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아리랑의 인식에 대해서는 응답자의 약 70% 정도가 인식을 잘 하고 있었고, 아리랑의 선호도는 약 80%이었고, 대중가요의 선호도는 약 69%였으며, 아리랑의 종류(정선, 밀양, 본, 진도)에 대해서는 거의 유사하게 선호했다. 아리랑의 자연치유 경험에 대한 설문에서는 아리랑 가사와 노래를 부르는 것이 좋고, 호흡수련, 스트레스 해소 및 우울증 치료에 효과가 있고, 아리랑 노래를 부르면 활기차지고 생활에 도움이 된다고 응답하였다. 이상의 결과를 볼 때에 아리랑 노래를 자연치유 노래로 활용하여 국민들의 건강이 더 좋아지기를 기대하며, 국가적으로 활용의 가치가 있다고 본다.

Arirang is an important song with a healing power and has been actually used in diverse ways for it. To use the song for the music therapy a field of natural therapy, this study surveyed the recognition of Arirang for 68 men and 224 women. The purpose of this study is to analyze the thought and the behavior of subjects when the folk song Arirang is extended to the music therapy. The survey items were their recognition of Arirang, preference and recognition of naturopathic power in Arirang. In the recognition of Arirang, about 70% of respondents had a good recognition; about 80% showed the preference for Arirang while 69% showed it for popular songs; and the preference of different Arirang types (Jeongseon, Milyang, Bon, Jindo) was fairly similar. In the question about the naturopathic experience of Arirang, most people answered that words of Arirang and its singing were pleasant, good for respiratory training, relaxing and depression treatment, promoting the vigorous and healthy life. With this result, Arirang song may well be nationally used for the natural healing to enhance the health of people.

본 연구의 목적은 하모니카를 활용한 입 운동 및 호흡훈련(OMREX)중심의 음악치료 프로그램이 뇌졸중환자의 호흡기능과 구강운동기능에 미치는 효과를 알아보는데 있다. 이에 대한 효과를 알아보기 위해 사전, 사후 진단폐활량계(PF-100)를 사용하여 최대호기유량(PEF)과 1초간 노력성 호기량(FEV1)을 측정하였고, 구강조음기관검사(OSMSE-R)를 사용하여 뇌졸중 환자의 턱, 입술, 혀의 운동기능의 데이터를 측정하였다. 연구 결과, 뇌졸중 환자의 호흡기능에서는 하모니카를 활용한 입 운동 및 호흡 훈련이 최대호기유량(F(1.18)=19.40, p<.001)과 1초간 노력성 호기량의 향상(F(1.18)=29.99, p<.001)에 유의미한 변화가 있었다. 뇌졸중 환자의 구강운동기능에서는 턱의 운동기능(F(1.18)=12.37, p<.01)과 입술의 운동기능(F(1.18)=42.76, p<.01) 그리고 혀의 운동기능의 향상(F(1.18)=41.06, p<.001)에 유의미한 변화가 있었다. 이는 하모니카를 활용한 음악치료프로그램이 뇌졸중환자의 호흡기능과 구강운동기능에 향상된 결과를 가져왔음을 보여주는 연구결과이다.

The purpose of this study was to examine the effects of Harmonica-based Oral Motor and Respiratory Exercise (OMREX) Music Therapy designed to improve respiratory and oral motor functions in patients recovering from a stroke. Assessments of PEF and FEV1 for PF-100 were conducted to measure pre and post-test differences. In addition, OSME-R (Oral Speech Mechanism Screening Examination-Revised) was utilized to assess the oral (jaw, lip and tongue) motor functioning of the patients. Results show that harmonica-based music therapy resulted in statistically significant differences in the oral motor functioning of patients; findings are as follows: respiratory function PEF(F(1.18)=19.40, p<.001) and FEV1(F(1.18)=29.99, p<.001), oral motor function of the Jaw (F(1.18)=12.37, p<.01), the Lips (F(1.18)=42.76, p<.01) and the Tongue (F(1.18)=41.06, p<.001). These results indicate that a music therapy program using the harmonica improve both respiratory function and oral motor function of patients recovering from a stroke.

