No abstract available.
Respiration, Artificial*

BACKGROUND: Bilateral interruption of the upper thoracic sympathetic chain at T2 level represents a selective cure for essential hyperhidrosis. Following the surgical sympathectomy, significant changes in pulmonary function has been observed. Our hypothesis was that thoracic sympathectomy may increase airway resistance during mechanical ventilation and which may be attenuated by the anticholinergics. METHODS: 21 patients with essential hyperhidrosis in ASA physical status class 1 under going thoracoscopic sympathectomy, they were randomizely divided into two groups: glycopyrrolate premedication group (n=13) and non-premedication, control group (n=9). Glycopyrrolate 0.2 mg was administered 30 minutes before the induction of anesthesia. Blood pressure, heart rate, peak airway pressure, plateau pressure were measured at before and immediate after sympathectomy. Respiratory compliance and resistance were calculated. RESULTS: After thoracoscopic sympathectomy, there was significant increase in mean peak airway pressure (15 +/- 3 vs 18 +/- 3 cmH2O, P<0.05) and decrease in respiratory compliance (52 +/- 12 vs 45 +/- 10 ml/cmH2O, P<0.05) compared to baseline. However there was no significant difference between glycopyrolate premedication group and non-premedication group. Conclusion: Thoracoscopic upper dorsal sympathectomy in patients with essential hyperhidrosis causes increase peak airway pressure and decrease the compliance of respiratory system during mechanical ventilation.
Airway Resistance ; Anesthesia ; Blood Pressure ; Cholinergic Antagonists ; Compliance ; Glycopyrrolate ; Heart Rate ; Humans ; Hyperhidrosis* ; Premedication ; Respiration, Artificial ; Respiratory System ; Sympathectomy*

BACKGROUND: Although primary dermatological conditions requiring intensive care unit (ICU) admission is rare, skin lesions due to manifestations of systemic diseases or complications in the critically ill patients are relatively common. During the process of critical care for the significant illness, the skin lesions are often ignored in daily clinical examination. OBJECTIVE: We have analyzed the skin manifestations of patients in the ICU and to correlate them with ventilator care, nutrition and the period of admission. METHODS: Among 113 patients in the ICU, 83 with ventilator care and 30 without ventilator care were examined for their skin lesions. The dermatologic conditions were classified into 5 groups: (1) primary skin diseases requiring intensive care; (2) dermatologic disorders due to multi-system disorders; (3) skin diseases as complications of intensive care; (4) previously acquired coincidental dermatologic diseases; and (5) nonspecific cutaneous manifestations. Dermatologic conditions in each category between the ventilator group and the non-ventilator group were compared. RESULTS: The study results are summarized as follows: 1. The incidence of cutaneous manifestations was 80.5% (91/113) in total, 80.7% (67/83) in the ventilator group and 80.0% (24/30) in the non-ventilator group. 2. The skin manifestations of ICU patients were classified into primary dermatological conditions, multi-system disorders with cutaneous signs, skin conditions developing as the complications of intensive care, previous dermatologic disorders, and nonspecific cutaneous symptoms which were 0 cases (0%), 25 cases (22.1%), 32 cases (28.3%), 37 cases (32.7%) and 45 cases (39.8%) respectively. Twenty-two patients had no skin lesions. These manifestations were not significantly different between the ventilator group and the non-ventilator group. 3. The incidence of xerosis was elevated in proportion to the period of admission. 4. Nonspecific cutaneous manifestations such as edema on the extremities and xerotic skin were not correlated with the nutritional status of the patients. CONCLUSION: The most common dermatologic manifestation in ICU patients is nonspecific skin lesion such as peripheral edema and xerotic skin. The incidence of xerosis was related with the periods of admission, it is considered that the longer the duration of hospitalization was, the dryness of the ICU environment and the exposed skin of patients were increased. Therefore the dryness should be corrected and the exposure of the skin should be avoided.
Critical Care ; Critical Illness ; Edema ; Extremities ; Hospitalization ; Humans ; Incidence ; Intensive Care Units* ; Critical Care* ; Nutritional Status ; Skin ; Skin Diseases ; Skin Manifestations ; Ventilators, Mechanical

