 높으므로, 폐소결절의 양성 및 악성 결절의 감별 진단과 폐종양의 항암 치료 반응을 평가하는 데 있어 매우 유용하다 할 수 있다.

Volume-controlled versus pressure-controlled ventilation-volume guaranteed mode during one-lung ventilation

송석영,조민수,김종해,류태하,김봉일,정진용 대한마취통증의학회 2014 Korean Journal of Anesthesiology Vol.67 No.4

Background: The purpose of this study was to investigate the changes in airway pressure and arterial oxygenation between ventilation modes during one-lung ventilation (OLV) in patients undergoing thoracic surgery. Methods: We enrolled 27 patients for thoracic surgery with OLV in the lateral decubitus position. The subjects received various modes of ventilation in random sequences during surgery, including volume-controlled ventilation (VCV) and pressure-controlled ventilation-volume guaranteed (PCV-VG) with a tidal volume (TV) of 8 ml/kg of actual body weight. Target-controlled infusion (TCI) with propofol and remifentanil was used for anesthesia induction and maintenance. After double-lumen endobronchial tube (DLT) insertion, the proper positioning of the DLT was assessed using a fiberoptic bronchoscope. Peak inspiratory pressure (Ppeak), exhaled TV, and arterial blood gas were measured 30 min after each ventilation mode. Results: Ppeak was significantly reduced with the PCV-VG mode (19.6 ± 2.5 cmH2O) compared with the VCV mode (23.2 ± 3.1 cmH2O) (P < 0.000). However, no difference in arterial oxygen tension was noted between the groups (PCV-VG, 375.8 ± 145.1 mmHg; VCV, 328.1 ± 123.7 mmHg) (P = 0.063). The exhaled TV was also significantly increased in PCV-VG compared with VCV (451.4 ± 85.4 vs. 443.9 ± 85.9 ml; P = 0.035). Conclusions: During OLV in patients with normal lung function, although PCV-VG did not provide significantly improved arterial oxygen tension compared with VCV, PCV-VG provided significantly attenuated airway pressure despite significantly increased exhaled TV compared with VCV.

일측 폐환기 시 용적조절환기와 압력조절환기의 비교

염종훈 ( Jong Hoon Yeom ),신우종 ( Woo Jong Shin ),김유정 ( Yu Jung Kim ),심재항 ( Jae Hang Shim ),전우재 ( Woo Jae Jeon ),조상윤 ( Sang Yun Cho ),김경헌 ( Kyoung Hun Kim ) 대한마취과학회 2009 Korean Journal of Anesthesiology Vol.56 No.5

Background: We hypothesized that pressure control ventilation allows a more even distribution in the lung and better maintenance of the mean airway pressure than is achieved with volume control ventilation. We try to compare the effect of pressure control ventilation (PC) with that of volume control ventilation without an end-inspiratory pause (VC) during one-lung ventilation (OLV) in an anesthetized, paralyzed patient for performing thoracopic bullectomy of the lung. Methods: We ventilated 20 patients with VC and PC after the insertion of a thoracoscope in continual order for, at least for 15 minutes, for each, VC and PC procedure. At the end of VC and PC, the respiratory mechanics, gasometrics, and hemodynamic parameters were measured and collected. Results: We found no significant differences between VC and PC except for the peak inspiratory airway pressure (PIP), the mean airway pressure and the arterial oxygen partial pressure (PaO2). The PIP was significantly decreased from 27.0±6.0 cmH2O (VC) to 21.8±5.4 cmH2O (PC). The mean airway pressure was significantly increased from 8.6±1.6 cmH2O (VC) to 9.4±2.0 cmH2O (PC), and the PaO2 was significantly increased from 252.9±97.3 mmHg (VC) to 285.2±103.8 mmHg (PC). Conclusions: If PC allows mechanical ventilation with the same tidal volume and respiratory rate as VC during OLV, then PC significantly increases the PaO2 but this is not clinically significant, and the PC significantly decreases the PIP, which induces barotrauma or volutrauma when the PIP is excessively high. (Korean J Anesthesiol 2009;56:492~6)

The Prognostic Value of Residual Volume/Total Lung Capacity in Patients with Chronic Obstructive Pulmonary Disease

신태림,오연목,박주헌,이규성,오성희,강대룡,신승수,서준범,유광하,이지현,김태형,임성용,윤호일,이진국,최강현,이재승,이상도 대한의학회 2015 Journal of Korean medical science Vol.30 No.10

The prognostic role of resting pulmonary hyperinflation as measured by residual volume (RV)/total lung capacity (TLC) in chronic obstructive pulmonary disease (COPD) remains poorly understood. Therefore, this study aimed to identify the factors related to resting pulmonary hyperinflation in COPD and to determine whether resting pulmonary hyperinflation is a prognostic factor in COPD. In total, 353 patients with COPD in the Korean Obstructive Lung Disease cohort recruited from 16 hospitals were enrolled. Resting pulmonary hyperinflation was defined as RV/TLC ≥ 40%. Multivariate logistic regression analysis demonstrated that older age (P = 0.001), lower forced expiratory volume in 1 second (FEV1) (P < 0.001), higher St. George Respiratory Questionnaire (SGRQ) score (P = 0.019), and higher emphysema index (P = 0.010) were associated independently with resting hyperinflation. Multivariate Cox regression model that included age, gender, dyspnea scale, SGRQ, RV/TLC, and 6-min walking distance revealed that an older age (HR = 1.07, P = 0.027), a higher RV/TLC (HR = 1.04, P = 0.025), and a shorter 6-min walking distance (HR = 0.99, P < 0.001) were independent predictors of all-cause mortality. Our data showed that older age, higher emphysema index, higher SGRQ score, and lower FEV1 were associated independently with resting pulmonary hyperinflation in COPD. RV/TLC is an independent risk factor for all-cause mortality in COPD.