Background : Treatment experiences with antiviral agents against MERS-CoV (Middle East Respiratory Syndrome Coronavirus) infection are limited, and there is lack of information regarding adverse drug reactions (ADRs) in this patient group. In 2015, we evaluated the ADRs of antiviral treatment against MERS-CoV infections in one tertiary teaching hospital in South Korea. Methods : Between May 20th and July 20th 2015, a retrospective chart review was conducted to evaluate any ADRs. We focused on three antiviral agents: ribavirin, peginterferon alpha2a and lopinavir/ritonavir. Laboratory data and clinical implications of ADRs were collected through electronic medical records. The ADRs were evaluated and cross checked by three independent pharmacists. Results : Totally, 28 patients were evaluated, and 15 ADRs were detected. Ribavirin was the most causative agent. Hematologic ADRs were the maximum reported, and nausea/vomiting was second ranked. Seven ADRs were scored as Grade 3 severity of ADRs, as per the CTCAE ver. 4.0; the causative drug was discontinued in 9 cases. Causality scores using WHO-UMC and Naranjo scale indicated that most of the ADR cases had a‘ possible’relationship. Conclusion : ADR patterns of the three drugs evaluated for MERS-CoV patients were mostly similar with the limited existing reports.

In people with spinal cord injury (SCI), the paralysis of respiratory muscles directly results in the weakness of respiratory function and increased level in diaphragmatic fatigue, demonstrating the features of restrictive diseases. If there are no appropriate therapeutic strategies for its management, respiratory failure can be exacerbated over time, and complications are much likely to worsen physical function, being frequently regarded as life-threatening condition. Therefore, pulmonary rehabilitation should be considered as important health issues to facilitate functional recovery of people with SCI, especially in cervical injury. Following SCI, the function of paralyzed chest wall musculature is compensated by abdominal movements, and thereby respiratory efficiency is remarkably reduced by this abnormal mechanism. This is indicative of intensive respiratory training to improve breathing pattern, gas exchange, and oxygen consumption. In particular, given that people with cervical cord injury are so susceptible for respiratory failure with higher risk of respiratory complications, pulmonary rehabilitation must be a critical step in the pathway to ameliorate their symptoms and facilitate functional recovery. Respiratory muscle training is inevitable for enhancing physical function of people with SCI as well as increasing breathing capacity, and particularly in cervical cord injury, and it also may be helpful to prevent respiratory complications. This study was designed to describe comprehensive knowledge about the management of respiratory problems in people with SCI. This study provides useful information for clinicians and researchers that explore the best therapeutic way to manage respiratory symptoms of people with SCI. Further studies need to evidence the effectiveness of various therapeutic approaches to treat their respiratory problems.

PURPOSE : The purpose of this study is to compare prior studies on various motor therapeutic approaches that affect the improvement of respiratory function in stroke patients and to present motor therapy for more effective respiratory function improvement in stroke patients. METHOD : The various prior studies affecting the increase of respiratory function in stroke patients are collected, arranged and compared referring to RISS, NDSL. RESULT : As a result of the study, the diaphragm respiratory exercise, feedback respiratory exercises, combined respiratory exercises, deep neck flexion exercises, sternum and chest extended resistance exercise, respiratory rehabilitation exercise, inhalation and exhalation strengthening exercise and elastic band exercise showed significant increase in effort lung capacity, effortless breathing rate for 1 second, and maximum exhalation speed test. CONCLUSION : In conclusion, feedback respiration exercise, diaphragm exercise, increased thoracic size and diaphragm thickness, which helped the inhalation function. The elastic band exercise strengthened the abdominal muscles and helped the exhalation function. Combined breathing exercises and deep neck flexion strengthening exercises helped maintain the operability of the chest and improve the activity of the breathing auxiliary muscles, helping the function of exhalation and exhalation. In order to achieve such effective exercise results for stroke patients, appropriate breathing exercise methods should be applied depending on the symptoms, environment and condition of stroke patients. Further research on respiratory physiotherapy is also needed.

