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Yang SH, Chen CY, Liu WL, Liu HW, Chao KY. Development of a Cost-Effective 3D-Printed Airway Suction Simulator for Respiratory Therapy Students. Respir Care 2024; 69:549-556. [PMID: 38167213 DOI: 10.4187/respcare.11277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2024]
Abstract
BACKGROUND Three-dimensional (3D)-printed models are cost-effective and can be customized by trainers. This study designed a 3D-printed airway suction simulator for use by respiratory therapy (RT) students. The objective was to demonstrate the cost-effectiveness and application of 3D-printed models in respiratory care training, aiming to enhance the educational experience for RT students. METHODS This study developed a 3D-printed airway suction simulator that was cost-effective. A randomized controlled trial was conducted involving RT students to compare effectiveness in a 3D-model group and a control group. Skill assessments and written examinations were used to evaluate the participants' knowledge and skills. RESULTS A total of 38 second-year RT students were randomly assigned to either the 3D-model group (n = 19) or the control group (n = 19). One participant in the 3D-model group was lost to follow-up during the planned direct observation of procedural skills (DOPS) assessment and satisfaction questionnaire completion. The posttest written examination scores were significantly higher in the 3D-model group than in the control group (100% vs 80%, P = .02). The scores from the DOPS and satisfaction questionnaire were comparable in the 2 groups. CONCLUSIONS This study demonstrated that 3D printing can be used to create a safe and cost-effective airway suction simulator for use by RT students, with potential to enhance training methods. Further research is necessary.
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Affiliation(s)
- Shih-Hsing Yang
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; and Department of Respiratory Therapy, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chao-Yu Chen
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; and Department of Life Science, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Wei-Lun Liu
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; and Data Science Center, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hsia-Wei Liu
- Department of Life Science, Fu Jen Catholic University, New Taipei City, Taiwan; and Graduate Institute of Applied Science and Engineering, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan; and Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan.
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2
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Liu WL, Lee IH, Lee LN, Yang SH, Chao KY. A 3D-Printed High-Fidelity Bronchial Tree for Bronchoscopy. Respir Care 2023; 68:527-530. [PMID: 36854470 PMCID: PMC10173112 DOI: 10.4187/respcare.10671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Affiliation(s)
- Wei-Lun Liu
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; and Department of Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - I-Hsien Lee
- Department of Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Li-Na Lee
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan; Department of Laboratory Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; Division of Chest Medicine, Department of Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; and Department of Laboratory Medicine, National Taiwan University College of Medicine and Hospital, Taipei Taiwan
| | - Shih-Hsing Yang
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; and School of Respiratory Therapy, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.
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Tseng CW, Chao KY, Wu HL, Lin CC, Hsu HS. Effectiveness of high-flow nasal cannulae compared with noninvasive positive-pressure ventilation in preventing reintubation in patients receiving prolonged mechanical ventilation. Sci Rep 2023; 13:4689. [PMID: 36949116 PMCID: PMC10033681 DOI: 10.1038/s41598-023-31444-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 03/11/2023] [Indexed: 03/24/2023] Open
Abstract
Many intensive care unit patients who undergo endotracheal extubation experience extubation failure and require reintubation. Because of the high mortality rate associated with reintubation, postextubation respiratory management is crucial, especially for high-risk populations. We conducted the present study to compare the effectiveness of oxygen therapy administered using high-flow nasal cannulae (HFNC) and noninvasive positive pressure ventilation (NIPPV) in preventing reintubation among patients receiving prolonged mechanical ventilation (PMV). This single-center, prospective, unblinded randomized controlled trial was at the respiratory care center (RCC). Participants were randomized to an HFNC group or an NIPPV group (20 patients in each) and received noninvasive respiratory support (NRS) administered using their assigned method. The primary outcome was reintubation within7 days after extubation. None of the patients in the NIPPV group required reintubation, whereas 5 (25%) of the patients in the HFNC group required reintubation (P = 0.047). The 90-day mortality rates of the NIPPV and HFNC groups (four patients [20%] vs. two patients [10%], respectively) did not differ significantly. No significant differences in length of RCC stay, length of hospital stay, time to liberation from NRS, and ventilator-free days at 28-day were identified. The time to event outcome analysis also revealed that the risk of reintubation in the HFNC group was higher than that in the NIPPV group (P = 0.018). Although HFNC is becoming increasingly common as a form of postextubation NRS, HFNC may not be as effective as NIPPV in preventing reintubation among patients who have been receiving PMV for at least 2 weeks. Additional studies evaluating HFNC as an alternative to NIPPV for patients receiving PMV are warranted.ClinicalTrial.gov ID: NCT04564859; IRB number: 20160901R.Trial registration: ClinicalTrial.gov ( https://clinicaltrials.gov/ct2/show/NCT04564859 ).
