Acute and Critical Care

Systolic Time Intervals ( STI ): Hong Yong Jin; Korean J Crit Care Med. 1987;2(2):79-89.

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Abstract PDF: Systolic time intervals (STI), which are measured by ana1ysis of the integral data (HR, QS2, LVET, PEP, PEP/LVET, S2Q, PTT etc) from the electrocardiogram, phonocardiogram and carotid sphygmogram, are one of the established "noninvasive" tests of cardiac function. Nowadays, ST1 are frequently used in the various medical fields because of their simplicity and reliability, STI provide a quantitative estimate of the effect of various cardiovascular disorders upon the left ventricle. Like all noninvasive techniques, STI have the singular advantage that multiple observations can be performed. This allows study of the natural history of disorders and long-term effects of therapeutic interventions. On the basis of studies in recent years, a new understanding of the use of STI in the analysis of the left ventricular performance in man has evaluated. It is the purpose of this review to summarize these more current knowledge of STI (historical background, measuring methodology and contents, pathophysiologic basis, and drug effects) and to direct interest to clinical application of STI.

Clinical Use of Univent Tube with Movable Blocker for the Patient of Bronchopleural Fistula: Shin Ok Koh, Hung Kun Oh; Korean J Crit Care Med. 1987;2(2):90-94.

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Abstract PDF: The loss of substantial portion of critically ill patient's tidal volume through a bronchopleual pleural fistula may significantly alter the intrapulmonary distribution of ventilation, ventilation-perfusion matching and arterial blood gases. Prompt localization of surgical closure of bronchopleural fistula remains the treatment of choice in most patients. We had a chance to use a Univent tube with movable blocker to the patients of bronchopleural fistula which developed during esophageal bougienation, The endotracheal tube has two compartment, a large lumen for conventional air passage and a small lumen where a movable tube is placed. Intubation a accomplished by ordinary technique, advancement of the bronchial tube to the right lowers bronchus being guided by fiberoptic bronchoscopy.

The Reconstruction of Injured Hands by Microsurgery: Kwang Suk Lee, Tai Seung Kim, Won Koo Yoon; Korean J Crit Care Med. 1987;2(2):95-107.

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Abstract PDF: The human hand is a highly sophisticated tool of sensibility ane1 prehension, and the reconstruction of injured hands are essential to not only reconstruct of hand function but also recanstruct of body. Seven cases of tendocutaneous flap, a case of osteocutaneous flap nime cases of thumb reconstruction with a free neurovascular wrap--around flap from the big toe, two cases of second toe-to-index transfer, and a case of left ring finger to right index finger transfer were performed at the Department of Orthopedic Surgery of Hanyang University Hospital, and satisfactory results were obtained both comsmetically and functionally.

The Effect of I : E ratio on Pulmonary Gas Exchange During Pediatric Respiratory Intensive Care: Seong Deok Kim, Cheong Lee, Seung Woon Lim; Korean J Crit Care Med. 1987;2(2):108-112.

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Abstract PDF: The children who received. open heart surgery were mechanically ventilated with Bear 2 volume ventilator postoperatively in pediatric intensive care unit. To clarify the relationship of inspiratory: expiratory ratio to optimum ventilation and oxygenation, all the patients were ventilated at I: E ratios of 1: 2, 1: 1 and 2: 1, at random order, while peak inspiratory pressure, tidal volume and respiratory frequency remained constant. The results showed that the use of a long inspiratory phase resulted in increased PaO2 and decreased alveolar-arterial oxygen difference, indicating improvement in oxygenation, but PaCO2 and dead space(VD/VT) didn't show any changes, indicating no effects on pulmonary ventilation.

Effects of Length of Pressure Tubing on Arterial Blood Gas Determinations: Wyun Kon Park, Kyung Boon Yoon, Mee Jung Lee, Yang Sik Shin, Kang Won Park; Korean J Crit Care Med. 1987;2(2):113-116.

