BACKGROUND/AIMS: Immediate postpolypectomy bleeding (IPPB) increases the procedure time and it may disturb performing a safe polypectomy. The purpose of this study is to investigate whether clipping before snare polypectomy of large pedunculated polyps is useful for the prevention of IPPB. METHODS: This is a single arm, pilot study. We enrolled patients with pedunculated colorectal polyps that were 1 cm in size or more from 4 university hospitals between June 2009 and June 2010. Clips were applied at the stalk and snare polypectomy was then performed. The complications, including IPPB, were investigated. RESULTS: Fifty six pedunculated polyps in 47 patients (Male:Female=36:11; age, 56+/-11 years) were included. The size of the polyp heads was 17+/-8 mm. Tubular adenoma was most common (57%). The number of clips used before snare polypectomy was 2+/-0.5. The procedure was successful in all cases. IPPB occurred in 2 cases (3.6%), and both of these were managed by additional clipping. Delayed bleeding occurred in another one case (1.8%), which improved with conservative treatment. No perforation occurred. CONCLUSIONS: We suggest that clipping before snare polypectomy of pedunculated polyps may be an easy and effective technique for the prevention of IPPB, and this should be confirmed in large scale, prospective, controlled studies.
Adenoma ; Arm ; Head ; Hemorrhage ; Hospitals, University ; Humans ; Intermittent Positive-Pressure Breathing ; Pilot Projects ; Polyps ; SNARE Proteins

OBJECTIVETo evaluate the efficacy of targeted tidal volume ventilation in the treatment of severe neonatal respiratory distress syndrome (RDS).

METHODSEighty-four neonates with severe RDS between June 2008 and January 2010 were randomly assigned to 3 groups according to the ventilation mode: synchronized intermittent positive pressure ventilation plus volume guarantee (SIPPV+VG; n=31), high frequency oscillation ventilation (HFOV; n=23) and intermittent mandatory ventilation (IMV; n=30). The oxygenation status, the durations of oxygen exposure and ventilation and the incidence of complications were observed.

RESULTSThe oxygenation status (P/F and a/APO2) in the SIPPV+VG and the HFOV groups was improved significantly 12 hrs after ventilation (P<0.05). While in the IMV group, the oxygenation status was not improved until 24 hrs after ventilation. The durations of oxygen exposure and ventilation in the SIPPV+VG and the HFOV groups were shorter than in the IMV group (P<0.05). The incidences of air leak syndrome and ventilation-associated pneumonia (VAP) were lower in the SIPPV+VG and the HFOV groups than in the IMV group (P<0.05). The incidence of severe intracranial hemorrhage in the HFOV group was higher than in the other two groups (P<0.05).

CONCLUSIONSCompared with IMV, SIPPV+VG and HFOV can improve the oxygenation status more quickly, shorten the ventilation duration and decrease the incidences of air leak syndrome and VAP in neonates with severe RDS.

OBJECTIVE: To determine the influence and significance of intermittent ventilation on lung cytokines during cardiopulmonary bypass (CPB). METHODS: Thirty-six patients with rheumatic heart disease (RHD) were divided into 2 groups randomly: Treatment group (n = 18, given intermittent ventilation once every 5 minutes during CPB; control group ( n = 18), no ventilation during CPB. A brochioalveolar lavage was performed at 2 hours after the CPB. The numbers of granulocytes and the contents of IL-1, IL-6, TNF-alpha, and LDH in the brochioalveolar lavage fluids were measured, and lung PaO2/FiO2 were measured preoperatively and at 1 hour, 4 hours, and 8 hours after the CPB termination. RESULTS: The numbers of granulocytes and the contents of IL-1, IL-6, TNF-alpha, and LDH of the treatment group in the brochioalveolar lavage fluids were significantly lower than those of the control group (P < 0.05), and the lung PaO2/FiO2 of the treatment group at 1 hour, 4 hours, and 8 hours after the CPB termination significantly increased than those of the control group (P < 0.05). A significant decrease of lung PaO2/FiO2 occurred in both groups at 1 hour, 4 hours, and 8 hours after the CPB compared with the same group at the baseline before the CPB (P < 0.01). CONCLUSION Intermittent ventilation has protective effects on the lung injury during CPB by decreasing granulocyte adhesion and the level of lung cytokines, alleviating the lung inflammatory reaction and endothelial cell injury.
Adult ; Cardiopulmonary Bypass ; Cytokines ; metabolism ; Female ; Humans ; Interleukin-1 ; metabolism ; Interleukin-6 ; metabolism ; Intermittent Positive-Pressure Breathing ; Lung ; metabolism ; Male ; Middle Aged ; Rheumatic Heart Disease ; physiopathology ; surgery ; Tumor Necrosis Factor-alpha ; metabolism