Purpose: This study was conducted to identify the effects of educational intervention on pre-test and post-test tidal volume, endotracheal peak pressure, and ventilation interval measurements during single-rescuer respiratory-assistant therapy by paramedic students. Methods: The present study, with a quasi-experimental design, included a pre-test and post-test nonequivalent control group. A total of 62 paramedic students (31, experimental group; 31, control group) participated in this study. The intervention lasted 80 minutes. Data were collected from each student before the intervention and two weeks after the intervention, between September 3 and 21, 2018. The collected data were analyzed using IBM SPSS Statistics for Windows, Version 25.0. Results: Tidal volume (p<.001) and endotracheal peak pressure (p=.002) measurements after the intervention were significantly different between the two groups. Analysis of covariance was used to control the variance (the pretest value of endotracheal peak pressure) in order to identify the effect of the intervention in the two groups. Endotracheal peak pressure was not significantly different between the two groups. Conclusion: Education and training of paramedic students in emergency medical services on single-rescuer respiratory-assistant therapy is necessary for the emergency care of patients with respiratory arrest.

Purpose: This study was conducted to identify the factors influencing performance confidence by knowledge and experience of respiratory-assistant therapy in paramedic students. Methods: A descriptive survey study used a convenience sample comprising 387 students from September 15 to October 31, 2016. Data were analyzed using descriptive statistics, t-test, ANOVA, Pearson's correlation coefficient, and regression analysis. Results: Knowledge was statistically significant by college(3-year), acquired certification, and observation experience in respiratory-assistant therapy. Performance confidence was statistically significant by sex, academic grade(3.0≤), acquired certification, and observation and performance experience in respiratory-assistant therapy. There was a significant correlation between knowledge and acquired certification, clinical practice, and major satisfaction. There was a significant correlation between performance confidence and acquired certification, clinical practice, major satisfaction, and knowledge. Regression analysis revealed that performance confidence accounted for 22.9% of the variance by academic grade(3.0∼3.99), acquired certification, and major satisfaction. Conclusion: For paramedic students in clinical practice and in-school classes, it is important to improve performance confidence by combining training instruction with experience and education of respiratory-assistant therapy.

This study examined the effectiveness of combining remote physical therapy with task-oriented training to improve hand grip strength, and respiratory function in a patient with duchenne muscular dystrophy (DMD). An 18-year-old male with DMD participated in a 4-week program consisting of weekly clinic-based task-oriented respiratory therapy (balloon-blowing and inspiratory muscle training) and home-based exercises (diaphragmatic pursed-lip breathing, and upper extremity stretching) performed under parental supervision, with daily monitoring of exercise adherence. After the intervention, hand grip strength increased from 1 kg to 2 kg bilaterally, peak cough flow rose from 90 L/min to 96 L/min, and chest circumference showed slight increases at the axilla, xiphoid process, and the midpoint between the xiphoid and navel during both maximal expiration and inspiration, while forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) remained at similar, markedly reduced predicted levels without evidence of obstructive ventilatory impairment. Forearm supinator and pronator strength improved from trace to poor on manual muscle testing, and the visual analog scale score for dyspnea decreased from 5 to 2, with high exercise adherence and no adverse events reported. These findings suggest that combined remote physical therapy and task-oriented training is a feasible, safe, and practical home-based rehabilitation approach for a DMD patient, with potential benefits for maintaining functional status and quality of life.

