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Biomedical subjects

K S Jih

Publications and source records attributed to K S Jih.

18 recordsLinked to original sources
PubMed2000

Nutritional status of mechanically ventilated critically ill patients: comparison of different types of nutritional support.

Malnutrition is a common problem in hospitalized patients. Early assessment of nutritional status may help in identifying patients for whom nutritional interventions are needed. The purpose of this study was to assess and compare the nutritional status of mechanically ventilated critically ill patients who were receiving nutritional support. Forty-nine patients were divided into either enteral nutrition, total parenteral nutrition or combined (enteral plus total parenteral nutrition) groups. Anthropometric and biochemical measurements, and medical status (APACHE II score) were assessed at the 1st day and 14th day of admission in the intensive care unit (ICU) of Taichung Veteran General Hospital. The length of ventilator dependency was significantly positively correlated with calorie and carbohydrate intake in the pooled group. Patients receiving enteral and combined nutrition showed significantly lower anthropometric measurements at the 14th day after admission. Patients in all groups had abnormal mean biochemical values at the 1st day of admission. Subjects in the combined group showed a significant increase in prealbumin and the Maastricht Index levels after 14 days. Patients in all three groups were malnourished when admitted to the ICU. Patients showed a slightly improvement of nutritional status after receiving nutritional support for 14 days.

APACHE↗
PubMed1998

An intelligent control system for ventilators.

This study reports on a ventilator system that consists of several intelligent modules for controlling ventilator operation. These modules are software programs in two controllers. One controller is a personal computer used for diagnoses, determining settings and checking the effects of settings. The other controller is a single-chip microprocessor in a ventilator that controls the ventilator's settings in accordance with the computer settings. After setting up the system, an artificial lung model simulating a patient's lung is used to test the system. The result of test run indicated that it always responds to a patient's lung condition in a stable manner. Thus, the proposed system with its intelligent modules may assist clinicians in caring for patients and managing ventilator operation.

Algorithms↗
PubMed1996

Hypercapnic respiratory acidosis precipitated by hypercaloric carbohydrate infusion in resolving septic acute respiratory distress syndrome: a case report.

Complications may occur when nutritional support is administered either parenterally or enterally. Inappropriate nutritional formulas with high carbohydrate loads can precipitate respiratory failure in patients with compromised lung function, induce respiratory distress which manifests as dyspnea and tachypnea in an originally normal lung condition, produce hypercapnic acidosis in mechanically ventilated patients with chronic obstructive pulmonary disease (COPD) as well as patients recovering from acute respiratory distress syndrome (ARDS) without chronic lung disease, or result in difficult weaning. Hypercaloric mixed substrates administered either parenterally or enterally can also have profound impacts on gas exchange and energy expenditure. This report describes a patient who experienced exacerbation of respiratory distress and hypercapnic acidosis during recovery from septic ARDS as the result of a nutritionally-related increase in CO2 production. As carbohydrate calories were decreased, CO2 production diminished and the hypercapnia was resolved. The importance of indirect calorimetry cannot be overemphasized during tailoring of nutritional support for the critically ill patients.

Acidosis, Respiratory↗
PubMed1995

An urgent technique of applying high frequency jet ventilation in patients with extreme periglottic stenosis.

Applying high frequency jet ventilation (HFJV) to patients with extreme periglottic stenosis (EPS) carries high risk of barotrauma or severe circulatory depression, since the stenotic airway will result in inadequate outflow tract obstructing the passage of the expired gas. We encountered with emergent obstruction of the outflow tract in 13 patients with EPS during HFJV in endolaryngeal microsurgery (ELM) procedures. The phenomenon of progressive gas trapping occurred within seconds in all patients. Barotrauma and disastrous circulatory depression would occur if we had not recognized them and then taken some measures immediately. We surmounted these potentially lethal events without interrupting the surgical procedures and found neither hypoxia nor barotrauma in all these patients. This may attribute to an urgent technique, i.e., intermittent disconnecting the jet conduit at the junction of the proximal end of the insufflation catheter and the distal end of the patient connecting tube of jet ventilator during HFJV.

Adult↗
PubMed1993

Adult respiratory distress syndrome in children.

Adult respiratory distress syndrome or ARDS as coined by Ashbaugh et al in 1967, has been a great challenge in the field of critical care since then. It is a clinical entity which can be caused by various insults at any age. There have been several case reports of ARDS involving infants and children in the past 10 years, but pediatric ARDS is still not well recognized in Taiwan. A review of admissions to the pediatric intensive care unit in the past 2 years shows that 11 of the cases were included as pediatric ARDS combined with the expanded definition of Murray et al, and that each patient had an acute lung injury score greater than 2.5. Clinical manifestations also presented acute pulmonary distress indicating ARDS. The distribution of age ranged from 13 months to 11 years. The predisposing insults included sepsis, gastrointestinal bleeding with shock and massive blood transfusion, central nervous system infection, major trauma, near drowning, fulminant hepatitis and chemotherapy for acute leukemia. All received mechanical ventilatory support. The average peak inspiratory pressure was 46.7 +/- 6.4 cmH2O and the mean value of maximal PEEP used was 11.9 +/- 4.4 cmH2 O. Three patients developed barotrauma. Two patients survived and nine expired, a mortality rate of 82%. It is important for physicians caring for infants and children with respiratory failure to consider the diagnosis and initiate adequate ventilatory support and other resuscitation management.