BACKGROUND: Respiratory care for patients in intensive care units(ICUs) has been performed mainly by nurses in Korea. However, the current status of respiratory care i the Korea ICUs is not well known. Respiratory care and the methods of delivery in ICUs were surveyed. METHOD: A confidential questionnaire was distributed to the head nurses working the ICUs at 117 hospitals in Korea. One hundred hospitals returned the questionnaires, for a response rate of 85%. The hospitals were divided into three groups : Main university hospitals(MUH), university associated hospitals(UAH), and general hospitals(GH) RESULT: Eighteen units of 66 units in MUH and 35 units of 58 units in GH were organized as a general ICUs. The percentage of ICUs with full-time doctors was 47.1%. The nurses usually delivered respiratory care spending from 1 to 4 h during their 8 h of working time. Although the respondents felt that respiratory care should be delivered by trained respiratory therapists, these therapists were not found at the hospitals. Most of the units performed percussion, tracheal suctioning, and positional changes. However, vibration and IPPB were less frequently performed in GH. Among oxygen supply apparatus, venturi mask and T-piece were not frequently used in GH. GH applied a noninvasive ventilator mode less frequently than MUH and UAH. The percentage of Swan-Ganz catheter monitoring was only 21.4% in GH. CONCLUSION: Respiratory care for patients in the Korean ICUs was provided by nurses on the whole. In addition, there were many differences in the level of respiratory care according to the type of hospital. To overcome the current problems revealed, an effective in-hospital training program for the development of full-time respiratory care therapists should be established urgently in Korea.
Catheters ; Data Collection ; Education ; Humans ; Intensive Care Units* ; Intensive Care* ; Intermittent Positive-Pressure Breathing ; Korea ; Masks ; Nursing, Supervisory ; Oxygen ; Percussion ; Suction ; Ventilators, Mechanical ; Vibration

BACKGROUND: It is invasive and accompanies various risks to insert pulmonary artery catheter in order to measure mixed venous oxygen saturation (SvO2) that is associated with patients clinical course and prognosis. If there is relationship between central venous oxygen saturation (ScvO2) and mixed venous oxygen saturation, we can use the central venous oxygen saturation instead of mixed venous oxygen saturation to monitor and treat patients. METHODS: We inserted the Swan-Ganz catheter in 20 patients (male 8, female l2) scheduled for undergoing open heart surgery and accomplished the blood gas analysis of the radial arterial blood, central venous blood and mixed venous blood during postoperative respiratory care in intensive care unit at F1O2 1.0, 0.6 and 0.4 in order. RESULTS: There was no significant difference between central venous blood and mixed venous blood in respect to pH, PCO2, PO2. except the mixed venous blood pH at F1O2 0.6 that is greater than the central venous blood pH at F1O2 0.6. Central venous oxygen saturation and mixed venous saturation were not significantly different and showed the following close relationship: SvO2(%)=15.41+0.80XScvO2 (R=0.88, p<0.05). In respect to the difference according to the variation of F1O2, the SO2 and PO2 at F1O2. 1.0 were higher than the SO2 and PO2 at F1O2 0.6 and 0.4, but the differnce between F1O2 0.6 and 0.4 was not significant. CONCLUSIONS: We might conclude that central venous oxygen saturation might be replaced for the mixed venous oxygen saturation in respiratory care after open heart surgery in adults.
Adult ; Blood Gas Analysis ; Catheters ; Female ; Humans ; Hydrogen-Ion Concentration ; Intensive Care Units ; Intermittent Positive-Pressure Breathing ; Oxygen* ; Prognosis ; Pulmonary Artery ; Respiration, Artificial* ; Thoracic Surgery ; Ventilation

There are many predisposing factors for acute pulmonary edema, namely, left ventricular failure due to cardiac disease or fluid overloading, hypoalbuminemia, pulmonary capillary endothelial damage from bacterial toxins or irritant gases, rare central nervous system injuries pulmonary hyersensitivity reactions, etc. Acute pulmonary edema following operations is a rare complication especially in a patient whose preoperative cardiopulmonary status was within normal limits. We present a case of unilateral pulmonary edema immediately following operation in a 46 year old male patient who had a modified pull-through operation due to tongue cancer and who had no evidence of preoperative cardiopulmonary disorders. The edema was relieved after 9 hours with intensive care of pulmonary edema such as IPPB with Omorphine, diuretics, corticosteroid, asemi-sitting position and frequent tracheal suction.
Bacterial Toxins ; Capillaries ; Causality ; Central Nervous System ; Diuretics ; Edema ; Heart Diseases ; Humans ; Hypoalbuminemia ; Critical Care ; Intermittent Positive-Pressure Breathing ; Male ; Middle Aged ; Noble Gases ; Pulmonary Edema* ; Suction ; Tongue Neoplasms