Acute intermittent porphyria(AIP) is a rare hepatic disorder resulting from defects in the synthesis of heme. This occurs in approximately 0.01% of the general population and is even rare in black and orientals. Acute episode of this disease can be triggered by surgery, certain drug, pregnancy, mensturation, fasting and etc. We report a porphyrinogenic neuropathy occured after general anesthesia in a oriental woman who presented with abdominal pain and other typical sign and symptom. 56 year-old female patient was diagnosed as acute appendicitis for 2 days of constipation and abdominal pain and appendectomy was performed under general anesthesia at local clinic. Anesthesia was induced with penthothal and maintained with halothane, and she was recovered from anesthesia without event. After operation she experienced difficult swallowing and generalized weakness which were aggrevated day by day. Therefore she was transferred to our hospital on fourth postoperative day. Physical examination revealed Grade II motor weakness of Gxtremities and decreased deep tendon reflex. Neostigmine test and Jolly test were done under impression of myasthenia gravis but revealed negative. Guillian-Barre syndrome was difficult to rule out in this patient, but urinalysis revealed increased delta aminolevulinic acid and urine color changed dark under light. Therefore we diagnosed her as AIP. 6 days after appendectomy she complained severe dyspnea with vital capacity 350 ml and arterial blood gas analysis revealed PO2 of 56 mmHg and PCO2 of 44 mmHg under nasal oxygen 5 1/min inhalation. Therefore we diagnosed this peripheral neuropathy as AIP and report here with references.
Abdominal Pain ; Aminolevulinic Acid ; Anesthesia ; Anesthesia, General ; Appendectomy ; Appendicitis ; Blood Gas Analysis ; Constipation ; Deglutition ; Dyspnea ; Fasting ; Female ; Halothane ; Heme ; Humans ; Inhalation ; Middle Aged ; Myasthenia Gravis ; Neostigmine ; Oxygen ; Peripheral Nervous System Diseases ; Physical Examination ; Porphyrias ; Pregnancy ; Reflex, Stretch ; Urinalysis ; Vital Capacity

Adult Respiratory Distress Syndrome(ARDS) is defined as a syndrome of acute respiratory failure characterized by noncardiogenic pulmonary edema with severe hypoxemia caused by right to left intrapulmonary shunting secondary to atelectasis and air space filled with edema fluid. On the past respiratory failure was thought to be the most common cause of mortality of ARDS in the past but recent research suggests the importance of non-pulmonary organ failure. And this has been increasingly recognized as a major cause of death in patients who develope a acute lung injury. Therefore the prognosis of ARDS depends on the associated clinical disorders. But there are very few reports about the prognosis and predisposing factor of ARDS in korea. We performed a retrospective study on ARDS in association with sex prevalance, in 103 ARDS patients. Age distribution, associated disease and prognosis. The results were as follows l) ARDS occurred more frequantly in male.(male female=1.9: 1) 2) Common clinical disorders associcated with development of ARDS were sepsis(26%), pneumonia(16%), gastric aspiration(12%) and etc. 3) Overall mortality was 54%, but the mortality was high in trauma patient with 80%. 4) Mortality of ARDS increased by age.
Acute Lung Injury ; Adult* ; Age Distribution ; Anoxia ; Causality* ; Cause of Death ; Edema ; Humans ; Korea ; Mortality ; Prognosis* ; Pulmonary Atelectasis ; Pulmonary Edema ; Respiratory Distress Syndrome, Adult* ; Respiratory Insufficiency ; Retrospective Studies

BACKGROUND: Despite the importance of burn-induced encephalopathy, cerebral hemodynamics after burn injury and during resuscitation remains undefined. The aim of our study was to evaluate the effects of a large cutaneous burn injury on the cerebral circulation. METHODS: Anesthetized sheep(n=8) were prepared with vascular catheters, a urinary catheter and a Richmond bolt for intracranial pressure monitoring. A scald injury was inflicted on 70% of total body surface area with hot water. Resuscitation was started 30 minutes after scald with Ringer's lactate to restore and then maintain baseline oxygen delivery. Resuscitation maintained blood pressure, cardiac output and urine output at normal levels. Brain blood flow was measured with colored microspheres. RESULTS: During resuscitation intracranial pressure rose slowly from 10.6+/-1.5 to 17.0+/- 4.0 mmHg(P<0.05) and cerebral perfusion pressure was reduced from 86.4+/- 6.8 to 64.1+/- 2.8 mmHg(P<0.05). During early resuscitation cerebrovascular resistance declined to maintain brain blood flow and oxygen delivery at baseline or better. After 6 hours, cerebrovascular resistance was inappropriately increased during a period of reduced cerebral perfusion pressure which resulted in brain blood flow being half the baseline levels. CONCLUSIONS: These data suggest that autoregulation maintains brain blood flow immediately after burn shock and early resuscitation, but autoregulation may be less effective as burn resuscitation proceeds.
Blood Pressure ; Body Surface Area ; Brain ; Burns* ; Cardiac Output ; Hemodynamics ; Homeostasis ; Intracranial Pressure ; Lactic Acid ; Microspheres ; Oxygen ; Perfusion ; Resuscitation* ; Shock ; Skin ; Urinary Catheters ; Vascular Access Devices ; Water

