1.Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation
Jae Kyeom SIM ; Sang-Min LEE ; Hyung Koo KANG ; Kyung Chan KIM ; Young Sam KIM ; Yun Seong KIM ; Won-Yeon LEE ; Sunghoon PARK ; So Young PARK ; Ju-Hee PARK ; Yun Su SIM ; Kwangha LEE ; Yeon Joo LEE ; Jin Hwa LEE ; Heung Bum LEE ; Chae-Man LIM ; Won-Il CHOI ; Ji Young HONG ; Won Jun SONG ; Gee Young SUH
Acute and Critical Care 2024;39(1):91-99
Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality. Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed. Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579). Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.
2.Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation
Jae Kyeom SIM ; Sang-Min LEE ; Hyung Koo KANG ; Kyung Chan KIM ; Young Sam KIM ; Yun Seong KIM ; Won-Yeon LEE ; Sunghoon PARK ; So Young PARK ; Ju-Hee PARK ; Yun Su SIM ; Kwangha LEE ; Yeon Joo LEE ; Jin Hwa LEE ; Heung Bum LEE ; Chae-Man LIM ; Won-Il CHOI ; Ji Young HONG ; Won Jun SONG ; Gee Young SUH
Acute and Critical Care 2024;39(1):91-99
Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality. Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed. Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579). Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.
3.Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation
Jae Kyeom SIM ; Sang-Min LEE ; Hyung Koo KANG ; Kyung Chan KIM ; Young Sam KIM ; Yun Seong KIM ; Won-Yeon LEE ; Sunghoon PARK ; So Young PARK ; Ju-Hee PARK ; Yun Su SIM ; Kwangha LEE ; Yeon Joo LEE ; Jin Hwa LEE ; Heung Bum LEE ; Chae-Man LIM ; Won-Il CHOI ; Ji Young HONG ; Won Jun SONG ; Gee Young SUH
Acute and Critical Care 2024;39(1):91-99
Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality. Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed. Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579). Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.
4.Association between mechanical power and intensive care unit mortality in Korean patients under pressure-controlled ventilation
Jae Kyeom SIM ; Sang-Min LEE ; Hyung Koo KANG ; Kyung Chan KIM ; Young Sam KIM ; Yun Seong KIM ; Won-Yeon LEE ; Sunghoon PARK ; So Young PARK ; Ju-Hee PARK ; Yun Su SIM ; Kwangha LEE ; Yeon Joo LEE ; Jin Hwa LEE ; Heung Bum LEE ; Chae-Man LIM ; Won-Il CHOI ; Ji Young HONG ; Won Jun SONG ; Gee Young SUH
Acute and Critical Care 2024;39(1):91-99
Mechanical power (MP) has been reported to be associated with clinical outcomes. Because the original MP equation is derived from paralyzed patients under volume-controlled ventilation, its application in practice could be limited in patients receiving pressure-controlled ventilation (PCV). Recently, a simplified equation for patients under PCV was developed. We investigated the association between MP and intensive care unit (ICU) mortality. Methods: We conducted a retrospective analysis of Korean data from the Fourth International Study of Mechanical Ventilation. We extracted data of patients under PCV on day 1 and calculated MP using the following simplified equation: MPPCV = 0.098 ∙ respiratory rate ∙ tidal volume ∙ (ΔPinsp + positive end-expiratory pressure), where ΔPinsp is the change in airway pressure during inspiration. Patients were divided into survivors and non-survivors and then compared. Multivariable logistic regression was performed to determine association between MPPCV and ICU mortality. The interaction of MPPCV and use of neuromuscular blocking agent (NMBA) was also analyzed. Results: A total of 125 patients was eligible for final analysis, of whom 38 died in the ICU. MPPCV was higher in non-survivors (17.6 vs. 26.3 J/min, P<0.001). In logistic regression analysis, only MPPCV was significantly associated with ICU mortality (odds ratio, 1.090; 95% confidence interval, 1.029–1.155; P=0.003). There was no significant effect of the interaction between MPPCV and use of NMBA on ICU mortality (P=0.579). Conclusions: MPPCV is associated with ICU mortality in patients mechanically ventilated with PCV mode, regardless of NMBA use.