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Abstract PDF: A study was undertaken to determine the blood gas values affected by the flush solution incompletely purged and heparinized in an indwelling arterial catheter and pressure tubing. Arterial blood gases were measured serially after weithdrawing 2,4,6,8,10, and 12 ml of flush-blood solutions from a 20-gauge radial artery catheter which was connected through a transducer to Cobe pressure tubing having the length of 4 or 6 feet, respectively. The pH was nearly unchanged from the sample 2 and PaCO2, PaO2. actual bicarbonate, and base excess were from the sample 3 in 4-ft Cobe pressure tubing. In 6-ft Cobe pressure line pH was nearly unchanged from the sample 3 and PaCO2, actual bicarbonate, and base excess were from the sample 4 PaO2, were unchanged in all samples. So we conclude that arterial blood for the blood gas analysis should be withdrawn at least 4 ml in 4-ft Cobe pressure tubing and 6ml in 6-ft Cobe pressure line,

Clinical Experience of Complications from Prolonged Endotracheal Intubation: Hae Keum Kil, Yang Sik Shin, Shin Ok Koh; Korean J Crit Care Med. 1987;2(2):117-123.

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Abstract PDF: Prolonged intubation of the trachea in the treatment of acute respiratory failure has become commonplace in the Intensive Care Unite during the last decade. We defined prolonged endotracheal intubation as cases in which endotracheal intubation is required more than 7 days, and then experiences 202 cases out of 5,856 Intensive Care Unit patients from March 1981 to February l986 in Severance Hospital, Yonsei Medical Complex were evaluated. The results were as follows" 1) The number of patients were 202 cases in total. and male and females were 136 and 69 cases. The teen-age groups was most common, 69 cases(33.7%) and forties was 35 cases (17. 3%). 2) The patients of internal medicine department was the most common, 23,3% and pediatric and neurosurgical department followed in order. 3) The most common causes of acute respiratory failure is central nervous system disorders and ARDS (Adult Respiratory Distress Syndrome). 4) Average stay in Intensive Care Unit was 23.5 day, from 3 to days. Ninty-nine cases (49%) were improved and the remainder (103 cases) were expired. 5) Orotracheal intubation is performed in l44 cases (71.4%) and tracheostomy was done in 4S cases, among them, in 39 cases oro-and nasotracheal intubation was changed to trac-heostomy after 12 days. 6) Oro-or nasotracheal tube was changed 2.5 times every 6.3 days. Mean intubation and tracheostomy days was 15.5 and 76.3 days. 7) Ventilatory support was maintained in 199 cases and 12.1 days in endotraeheal intubation patients and 29.1 days in tracheostomy patients. 8) Complication developed in 29 cases awang them 10 cases were in oro- or nasotracheal intubation patients and 19 cases were in tracheoatomy patients. Horsenss, laryngeal edema, and sore throat were developed in 3.2 and 1 cases, respectively, in orotracheal intubation patients and granu1oma, tracheal stenosis. trachea1 ulceration. and vocal cord palsy were developed in 9,5,2, and 2 cases, respectively, in tracheostomy patents. From the above results. it can be concluded that tracheal complication was serious for the patients who required required ventilatory support under prolonged endotracheal intubation. So we must try to prevent the complication which develop after prolonged endotracheal intubation and maintaining the patients with cardio-respiratory support.

Effect of Lidocaine, Propranolol Pretreatment on Ephedrime Induced Arrhythmia During Halothane - N2O Anesthesia: Sung Su Chung, Kyung Yeun Yoo, Chang Young Chung, Woong Mo Im, Chan Jin Park, In Ho Ha; Korean J Crit Care Med. 1987;2(2):124-132.

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Oxygen Transport during Acute Hemodilution in Hypoxic Environment: Sang Chul Lee, Hae Jung Jung, Seong Deok Kim, Kwang Woo Kim; Korean J Crit Care Med. 1987;2(2):133-140.

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Transperitoneal Oxygenation with Lactated Ringer's Solution: Won Oak Kim, Chung Hyun Cho; Korean J Crit Care Med. 1987;2(2):141-144.

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