Purpose: Respiratory therapy (RT) has become a vital component of modern healthcare, particularly in managing acute and chronic pulmonary conditions. The rising global burden of respiratory diseases has amplified the demand for skilled RT professionals capable of performing high-risk, low-frequency procedures with precision. Despite the shift toward competency-based education in healthcare, RT training remains fragmented. Disparities in training quality, assessment methodologies, and simulation access result in inconsistent clinical competencies among RT graduates. The absence of a standardized, globally recognized competency framework further compounds these challenges, affecting workforce readiness and patient safety. To date, no global study has systematically quantified competency disparities across RT programs using a standardized framework, leaving a critical gap in comparative evidence needed to guide educational policy and global accreditation.Methods: A cross-sectional survey was conducted targeting RT professionals, educators, and institutional leaders across multiple countries. Quantitative data were analyzed using descriptive statistics, chi-square tests, and gap percentage analysis to identify variations in training practices, competency expectations, and observed deficiencies.Results: Findings revealed significant competency gaps, especially in advanced interventions like extracorporeal membrane oxygenation and lung ultrasound. Inconsistencies in assessment tools, simulation integration, and remediation protocols were noted across institutions. The majority of respondents emphasized the need for competency standardization.Conclusion: The study confirms a pressing global need for a structured, evidence-based competency framework in RT education. Standardization will improve clinical consistency, facilitate workforce mobility, and enhance patient care outcomes worldwide.

목 적: 호흡동조방사선치료(Respiratory Gating Radiation Therapy, RGRT)에서 호흡의 안정성은 매우 중요한 인자이다. 이러한 호흡의 안정을 위해 본인의 호흡주기를 직접 확인할 수 있도록 시청각시스템을 이용한 호흡유도시스템을 개발하였고 이의 유용성을 평가하고자 하였다. 대상 및 방법: 2011년 6월부터 2012년 4월까지 본원에서 호흡동조방사선치료를 받은 7명의 환자를 대상으로 시청각시스템을 이용하지 않는 자유호흡을 먼저 측정하고 자체개발한 호흡유도시스템을 이용한 호흡을 측정하였다. 시청각시스템을 이용한 호흡연습 후에는 치료실내에서의 자가호흡과 시청각시스템을 이용한 호흡을 각각 측정하였다. 측정된 데이터는 호흡주기, 호흡함수의 면적을 구하여 표준편차를 구하였으며, 이를 분석하여 치료전후의 호흡변화를 알아 보았다. 결 과: 자유호흡과 오디오 유도시스템, 시청각 유도시스템의 표준편차는 PTP (peak to peak)가 각각 0.343, 0.148, 0.078이다. 호흡주기는 각각 0.645, 0.345, 0.171이며, 호흡함수의 면적은 각각 2.591, 1.008, 0.877로 나타났다. 전체 환자의 CT실과 치료실에서의 차이를 평균한 값은 PTP가 0.425, 호흡주기가 1.566, 호흡면적이 3.671로 측정되었다. 호흡유도시스템 적용전후의 표준편자는 PTP가 0.265, 호흡주기가 0.474, 호흡면적이 1.714의 차이를 나타내었다. 자유호흡과 시청각유도시스템 적용전후의 값을 T-검정한 결과에서는 PTP, 주기, 호흡함수면적에서 각각 P-value 0.035, 0.009, 0.010의 값을 나타냈다. 결 론: 호흡동조방사선치료에서 호흡조절은 치료의 성패를 좌우할 만큼 중요한 인자이다. 자유호흡이나 청각에 의존한 호흡주기 획득에 비해 시청각 호흡유도 시스템을 이용한 경우에 보다 안정적인 호흡을 얻을 수 있었다. 특히, 치료실에서도 같은 시스템을 이용하여 호흡을 조절함으로써 호흡주기의 재현성이 뛰어났다. 이러한 시스템은 호흡불안정에 의한 치료시간의 지연을 줄이고 좀 더 정확하고 정밀한 치료가 가능하게 되었다.