5.Isolated unilateral temporalis muscle hypertrophy of unknown etiology: a case report and literature review
Jun Ho CHOI ; Seung Yeon CHOI ; Jae Ha HWANG ; Kwang Seog KIM ; Sam Yong LEE
Archives of Craniofacial Surgery 2023;24(6):278-283
The initial instance of isolated unilateral temporalis muscle hypertrophy (IUTMH) was reported in 1990. Since then, only few cases have been documented. The cause of this condition remains ambiguous; however, it is presumed to be linked to compensatory and stress-induced hypertrophy. We introduce a rare case of the diagnosis and treatment of IUTMH. A 39-year-old woman presented with a steadily enlarging pain-free swelling on the left side of her face, first noticed a month ago. Apart from a hyperthyroidism medication regimen her medical history was unremarkable. She had no history of temporomandibular joint disease, bruxism, surgery, or trauma. However, she complained of having been under substantial stress lately. Contrast-enhanced magnetic resonance imaging revealed asymmetric temporalis muscle hypertrophy. The treatment plan consisted of administering type A botulinum toxin injections into left temporalis muscle, supplemented by lifestyle changes and relaxation techniques. At a follow-up visit 9 months after the injections, the muscle contour was normalized both in physical and in radiologic examinations. While further supportive evidence is needed, it can be anticipated that cosmetic treatment with botulinum toxin, rather than surgical interventions, will become the standard treatment of IUTMH.
6.Relationship between midfacial fractures and maxillary sinus pathology
Dong Wan KIM ; Soo Hyuk LEE ; Jun Ho CHOI ; Jae Ha HWANG ; Kwang Seog KIM ; Sam Yong LEE
Archives of Craniofacial Surgery 2023;24(3):117-123
Background:
Midfacial fractures frequently involve the maxillary sinus, leading to maxillary sinus pathology. We aimed to examine the incidence and contributing factors of maxillary sinus pathology in patients who underwent open reduction and internal fixation (ORIF) for midfacial fractures.
Methods:
A retrospective analysis was conducted on patients who underwent ORIF for midfacial fractures at our department over the past 10 years. The incidence of maxillary sinus pathology was identified clinically and/or by computed tomography findings. Factors that significantly influenced the groups with and without maxillary sinus pathology were examined.
Results:
The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was found to be 11.27%, with sinusitis being the most common pathology. Maxillary sinus pathology was significantly associated with the presence of a blowout fracture involving both the medial and the inferior orbital walls. Factors such as sex, age, diabetes mellitus, hypertension, smoking, inflammatory disease, follow-up period, use of absorbable plates, and use of titanium plates did not have a significant impact on the development of maxillary sinus pathology.
Conclusion
The incidence of maxillary sinus pathology in patients who underwent ORIF for midfacial fractures was relatively low, and in most cases, it resolved without the need for specific treatment. Consequently, there may not be a significant need for concern regarding postoperative maxillary sinus pathology.
7.Solitary fibrous tumor in the temporalis muscle: a case report and literature review
Jun Ho CHOI ; Soo Hyuk LEE ; Jae Ha HWANG ; Kwang Seog KIM ; Sam Yong LEE
Archives of Craniofacial Surgery 2023;24(5):230-235
Solitary fibrous tumor (SFT) is an infrequently occurring neoplasm most commonly observed in the pleura, but it can develop in the head and neck region in occasional cases. However, no reports have described SFT in the temporalis muscle. Herein, we present the first known case of SFT in the temporalis muscle. A 47-year-old man complained of a painless palpable mass on his right temple. Facial enhanced computed tomography identified a 4.0× 2.9× 1.4 cm mass presenting as a vascular tumor in the right temporalis muscle under the zygomatic arch. The mass was excised from the right temporalis muscle under general anesthesia. A histopathologic examination revealed that the mass was an SFT. No complications occurred after surgery, including functional disability or sensory loss. The patient was followed up for 3 months without complications. Although SFT in extrapulmonary regions is rare, it should be considered in the differential diagnosis of masses that occur in the temporal area.