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Affiliation(s)
- Chi-Wei Tseng
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, No. 201, Sec. 2, Shih-Pai Road, Beitou District, Taipei, 112, Taiwan, R.O.C
| | - Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
- School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
- Artificial Intelligence Development Center, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Hsiu-Li Wu
- Department of Nursing, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chen-Chun Lin
- Division of Pulmonary Medicine, Shin Kong Wu Ho-Su Memorial Hospital, Taiwan. No.95, Wenchang Rd., Shilin Dist., Taipei, 111, Taiwan, R.O.C..
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
| | - Han-Shui Hsu
- Institute of Emergency and Critical Care Medicine, National Yang Ming Chiao Tung University, No. 201, Sec. 2, Shih-Pai Road, Beitou District, Taipei, 112, Taiwan, R.O.C..
- Division of Thoracic Surgery, Department of Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.
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Mu SC, Chien YH, Lai PZ, Chao KY. Corrigendum: Helmet ventilation for pediatric patients during the COVID-19 pandemic: A narrative review. Front Pediatr 2023; 11:1168133. [PMID: 37020648 PMCID: PMC10067923 DOI: 10.3389/fped.2023.1168133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 03/08/2023] [Indexed: 04/07/2023] Open
Abstract
[This corrects the article DOI: 10.3389/fped.2022.839476.].
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Affiliation(s)
- Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Yu-Hsuan Chien
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei, Taiwan
| | - Pin-Zhen Lai
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei, Taiwan
| | - Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei, Taiwan
- School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
- Correspondence: Ke-Yun Chao
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Lee LN, Chou WR, Wang JY, Kuo YL, Chang CY, Lee YC, Tung SH, Tsao WC, Chao KY, Liu WL. Characteristics and local risk factors of community-acquired and health-care-associated Staphylococcus aureus pneumonia. Sci Rep 2022; 12:18670. [PMID: 36333461 PMCID: PMC9636242 DOI: 10.1038/s41598-022-23246-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Accepted: 10/27/2022] [Indexed: 11/06/2022] Open
Abstract
This study aims at identifying characteristics, risk factors and mortality of community-acquired (CAP) and health-care-associated pneumonia (HCAP) by Staphylococcus aureus (S. aureus). We retrieved adults with S. aureus CAP or HCAP diagnosed by blood or pleural effusion culture in 2.6 years, and compared with those of Streptococcus pneumoniae (S. pneumoniae) CAP or HCAP diagnosed by blood or respiratory culture, or urine antigen. We found 18 patients with CAP and 9 HCAP due to S. aureus (female 33%, 66.6 ± 12.4 years-old), and 48 patients with CAP and 15 HCAP due to S pneumoniae (female 41%, 69.5 ± 17.5 years). Diabetes mellitus (52% vs. 24%, p = 0.019), hemodialysis (11% vs. 0%, p = 0.046), skin lesions (44% vs. 0%, p < 0.001), cavitary nodules (37% vs. 1.6%, p < 0.001) and pleural effusions (48% vs. 18%, p = 0.007) were more common in staphylococcal than pneumococcal group. Three patients with staphylococcal pneumonia had acute myocardial infarction. Pneumonia severity index (139 ± 52 vs. 109 ± 43, p = 0.005) and 30-day mortality (41% vs. 9.5%, p = 0.001) were higher in staphylococcal group. Multivariate analysis showed underlying disease (especially cancer and cirrhosis), risk class 4/5, altered mentality, shock and bilateral pneumonia were risk factors for 30-day mortality.