Purpose: The respiration is one of the most important factors in respiratory gating radiation therapy (RGRT). We have developed an unique respiratory guidance system using an audio-visual system in order to support and stabilize individual patient's respiration and evaluated the usefulness of this system. Materials and Methods: Seven patients received the RGRT at our clinic from June 2011 to April 2012. After breathing exercise with the audio-visual system, we measured their spontaneous respiration and their respiration with the audio-visual system respectively. With the measured data, we yielded standard deviations by the superficial contents of respiratory cycles and functions, and analyzed them to examine changes in their breathing before and after the therapy. Results: The PTP (peak to peak) of the standard deviations of the free breathing, the audio guidance system, and the respiratory guidance system were 0.343, 0.148, and 0.078 respectively. The respiratory cycles were 0.645, 0.345, and 0.171 respectively and the superficial contents of the respiratory functions were 2.591, 1.008, and 0.877 respectively. The average values of the differences in the standard deviations among the whole patients at the CT room and therapy room were 0.425 for the PTP, 1.566 for the respiratory cycles, and 3.671 for the respiratory superficial contents. As for the standard deviations before and after the application of the PTP respiratory guidance system, that of the PTP was 0.265, that of the respiratory cycles was 0.474, and that of the respiratory superficial contents. The results of t-test of the values before and after free breathing and the audio-visual guidance system showed that the P-value of the PTP was 0.035, that of the cycles 0.009, and that of the respiratory superficial contents 0.010. Conclusion: The respiratory control could be one of the most important factors in the RGRT which determines the success or failure of a treatment. We were able to get more stable breathing with the audio-visual respiratory guidance system than free breathing or breathing with auditory guidance alone. In particular, the above system was excellent at the reproduction of respiratory cycles in care units. Such a system enables to reduce time due to unstable breathing and to perform more precise and detailed treatment.

Purpose: The efficacy of helmet continuous positive airway pressure (CPAP) in hypoxemic acute respiratory failure (hARF) remainsunclear. The aim of this meta-analysis was to critically review studies that investigated the effect of helmet CPAP on gas exchange,mortality, and intubation rate in comparison with standard oxygen therapy. Materials and Methods: We performed a meta-analysis of randomized controlled trials (RCTs) by searching the PubMed, Embase,Cochrane library, OVID, and CBM databases, and the bibliographies of the retrieved articles. Studies that enrolled adults with hARF who were treated with helmet CPAP and measured at least one of the following parameters were included: gas exchange,intubation rate, in-hospital mortality rate. Results: Four studies with 377 subjects met the inclusion criteria and were analyzed. Compared to the standard oxygen therapy, helmet CPAP significantly increased the PaO2/FiO2 [weighted mean difference (WMD)=73.40, 95% confidence interval (95% CI): 43.92 to 102.87, p<0.00001], and decreased the arterial carbon dioxide levels (WMD=-1.92, 95% CI: -3.21 to -0.63, p=0.003), intubationrate [relative risk (RR)=0.21, 95% CI: 0.11 to 0.40, p<0.00001], and in-hospital mortality rate (RR=0.22, 95% CI: 0.09 to 0.50, p=0.0004). Conclusion: The results of this meta-analysis suggest that helmet CPAP improves oxygenation and reduces mortality and intubationrates in hARF. However, the significant clinical and statistical heterogeneity of the literature implies that large RCTs are neededto determine the role of helmet CPAP in different hypoxemic ARF populations.

