BACKGROUND/AIMS: Despite the clinical importance and widespread use of pulse wave velocity (PWV), there are no standards for pulse sensors or for system requirements to ensure accurate pulse wave measurement. We assessed the reproducibility of PWV values using a newly developed PWV measurement system. METHODS: The system used in this study was the PP-1000, which simultaneously provides regional PWV values from arteries at four different sites (carotid, femoral, radial, and dorsalis pedis). Seventeen healthy male subjects without any cardiovascular disease participated in this study. Two observers performed two consecutive measurements in the same subject in random order. To evaluate the reproducibility of the system, two sets of analyses (within-observer and between-observer) were performed. RESULTS: The means+/-SD of PWV for the aorta, arm, and leg were 7.0+/-1.48, 8.43+/-1.14, and 8.09+/-0.98 m/s as measured by observer A and 6.76+/-1.00, 7.97+/-0.80, and 7.97+/-0.72 m/s by observer B, respectively. Betweenobserver differences for the aorta, arm, and leg were 0.14+/-0.62, 0.18+/-0.84, and 0.07+/-0.86 m/s, respectively, and the correlation coefficients were high, especially for aortic PWV (r=0.93). All the measurements showed significant correlation coefficients, ranging from 0.94 to 0.99. CONCLUSIONS: The PWV measurement system used in this study provides accurate analysis results with high reproducibility. It is necessary to provide an accurate algorithm for the detection of additional features such as flow wave, reflection wave, and dicrotic notch from a pulse waveform.
Adult ; Blood Flow Velocity/*physiology ; Carotid Arteries/*physiology ; Femoral Artery/*physiology ; Foot/*blood supply ; Humans ; Male ; Middle Aged ; Radial Artery/*physiology ; Reference Values ; Regional Blood Flow/*physiology ; Reproducibility of Results ; Vascular Diseases/diagnosis ; Vascular Resistance/physiology ; Young Adult

PURPOSE: Extracorporeal life support has been used as an extension of conventional cardiopulmonary resuscitation (CPR). However, the appropriate indications for extracorporeal CPR (ECPR) including the duration of CPR are unknown. We analyzed the cases of patients who received ECPR in our institute to find indicators for ECPR. METHODS: Patients who received ECPR in the emergency department of Korea University Ansan hospital from April 2006 to March 2007 were candidates for enrolment. Inclusion criteria were 1) a witnessed sudden cardiac arrest with correctable cause, 2) age <75 years, 3) cardiac arrest unresponsive to standard CPR, 4) absence of serious underlying disease such as advanced cancer, 5) impending arrest state due to respiratory failure or cardiogenic shock. Cardiac arrest related to trauma was excluded from the study. Tracked outcomes were hospital survival, improvement of Glasgow Coma Scale-motor respones, and return of spontaneous circulation. We analyzed the cause of arrest, arrest rhythm, time of administration of extracorporeal life support, and laboratory values. RESULTS: A total of seven patients received ECPR during one year. All patients achieved spontaneous circulation after ECPR and four patients showed improvement of GCS-motor response. Two patients were discharged alive. Their GCS and CPC were 15 points and 1 point, respectively. Intervention to correct underlying cause of arrest during ECPR, rapid start of ECPR during chest compression, and recovery of mean arterial pressure, heart rate, and urine output during ECPR all correlated with good outcomes. CONCLUSION: ECPR as a method of extended CPR improved the survival of cardiac arrest patients unresponsive to standard CPR.
Arterial Pressure ; Cardiopulmonary Resuscitation* ; Coma ; Death, Sudden, Cardiac ; Emergency Service, Hospital ; Gyeonggi-do ; Heart Arrest* ; Heart Rate ; Humans ; Korea ; Respiratory Insufficiency ; Shock, Cardiogenic ; Thorax