BACKGROUND: Positive end expiratory pressure (PEEP) ventilation is well established as an integral part of the management of patients with the acute lung injury. PEEP is a key element in the treatment of hypoxemia resulting from pulmonary edema. Pulmonary capillary pressure (Pcap) is the most important factor influencing lung edema formation, and an understanding of how Pcap is altered by variations of PEEP or pulmonary arterial occlusion pressure (PAOP) is important to improve the treatment of acute lung injury patients. This study was performed to evaluate the effects of PEEP on the pulmonary capillary pressure in acute lung injury patients. METHODS: This was a prospective study of 11 acute lung injury patients. The effect of PEEP on pulmonary circulation at four different levels (0,4,8, and 12cm H2O) was analyzed. Pcap was estimated visually at bed side with Swan Ganz catheters. The pulmonary vasculature was analyzed by calculating the pressure difference at the arterial and venous parts of the circulation. RESULTS: As PEEP increased from 0 to 12 cm H2O, the mean puhnonary arterial pressure (PAP) and Pcap increased respectively from 22.7 ± 7.4 to 25.3 ± 7.3 mmHg and 15.3 ± 3.3 to 17.8 ±3.2 mmHg (p<0.05). Similarly, PAOP increased from 9.8 ± 2.1 to 12.8 ± 2.1 mmHg and the central venous pressure increased from 6.1 ± 1.6 to 9.3 1: 2.3 mmHg(p<0.05). However, the pressure gradient at the arterial (PAP-Pcap) and venous (Pcap-Pcwp) part of pulmonary circulation remained unchanged at all evaluated PEEP levels. CONCLUSION: Although Pcap increasoo gradually with increased PEEP, the pressure gradient at the arterial and venous part of the pulmonary vasculature remained unchanged at all evaluated PEEP levels in acute lung injury patients.
Acute Lung Injury* ; Anoxia ; Arterial Pressure ; Capillaries* ; Catheters ; Central Venous Pressure ; Edema ; Humans ; Lung ; Positive-Pressure Respiration* ; Prospective Studies ; Pulmonary Circulation ; Pulmonary Edema ; Ventilation

BACKGROUND: Maintenance of normal arterial carbon dioxide tension (PaCO2) is not generally a problem if the same tidal volume can be maintained when changing from two-lung(TLV) to one-lung ventilation(OLV). However, there have been a few studies on the use of capnography in monitoring the adequacy of ventilation during one-lung anesthesia. We have therefore studied how closely end-tidal PCO2 (PETCO2) values reflect changes in PaCO2 in patients undergoing thoracoscopic sympathectomy during TLV and after transition to OLV. METHODS: We have measured arterial oxygen tension(PaO2), PaCO2, PETCO2, and (PaCO2-PETCO2) in 24 adult, either sex, patients by infra-red spectrometry. They were measured after induction of anesthesia, in supine position(TLVsup), after a lateral decubitus position(TLVlat), at 15 minutes after left OLV(OLVLt), after right OLV(OLVRt), and at 10 minutes in the supine position re-positioned at the end of the operation(TLVrep). Data were analyzed with a one-way analysis of variance with repeated measures followed by multiple comparision. The correlation between PaCO2 and PETCO2 were tested using linear regression. RESULTS: PaCO2 did not significantly change, whereas PETCO2 significantly decreased at OLVLt, OLVRt compared with TLVsup value (OLVLt, 29.7 mmHg OLVRt, 30.5 mmHg and TLVsup, 33.6 mmHg; P< 0.05). Compared with TLVsup(0.2 mmHg), (PaCO2-PETCO2) significantly increased at OLVLt, OLVRt, TLVrep(3.7 mmHg, 2.3 mmHg, 3.5 mmHg). The correlation between PaCO2 and PETCO2 in these series is consistent. (r>0.65, P<0.0006) CONCLUSIONS: In the patients undergoing thoracoscopic sympathectomy with TLV or OLV in the lateral decubitus position, PETCO2 is a reliable estimate of the PaCO2. However, when the operative time is prolonged the arterial PCO2 may be more reliable than PETCO2.
Adult ; Anesthesia ; Capnography ; Carbon Dioxide ; Humans ; Linear Models ; One-Lung Ventilation* ; Operative Time ; Oxygen ; Spectrum Analysis ; Supine Position ; Sympathectomy ; Thoracoscopy* ; Tidal Volume ; Ventilation