Background/Aims: Home oxygen therapy (HOT) costs a great deal every year and demand for the service is growing. In Korea, health insurance has covered HOT since November 1, 2006. The objective of this study was to evaluate clinical features of patients who used long-term HOT due to chronic respiratory failure and to determine the appropriateness of oxygen prescriptions. Methods: Between November 2006 and April 2010, patients prescribed long-term HOT were enrolled in the study at a tertiary university referral hospital and their medical records and telephone survey information were evaluated. In total, 340 patients were evaluated retrospectively. Results: Regarding the initial indications for HOT, their mean PaO2 was 49.8 mmHg and mean SpO2 was 82.2%. Underlying diseases included chronic obstructive pulmonary disease (COPD, 19.8%), lung cancer (12.6%), and interstitial lung disease (11.2%). The admission rate within 1 year was 53.4% and the average number of admissions was 1.64/patient. Other underlying diseases for which oxygen was prescribed, despite not meeting the insurance coverage criteria, were lung cancer (36.6%) and interstitial pneumonia (16.6%). Conclusions: Home oxygen prescriptions have increased since health insurance coverage was extended. However, cases of oxygen prescriptions frequently do not meet the coverage criteria. It is important to discuss extending the coverage criteria to other disease groups, such as interstitial lung disease and lung cancer, in terms of costeffectiveness. Further, physicians prescribing oxygen therapy should be educated regarding the criteria.

Background: It has been suggested that a high-flow nasal cannula (HFNC) could help to remove carbon dioxide (CO2) from anatomical dead spaces, but evidence to support that is lacking. The objective of this study was to elucidate whether use of an HFNC could reduce the arterial partial pressure of CO2 (PaCO2) in patients with acute hypercapnic respiratory failure who are receiving conventional oxygen (O2) therapy. Methods: A propensity score-matched observational study was conducted to evaluate patients treated with an HFNC for acute hypercapnic respiratory failure from 2015 to 2016. The hypercapnia group was defined as patients with a PaCO2 >50 mm Hg and arterial pH <7.35. Results: Eighteen patients in the hypercapnia group and 177 patients in the nonhypercapnia group were eligible for the present study. Eighteen patients in each group were matched by propensity score. Decreased PaCO2 and consequent pH normalization over time occurred in the hypercapnia group (P=0.002 and P=0.005, respectively). The initial PaCO2 level correlated linearly with PaCO2 removal after the use of an HFNC (R2=0.378, P=0.010). The fraction of inspired O2 used in the intensive care unit was consistently higher for 48 hours in the non-hypercapnia group. Physiological parameters such as respiratory rate and arterial partial pressure of O2 improved over time in both groups. Conclusions: Physiological parameters can improve after the use of an HFNC in patients with acute hypercapnic respiratory failure given low-flow O2 therapy via a facial mask. Further studies are needed to identify which hypercapnic patients might benefit from an HFNC.

Purpose: Acute respiratory distress syndrome (ARDS) is characterized by its acute onset of symptoms such as bilateral pulmonary infiltrates, severe hypoxemia, and pulmonary edema. Many patients with ARDS survive in the acute phase, but then die from significant lung fibrosis.Methods: The effect of combination therapy with polydeoxyribonucleotide (PDRN) and pirfenidone on ARDS was investigated using human lung epithelial A549 cells. ARDS environment was induced by treatment with lipopolysaccharide and transforming growth factor (TGF)-β. Enzyme-linked immunoassay for connective tissue growth factor (CTGF) and hydroxyproline were conducted. Western blot for collagen type I, fibroblast growth factor (FGF), tumor necrosis factor (TNF)-α, and interleukin (IL)-6 was performed.Results: In this study, 8-μg/mL PDRN enhanced cell viability. Combination therapy with PDRN and pirfenidone and pirfenidone monotherapy suppressed expressions of CTGF and hydroxyproline and inhibited expressions of collagen type I and FGF. Combination therapy with PDRN and pirfenidone and PDRN monotherapy suppressed expression of TNF-α and IL-1β.Conclusions: The combination therapy with PDRN and pirfenidone exerted stronger therapeutic effect against lipopolysaccharide and TGF-β-induced ARDS environment compared to the PDRN monotherapy or pirfenidone monotherapy. The excellent therapeutic effect of combination therapy with PDRN and pirfenidone on ARDS was shown by promoting the rapid anti-inflammatory effect and inhibiting the fibrotic processes.