Thirty six pediatric patients who were diagnosed as pulmonary atelectasis by chest radiography were managed with one of the following techniques for the treatment of atelectasis: 1) intermittent positive pressure breathing (IPPB) with extrathoracic chest percussion and vibration, 2) IPPB and intrapulmonary percussive ventilation (IPV) and 3) IPV only. Chest X-ray films and arterial pH, Pco, and Po, were obtained for all patients in the morning and the afternoon. And systolic and diastolic blood pressure and heart rate were measured at that time. Alveolar arterial oxygen tension difference was calculated from inspired oxygen fracton and arterial oxygen tension. The rate of treatment of atelectasis was significantly low in the patients with IPPB and chest physiotherpy. But the durations for the treatment were not significantly different among the three groups. There were no significant differences in blood pressures, heart rates and artrial blood gases between pre-treatment and post- treatment states in all groups.
Blood Pressure ; Critical Illness* ; Gases ; Heart Rate ; Humans ; Hydrogen-Ion Concentration ; Intermittent Positive-Pressure Breathing ; Oxygen ; Percussion ; Pulmonary Atelectasis* ; Radiography ; Thorax ; Ventilation* ; Vibration ; X-Ray Film

Chronic obstructive pulmonary diseases are being increased every year by many factors. But there are two important factors. First of all the atmospheric contamination is due to modern civilization, secondarily, the increase of old age population which is the result of prolonged life span by contribution of modern medicine. For these reasons increasing chronic obstructive pulmonary disease, anesthesiologists have had increased problems to administer anesthesia, because these patients are most difficult to manage for anesthesia. Author have studied for if it could be diminished these problems by comparing of the complications during period of anesthesia induction, maintenance, recovery and 5 postoperative days, with IPPB therapy and other physical therapy. The results of the study are as follows: 1) Pre and postoperative IPPB therapy is more useful to diminish anesthesia problems compared with other physical therapy. 2) Other physical therapy is useful when compared with controlled group. 3) IPPB therapy is the choice of treatment for postoperative atelectasis. Statistical significance was assessed by using student t test.
Anesthesia ; Civilization ; History, Modern 1601- ; Humans ; Intermittent Positive-Pressure Breathing* ; Lung Diseases, Obstructive ; Pulmonary Atelectasis ; Pulmonary Disease, Chronic Obstructive

The authors have experienced three cases of pulmonary edema during anesthesia and after operation: 3 cases in urgent condition with toxemia and ectopic gestation underwent general anesthesia. One patient had no specific past history and the other two had cardiac or pulmonary problems before operation. In these cases, we believe that relative overloading of fluids in an undetected valular heart disease, preexisting pulmonary disease, severs preeclamptic condition, and myocardial depressant were the causative factors. High Fio2, with IPPB, diuretics, digitalis, dopamine and albumine were given immediately and so full recovery was observed in 4 hours to 3 days. There are many causes, prevention, and treatment for acute pulmonary edema. But believe that preoperative evaluation, intraoperative monitoring, prompt recognition and attention by the anesthetists are the most important preventive and therapeutic measures.
Anesthesia ; Anesthesia, General* ; Digitalis ; Diuretics ; Dopamine ; Heart Diseases ; Humans ; Intermittent Positive-Pressure Breathing ; Lung Diseases ; Monitoring, Intraoperative ; Pregnancy ; Pulmonary Edema* ; Toxemia

Gradually there are increasing tendencies toward Cesarean sections, either intentionally or inevitably. Since two lives are simultaneously in one case, we must make all efforts to administer anesthesia even more cautiously for Cesarean section patients than for other cases. Occasionally, grave problems occur during induction of anesthesia, especially in general anesthesia. Among them, one of the most serious accidents is aspiration of the stomach contents into the lungs by vomiting or regurgitation. This may induce severe complications, such as chemical pneumonitis due to aspiration of liquid acid contents and/or death due to asphyxia of solid materials. Already several decades ago Mendelson and other authorities described a lung syndrome which was associated with aspiration of vomitus in various degrees of acidity. In an emergency Cesarean section, the authors experienced a case of Mendelson's syndrome which was produced by aspiration of liquid acid stomach contents because of an intubation mistake. Immediately after the operation. the patient began to complain of severe respiratory discomfort and a febrile state which continued for several days post-operatively. However, because of intensive nursing care with oxygenation, intermittent positive pressure breathing, large doses of steroids and antibiotics, the patients condition was restored from the acute febrile stage to the pre-operative level. Within five days the chest X-ray films were normal and on the seventh day the patient and her baby were discharged in good condition. We would like to conclude that many different kinds of drugs and/or methods of anesthesia are not alone sufficient in managing dangerous situations, such as energency Cesarean section but intensive pre-operative care and highly proficient techniques are essential as a prophylactic method in undesirable complications.
Anesthesia* ; Anesthesia, General ; Anti-Bacterial Agents ; Asphyxia ; Cesarean Section* ; Emergencies ; Female ; Gastrointestinal Contents ; Humans ; Intention ; Intermittent Positive-Pressure Breathing ; Intubation ; Lung ; Nursing Care ; Oxygen ; Pneumonia* ; Pneumonia, Aspiration ; Pregnancy ; Steroids ; Thorax ; Vomiting ; X-Ray Film