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Affiliation(s)
- Li-Na Lee
- grid.256105.50000 0004 1937 1063Department of Laboratory Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan ,grid.256105.50000 0004 1937 1063Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan ,grid.256105.50000 0004 1937 1063School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, 24205 Taiwan ,grid.19188.390000 0004 0546 0241Department of Laboratory Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Wen-Ru Chou
- grid.256105.50000 0004 1937 1063Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Jann-Yuan Wang
- grid.19188.390000 0004 0546 0241Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan
| | - Yen-Liang Kuo
- grid.256105.50000 0004 1937 1063Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan ,grid.256105.50000 0004 1937 1063School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, 24205 Taiwan
| | - Chi-Yueh Chang
- grid.256105.50000 0004 1937 1063Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yi-Chien Lee
- grid.256105.50000 0004 1937 1063Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan ,grid.256105.50000 0004 1937 1063School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, 24205 Taiwan
| | - Shao-Hsien Tung
- grid.256105.50000 0004 1937 1063Internal Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Wen-Ching Tsao
- grid.256105.50000 0004 1937 1063Department of Laboratory Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ke-Yun Chao
- grid.256105.50000 0004 1937 1063Department of Respiratory Therapy, Fu Jen Catholic University Hospital, New Taipei City, Taiwan
| | - Wei-Lun Liu
- grid.256105.50000 0004 1937 1063School of Medicine, College of Medicine, Fu Jen Catholic University, No. 510, Zhongzheng Rd., Xinzhuang Dist., New Taipei City, 24205 Taiwan ,grid.256105.50000 0004 1937 1063Department of Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan ,grid.256105.50000 0004 1937 1063Data Science Center, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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Chao KY, Wang JS, Liu WL. Role of helmet ventilation during the 2019 coronavirus disease pandemic. Sci Prog 2022; 105:368504221092891. [PMID: 35404163 PMCID: PMC9006090 DOI: 10.1177/00368504221092891] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Coronavirus disease 2019 (COVID-19) has been declared a pandemic by the World Health Organization; it has affected millions of people and caused hundreds of thousands of deaths. Patients with COVID-19 pneumonia may develop acute hypoxia respiratory failure and require noninvasive respiratory support or invasive respiratory management. Healthcare workers have a high risk of contracting COVID-19 while fitting respiratory devices. Recently, European experts have suggested that the use of helmet continuous positive airway pressure should be the first choice for acute hypoxia respiratory failure caused by COVID-19 because it reduces the spread of the virus in the ambient air. By contrast, in the United States, helmets were restricted for respiratory care before the COVID-19 pandemic until the Food and Drug Administration provided the ‘Umbrella Emergency Use Authorization for Ventilators and Ventilator Accessories’. This narrative review provides an evidence-based overview of the use of helmet ventilation for patients with respiratory failure.
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Affiliation(s)
- Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
- School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Jong-Shyan Wang
- Department of Physical Medicine and Rehabilitation, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan
- Department of Physical Therapy, College of Medicine, Graduate Institute of Rehabilitation Science, Chang Gung University, Taoyuan, Taiwan
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Taoyuan, Taiwan
| | - Wei-Lun Liu
- Department of Emergency and Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
- Data Science Center, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
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Mu SC, Chien YH, Lai PZ, Chao KY. Helmet Ventilation for Pediatric Patients During the COVID-19 Pandemic: A Narrative Review. Front Pediatr 2022; 10:839476. [PMID: 35186812 PMCID: PMC8847782 DOI: 10.3389/fped.2022.839476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 01/11/2022] [Indexed: 12/15/2022] Open
Abstract
The air dispersion of exhaled droplets from patients is currently considered a major route of coronavirus disease 2019 (COVID-19) transmission, the use of non-invasive ventilation (NIV) should be more cautiously employed during the COVID-19 pandemic. Recently, helmet ventilation has been identified as the optimal treatment for acute hypoxia respiratory failure caused by COVID-19 due to its ability to deliver NIV respiratory support with high tolerability, low air leakage, and improved seal integrity. In the present review, we provide an evidence-based overview of the use of helmet ventilation in children with respiratory failure.