BACKGROUND AND OBJECTIVE: Controlled mechanical ventilation(CMV) with positive end expiratory pressure(PEEP) is frequently employed in the treatment of critically ill patients in the surgical intensive care unit. CMV with PEEP can impair many hemodynamic parameters such as a decrease in cardiac index. These hemodynamic changes may lead to vital organ dysfunctions such as oliguria. The purpose of this current study is to examine the effect on the hemodynamic and renal function of positive end expiratory pressure. MATERIALS AND METHODS: The study is performed in 10 patients treated with PEEP. Starting with no PEEP and then adding 4cmH2O of PEEP in 2 hrs interval till 12cmH2O of PEEP is reached. At each procedure, the hemodynamic parameters, urine output, creatinine clearance, fractional excretion of sodium are measured. RESULTS: The mean arterial pressure was decreased from 102.2+/-5mmHg(mean+/-SEM) at 0cmH2O of PEEP to 91.6+/-5.4mmHg at 12cmH2O of PEEP(P<0.05). The cardiac index decreased from 4.21+/-0.21L/min/m2 at 0cmH2O of PEEP to 3.59+/-0.14L/min/m2 at 8cmH2O of PEEP(P<0.01) and 3.25+/-0.12L/min/m2 at 12cmH2O of PEEP(P<0.01). Urine output decreased from 1.61+/-0.21ml/hr/kg at 0cmH2O of PEEP to 1.21+/-0.19ml/hr/kg at 8cmH2O of PEEP(P<0.05), 0.85+/-0.13ml/hr/kg at 12cmH2O of PEEP(P<0.01). Creatinine clearance decreased from 114.9+/-3.36ml/min at 0cmH2O of PEEP to 97+/-5.28ml/min at 8cmH2O of PEEP(P<0.01) and 80.2+/-3.11ml/min at 12cmH2O of PEEP(P<0.01). The pulmonary capillary wedge pressure, fractional excretion of sodium were unchanged. CONCLUSION: CMV with 8cmH2O of PEEP significantly affected the hemodynamic and renal function. At 12 cmH2O of PEEP, the changes in urine output and renal function may be affected more by hemodynamic changes than hormonal changes.
Arterial Pressure ; Creatinine ; Critical Illness ; Hemodynamics* ; Humans ; Critical Care ; Oliguria ; Positive-Pressure Respiration ; Pulmonary Wedge Pressure ; Sodium

BACKGROUND: If the effects of alveolar recruitment are beneficial, but of short duration, repetitive recruitment maneuvers (RMs) will be necessary to maintain oxygenation. This study was performed to assess the effect of repetitive alveolar recruitment, with high-sustained inflation pressure on oxygenation and compliance of the respiratory system, in patients with acute respiratory distress syndrome. METHODS: Ten adult patients on ventilator support, with controlled mechanical ventilation, received three repetitive RMs with a high-sustained inflation pressure. The time intervals from the first to second RM and from the second to third RM were 8.42 +/- 0.56 hours and 12.43 +/- 1.45 hours, respectively. Recruitment was conducted by setting the ventilator mode to a continuous positive airway pressure of 40 cmH2O for 40 seconds. After each alveolar recruitment, the previous ventilator settings in the pressure control mode were re-established with a high positive end expiratory pressure. The FIO2, PaO2/FIO2 and lung compliance (tidal volume/[plateau pressure-PEEP]) were recorded with reference to the arterial blood gas analysis at both 30 minutes pre and post recruitment. RESULTS: The FIO2 was able to be decreased from 0.9 to 0.5 while maintaining the PaO2 at higher than 80 mmHg after three recruitments. The PaO2/FIO2 improved from 98 to 288 and the compliance of the respiratory system improved from 26 to 41 ml/cmH2O after three recruitments. CONCLUSIONS: Our RESULTS suggest that repetitive recruitment can be used to maintain the beneficial effects of alveolar recruitment in patients with acute respiratory distress syndrome when supported using a lung protective mechanical ventilation strategy.
Adult ; Blood Gas Analysis ; Compliance* ; Continuous Positive Airway Pressure ; Humans ; Inflation, Economic ; Lung ; Lung Compliance ; Oxygen* ; Positive-Pressure Respiration ; Respiration, Artificial ; Respiratory Distress Syndrome, Adult ; Respiratory System ; Ventilators, Mechanical