Child↗
PubMed1993

Evaluation of prognostic indices based on pulmonary and hemodynamic variables in patients with adult respiratory distress syndrome (ARDS).

Patients with established ARDS have a high mortality rate. We continuously monitored hemodynamic and respiratory parameters of 30 patients in our ICU, all had acute respiratory failure during admission then progressively developed ARDS. We compared demographic characteristics, APACHE II (acute physiology and chronic health evaluation) score, ALI (acute lung injury) score, associated MSOF (multiple systems organ failure) in the disease process, pulmonary variables, and hemodynamic variables between survivors and nonsurvivors. Six of the 12 female patients and two of the 18 male patients survived. Our female patients had a better outcome than the males (P < 0.02); and, those who were younger than 35 years old and those who had less than two organ failures during the evolution of ARDS also had a better outcome (P < 0.001 vs. P < 0.03). After ARDS had developed, there were significant differences between survivors and nonsurvivors in the APACHE II score (P < 0.03), serum albumin level (P < 0.02), mean airway pressure (P < 0.05), PCWP (P < 0.02) and SaO2 (P < 0.02). Having a higher APACHE (> or = 15, P < 0.003), lower serum ablumin level (Alb < 2.5 gm/dl, P < 0.04), higher mean airway pressure (> or = 25 cm H2O, P < 0.04), higher PCWP (> or = 14 mmHg, P < 0.006), and lower SaO2 (< 93%, P < 0.002) predicted a poorer outcome. All patients received PEEP therapy and there were no significant differences between survivors and nonsurvivors in the PEEP level applied, either at the beginning of respiratory failure, or after development of ARDS. But those who had PEEP of 6 cm H2O or higher applied at the beginning of respiratory failure and those had PEEP of less than 10 cm H2O after development of ARDS had a better outcome (P < 0.04 vs. P < 0.05). Nevertheless, more controlled trials are needed before we make any conclusion about PEEP therapy.

Adult↗
PubMed1989

Sustained-release theophylline-uniphyllin in nocturnal asthmatics.

For a period of six months, we collected 12 cases of nocturnal asthmatics (7 males, 5 females); their ages ranged from 20 to 66 (the average age is 49). We found that administration of Uniphyllin (10 mg/kg) once a day at 6 PM could maintain the blood level of theophylline within therapeutic range at least 12 to 24 hrs. The peak expiratory flow rate of the 6 cases we collected, were significantly improved. The result of pharmokinetic parameters: 1) The average of a single dose (12 cases) is AUC (ug. hr/ml) 275.1 +/- 62. k; Kel (hr-1) 0.068 +/- 0.019; Ka (hr-1) 0.33 +/- 0.07); Tmax (hr) 6.3 +/- 1.4; T 1/2 (hr) 11.2 +/- 4.4; Clearance/F (ml/kg/hr) 37.9 +/- 9.0.2). The average of steady state (12 cases) is Css (mg/L) 5. 7 +/- 2.6; Cmax-Cmin (mg/L) 10.09 +/- 1.46.3). The average of relative bioavailability (3 cases) is 82%, 83%, 102%. However, the extent of absorption data is available for only 3 subjects. There are too few subjects to draw any meaningful conclusions about this relative bioavailability. Four cases show slight symptoms, including 1 case of dizziness, 2 cases of nausea, and 1 case gaseousness. It is suggested that the drug be administered at about 6-8 PM to coincide peak levels in the early morning in nocturnal asthmatics.

Adult↗
PubMed1989

[Prediction of postoperative pulmonary function in the patient undergoing pneumonectomy using combined pulmonary function test and ventilation/perfusion scintiphotography].

A method to predict postoperative lung function following pneumonectomy has been used in 11 patients. Preoperative unilateral lung function can be predicted by combining the preoperative information on lung volumes obtained by spirometry with the distributional information obtained from ventilation and perfusion scintigrams in order to estimate lung function after pneumonectomy. There was a high degree of correlation between predicted and measured lung function for both FEV1 (r = 0.81, p less than 0.050, and FVC (r = 0.81, p less than 0.05). The postoperative FEV1 and FVC were within 200 ml of the predicted value in most of the patients. A more accurate and easy prediction of postoperative lung function is obtained using unilateral perfusion rather than ventilation scintigrams. We suggest that the combined the results of simple spirometric data and a quantitative right-vs-left perfusion lung scan using radioactive Tc-99m provides a simple non-invasive and accurate method for the pre-operative functional evaluation of the high risk patient.

Adult↗