8.Secondary Use Provisions in the European Health Data Space Proposal and Policy Recommendations for Korea
Won Bok LEE ; Sam Jungyun CHOI
Healthcare Informatics Research 2023;29(3):199-208
Objectives:
This article explores the secondary use provisions of the European Health Data Space (EHDS), proposed by the European Commission in May 2022, and offers policy recommendations for South Korea.
Methods:
The authors analyzed the texts of the EHDS proposal and other documents published by the European Union, as well as surveyed the relevant literature.
Results:
The EHDS proposal seeks to create new patient rights over electronic health data collected and used for primary care; and establish a data sharing system for the re-use of electronic health data for secondary purposes, including research, the provision of personalized healthcare, and developing healthcare artificial intelligence (AI) applications. These provisions envisage requiring both private and public data holders to share certain types of electronic health data on a mandatory basis with third parties. New government bodies, called health data access bodies, would review data access applications and issue data permits.
Conclusions
The overarching aim of the EHDS proposal is to make electronic health data, which are currently held in the hands of a small number of organizations, available for re-use by third parties to stimulate innovation and research. While it will be very challenging for South Korea to adopt a similar scheme and require private entities to share their proprietary data with third parties, the South Korean government should consider making at least health data collected through publicly funded research more readily available for secondary use.
9.Image fusion technique using flat panel detector rotational angiography for transvenous embolization of intracranial dural arteriovenous fistula
Jai Ho CHOI ; Yong Sam SHIN ; Bum-soo KIM
Journal of Cerebrovascular and Endovascular Neurosurgery 2023;25(3):253-259
Precise evaluation of the feeders, fistulous points, and draining veins plays a key role for successful embolization of intracranial dural arteriovenous fistulas (DAVF). Digital subtraction angiography (DSA) is a gold standard diagnostic tool to assess the exact angioarchitecture of DAVFs. With the advent of new image postprocessing techniques, we lately have been able to apply image fusion techniques with two different image sets obtained with flat panel detector rotational angiography. This new technique can provide additional and better pretherapeutic information of DAVFs over the conventional 2D and 3D angiographies. In addition, it can be used during the endovascular treatment to help the accurate and precise navigation of the microcatheter and microguidwire inside the vessels and identify the proper location of microcatheter in the targeted shunting pouch. In this study, we briefly review the process of an image fusion technique and introduce our clinical application for treating DAVFs, especially focused on the transvenous embolization.
10.Sigmoid colon plexiform neurofibroma as a colonic subepithelial mass: a case report
Hee Won BAEK ; Eun Jeong CHOI ; Seung Jung YU ; Myeongpyo KIM ; Sang Heon LEE ; Sam Ryong JEE ; Hyungjoo BAIK ; Hong Sub LEE
Kosin Medical Journal 2023;38(2):138-143
Plexiform neurofibroma (PN) is an uncommon benign tumor, usually associated with neurofibromatosis type 1. As most PNs involve the craniomaxillofacial region, PN of the colon is very rare. Here we present a case of PN involving the sigmoid colon. A 43-year-old male patient presented to the outpatient clinic for the evaluation of an incidentally discovered sigmoid colon mass. A colonoscopic biopsy was performed for the mass, and the result revealed neuronal proliferation. The patient visited the outpatient clinic a year later with symptoms of abdominal pain and stool caliber change. Biopsy was repeated for the sigmoid colon mass, and the results showed mucosal Schwann cell proliferation and S-100 immunostaining positivity. Computed tomography and magnetic resonance imaging were performed for further evaluation, and neurofibroma or schwannoma was suspected based on the imaging studies. For an accurate diagnosis, the patient underwent surgery to remove the sigmoid colon mass. The final diagnosis of the mass was confirmed as PN. We hereby report a rare case of PN involving the sigmoid colon that could not be diagnosed before surgery.

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