Background/Aims: It is unclear whether corticosteroid use in patients with acute respiratory distress syndrome (ARDS) improves survival. This study aimed to investigate whether the administration of corticosteroids to patients in the early phase of moderate to severe ARDS is associated with improved outcomes. Methods: We analyzed the data of patients who received corticosteroids within 7 days of the onset of ARDS between June 2006 and December 2015 at a single tertiary teaching hospital. A total of 565 patients admitted with moderate to severe ARDS were eligible. The outcomes of patients treated with methylprednisolone 40 to 180 mg/day or equivalent (n = 404) were compared to those who did not receive steroids (n = 161). The primary and secondary outcomes were 28- and 90-day mortality rates, respectively. Propensity scores were used to adjust for baseline covariates. Results: The overall mortality at 28 days was not significantly different between the corticosteroid-treated and control groups (43.8% vs. 41%, p = 0.541). At 90 days, the overall mortality rate was higher in the corticosteroid-treated group than in the control group (59.2% vs. 48.4%, p = 0.021). However, on propensity score matching, corticosteroid therapy was not associated with a higher 28-day mortality rate (odds ratio, 1.031; 95% confidence interval, 0.657 to 1.618; p = 0.895) and 90 days (odds ratio, 1.435; 95% confidence interval, 0.877 to 2.348; p = 0.151). Conclusions: Corticosteroid therapy was not associated with 28- or 90-day mortality in the

Respiratory diseases in dogs and cats can be classified into respiratory problems brought about as a result of a specific abnormality of the respiratory system; so called primary respiratory disease, and bronchopulmonary problems which occur as a consequence of heart failure; so called secondary respiratory disease. This section will concentrate predominantly on considerations regarding the treatment of primary respiratory diseases. This includes agents used to facilitate bronchodilation, to reduce coughing and various expectorants and mucolytics. In addition, the optimal fluid therapy and various ways of oxygen delivery with complication will be discussed with emphasis In order to understand the indications for, and action of, various drugs used in the treatment of respiratory disease an understanding of normal respiratory physiology is important and these considerations is described in this section for helping to understand further for readers.

연구배경 : 급성호흡곤란증후군(ARDS) 환자의 폐 산소화를 개선시키기 위한 보조적 치료법인 복와위 자세에서의 인공환기는 대상 환자의 약 61%에서, 흡입 산화질소 투여는 60-80%에서 효과가 있는 것으로 보고되어 있다. 산소화 호전의 주된 기전은 복와위시는 이환이 심한 등쪽 폐의 환기 호전에 의한 단락 감소이며, 산화질소 투여 시는 이환부위로부터 정상 폐포로의 폐 혈류의 재분포에 의한 단락 감소안 것으로 알려져 있다. 그러므로 복와위와 산화질소의 병용 치료 시 산소화 개선에 상승 효과를 기대할 수 있으나 이에 관한 임상 연구는 없었다. 이에 저자들은 ARDS환자에서 두 치료의 병합이 가스 교환 및 혈류 역학에 미치는 영향을 관찰하였다. 방 법 : ARDS 환자 12명(연령 $56{\pm}12$ 세, 남 : 여=9 : 3)을 대상으로 앙와위에서 호흡 및 혈류역학적 지표를 측정한 후 복와위로 전환하였다. 복와위 30분과 2시간에 동일 지표들을 측정한 뒤 산화질소를 투여하고 (5-10 ppm), 이후 30분, 2 시간 및 산화질소 투여 중단 후 10분에 각각 동일 지표들을 재 측정하였다. 결 과 : 가스 교환 지표 : 복와위에서 산화질소 병용 치료시, 앙와위 및 복와위에서보다 $PaO_2/FiO_2$가 증가되었고(각각 p< 0.01) 폐동맥혈 산소분압차($AaDO_2$)는 감소하였다(각각 p<0.005). 호흡 역학적 지표 : 폐 탄성, 호흡기계 탄성, 기도 저항 및 흡기말 기도압은 치료 방법에 따른 차이가 없었다. 혈류 역학적 지표 : 복와위에서 산화질소 병용 치료시, 앙와위 및 복와위에서보다 심 박출량 및 조직산소전달량($DO_2$)이 증가되었으며(각 P< 0.05), 폐혈관 저항, 평균 폐동맥압 및 폐동맥쐐기압은 감소되었다(각 P< 0.05). 결 론 : 급성호흡곤란증후군 환자에서 복와위 및 산화질소 홉업의 병용 치료는 복와위 단독 치료에 비해 폐산소화 호전에 상승 작용이 있으며, 조직으로의 산소 전달량도 증가시키므로 급성호흡곤란증후군 환자의 보조적인 치료법으로써 유용할 것으로 사료되었다.