BACKGROUND: Blood pressure is clinically used for monitoring shock patients and as a therapeutic indicator for them. Non-invasive blood pressure measurement has weak points such as the use of a cuff and it is a discontinuous measurement. A method of measuring the blood pressure by using the PWTT (pulse wave transit time) has been studied to make up for those weak points. If blood pressure monitoring can be done by using the difference of the PWTT between different points in the body, then this method will be a quite useful to monitor the BP of seriously ill patients. This study aimed to verify whether or not the PWTT has a significant correlation with the blood pressure of shock patients who received vasopressor infusion and whether this method is clinically applicable. METHODS: The study subjects were 20 shock patients who were hospitalized in intensive care units and they had received vasopressor, and we measured the PWTT and we analyzed its correlation with the SBP (systolic blood pressure) and DBP (diastolic blood pressure), as measured by non-invasive monitoring. We then determined the effects of the PWTT on the SBP and DBP. RESULTS: From the results of correlation analysis between the PWTT and the SBP and DBP, the SBP displayed a statistically significant negative correlation with the PWTT of 18 patients, while no significant correlation between the PWTT and DBP was observed. At the same time, from the results of the regression analysis of the blood pressures and the PWTT of each patient, it was found that the PWTT had a negative effect on the SBP of all the patients, except two. CONCLUSIONS: The PWTT has a negative correlation with the SBP of the patients who received vasopressor infusion.
Blood Pressure ; Blood Pressure Monitors ; Humans ; Intensive Care Units ; Organothiophosphorus Compounds ; Pulse Wave Analysis ; Shock

The criteria for the evaluation of spinal impairment are diverse, complex, and have no standardized form. This makes it difficult and somewhat troublesome to accurately evaluate spinal impairment patients. A standardized guideline was studied for the evaluation of spinal impairment, based on the American Medical Association (AMA) Guides and the McBride method. This guideline proposal was developed by specialty medical societies under the Korean Academy of Medical Sciences. In this study, the grades of impairment were assessed by dividing patients into three different categories: spinal cord impairment, spinal injury impairment and spinal disorder impairment. The affected regions of the spine are divided into three: the cervical region, the thoracic region, and the lumbosacral region. The grade of impairment was differentially evaluated according to the affected region. The restricted range of motion was excluded in the evaluation spinal impairment because of low objectivity. Even though the new Korean guideline for the evaluation of spinal impairment has been proposed, it should be continuously supplemented and revised.
*Disability Evaluation ; Humans ; Korea ; Program Development ; Severity of Illness Index ; Spinal Cord Injuries/classification/diagnosis ; Spinal Diseases/classification/*diagnosis

Background: Current international guidelines recommend against deep sedation as it is associated with worse outcomes in the intensive care unit (ICU). However, in Korea the prevalence of deep sedation and its impact on patients in the ICU are not well known. Methods: From April 2020 to July 2021, a multicenter, prospective, longitudinal, noninterventional cohort study was performed in 20 Korean ICUs. Sedation depth extent was divided into light and deep using a mean Richmond Agitation–Sedation Scale value within the first 48 hours. Propensity score matching was used to balance covariables; the outcomes were compared between the two groups. Results: Overall, 631 patients (418 [66.2%] and 213 [33.8%] in the deep and light sedation groups, respectively) were included. Mortality rates were 14.1% and 8.4% in the deep and light sedation groups (P = 0.039), respectively. Kaplan-Meier estimates showed that time to extubation (P < 0.001), ICU length of stay (P = 0.005), and death P = 0.041) differed between the groups. After adjusting for confounders, early deep sedation was only associated with delayed time to extubation (hazard ratio [HR], 0.66; 95% confidence inter val [CI], 0.55– 0.80; P < 0.001). In the matched cohort, deep sedation remained significantly associated with delayed time to extubation (HR, 0.68; 95% 0.56–0.83; P < 0.001) but was not associated with ICU length of stay (HR, 0.94; 95% CI, 0.79–1.13; P = 0.500) and in-hospital mortality (HR, 1.19; 95% CI, 0.65–2.17; P = 0.582). Conclusion In many Korean ICUs, early deep sedation was highly prevalent in mechanically ventilated patients and was associated with delayed extubation, but not prolonged ICU stay or in-hospital death.