Background and Objective : Although prone positioning has been reported to improve gas exchange, prone positioning alone does not seem to be sufficient to increase systemic oxygen transport in an acute lung injury. The objective of this study was to investigate whether the combined therapy of low dose nitric oxide (NO) inhalation and prone positioning has an additive effect on the oxygenation and hemodynamics in patients with severe ARDS. Patients and Methods : Twelve patients with ARDS were included. Prone positioning alone, later combined with nitric oxide inhalation (5~10 ppm) from the supine position (baseline) were performed with serial measurement of gas exchange, respiratory mechanics and hemodynamic at sequential time points. The patient was regarded as a responder to prone positioning if an increase in $PaO_2/FiO_2$ of more than 20 mm Hg at 30 min or 120 min intervals after prone positioning was observed compared to that of the baseline. The same criterion was applied during nitric oxide inhalation. Results : Eight patients (66.5%) responded to prone positioning and ten patients (83.3%) including the eight just mentioned responded to the addition of NO inhalation. The $AaDO_2$ level also decreased promptly with the combination of prone positioning and NO inhalation compared to that of prone positioning alone ($191{\pm}109$ mm Hg vs. $256{\pm}137$ mm Hg, P<0.05). Hemodynamic parameters and lung compliance did not change significantly during prone positioning only. Following the addition of NO inhalation to prone positioning, the mean pulmonary artery pressure and pulmonary artery occlusion pressure decreased and cardiac output, stroke volume and oxygen delivery increased (P < 0.05) compared to those of prone 120 min. Conclusion : These findings indicate that NO inhalation would provide additional improvement in oxygenation and oxygen transport to mechanically ventilated patients with ARDS who are in a prone position.

Purpose: Minimally invasive surfactant therapy (MIST) is currently used as a method of surfactant replacement therapy (SRT) for the treatment of respiratory distress syndrome (RDS) in preterm infants with a gestational age of less than 30 weeks. However, few studies have been conducted on MIST in neonates with a gestational age of 30 weeks or more. In this study, we compared MIST with endotracheal intubation as a rescue SRT for spontaneously breathing neonates with a gestational age of 30 weeks or more who were diagnosed with RDS. Methods: We investigated the clinical characteristics of spontaneously breathing neonates admitted to the neonatal intensive care unit of the Inje University Sanggye Paik Hospital from January 1, 2014 to December 31, 2016. These neonates were born at a gestational age of 30 weeks or more and were diagnosed with RDS. The neonates who were administered surfactant by MIST were categorized into the MIST group (n=16) and those who underwent endotracheal intubation were categorized into the control group (n=45). Thereafter, the clinical characteristics between the groups were compared. Results: Compared to the control group, the MIST group was less likely to require mechanical ventilation within 72 hours (P<0.001). The frequency of bradycardia during SRT was also low in the MIST group (P=0.033). Conclusion: MIST is considered relatively feasible and safe for treating RDS for reducing the need for mechanical ventilation and decreasing the occurrence of bradycardia during surfactant administration in neonates with a gestational age of 30 weeks or more.