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Affiliation(s)
- Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Yu-Hsuan Chien
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.,Department of Pediatrics, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Pin-Zhen Lai
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
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Chao KY, Liu WL, Nassef Y, Tseng CW, Wang JS. Effects of high-flow nasal cannula with oxygen on self-paced exercise performance in COPD: A randomized cross-over trial. Medicine (Baltimore) 2021; 100:e28032. [PMID: 34941043 PMCID: PMC8701785 DOI: 10.1097/md.0000000000028032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 06/16/2021] [Accepted: 11/11/2021] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Studies have demonstrated that noninvasive ventilation improves exercise intolerance in patients with chronic obstructive pulmonary disease (COPD). The role of heated humidified high-flow nasal cannula (HFNC) therapy in patients with COPD on self-paced exercise performance remains unclear. Therefore, the purpose of the present study was to determine whether HFNC-aided supplemental oxygen during a 6-minute walk test (6MWT) would change self-paced exercise performance and cardiopulmonary outcomes in patients with stable COPD. METHODS A single-site, cross-over trial was conducted in a pulmonary rehabilitation outpatient department. This study enrolled 30 stable COPD patients without disability. The participants with and without HFNC performed 6MWTs on 2 consecutive days. Outcomes were the distance walked in the 6MWT, physiological, and cardiopulmonary parameters. RESULTS Those performing HFNC-aided walking exhibited a longer walking distance than those performing unaided walking. The mean difference in meters walked between the HFNC-aided and unaided walking scenarios was 27.3 ± 35.6 m (95% CI: 14.4-40.5 m). The energy expenditure index was significantly lower when walking was aided by HHHNFC rather than unaided (median: 1.21 beats/m walked vs median: 1.37 beats/m walked, P < .001). However, there were no differences in transcutaneous carbon dioxide tension between HHHNFC and non-HHHNFC patients. CONCLUSION Walking distance and arterial oxygen saturation improved in stable COPD patients receiving HFNC with additional oxygen support. However, HFNC did not affect transcutaneous carbon dioxide tension and the self-reported dyspnea score during the walking test. The present study demonstrated the feasibility and safety of using HFNC in self-paced exercise. TRIAL REGISTRATION NCT03863821.
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Affiliation(s)
- Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
- School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Wei-Lun Liu
- Department of Emergency and Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
- School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei, Taiwan
| | - Yasser Nassef
- Institution of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Chi-Wei Tseng
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Jong-Shyan Wang
- Heart Failure Center, Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Keelung, Taiwan
- Healthy Aging Research Center, Graduate Institute of Rehabilitation Science, Medical Collage, Chang Gung University, Tao-Yuan, Taiwan
- Research Center for Chinese Herbal Medicine, College of Human Ecology, Chang Gung University of Science and Technology, Tao-Yuan, Taiwan
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Chao KY, Chien YH, Mu SC. High-flow nasal cannula in children with asthma exacerbation: A review of current evidence. Paediatr Respir Rev 2021; 40:52-57. [PMID: 33771473 DOI: 10.1016/j.prrv.2021.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2020] [Revised: 12/24/2020] [Accepted: 01/14/2021] [Indexed: 10/22/2022]
Abstract
Asthma is the commonest obstructive airway disease and the leading cause of morbidity in children. In the pediatric population, acute exacerbations of asthma are a frequent cause of presentations and hospital admissions. An acute asthma exacerbation is potentially life-threatening; it is predominantly treated using conventional oxygen therapy with bronchodilators and systemic corticosteroids. The treatment of those who do not respond to conventional therapy is escalated to noninvasive positive pressure ventilation (NIPPV) before invasive ventilation. Although NIPPV has demonstrated benefits and safety, it still has limitations such as treatment intolerance caused mainly by discomfort and complications. High-flow oxygen therapy administered through a nasal cannula (HFNC) provides respiratory support with adequate airway humidity and has demonstrated safety and benefits in clinical practice. In the present review, we discuss HFNC and variations in HFNC use, focusing on its feasibility and current evidence of using it on children with asthma exacerbations.
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Affiliation(s)
- Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Hsuan Chien
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan.
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Chao KY, Nassef Y. A pilot study of short-term hemodynamic effects of negative pressure ventilation in chronic obstructive pulmonary disease assessed using electrical cardiometry. Ann Noninvasive Electrocardiol 2021; 26:e12843. [PMID: 33733510 PMCID: PMC8411802 DOI: 10.1111/anec.12843] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 02/18/2021] [Accepted: 02/21/2021] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Pulmonary rehabilitation combined with negative pressure ventilation (NPV) demonstrated benefits in patients with chronic obstructive pulmonary disease (COPD). The effect of NPV remains unknown. This study aims to clarify the short-term response of the hemodynamic outcome of NPV in patients with COPD undergoing pulmonary rehabilitation program by electrical cardiometry. METHODS This is an observational retrospective study of COPD patients who had been treated in a pulmonary rehabilitation unit with NPV between January 2018 and December 2019 that were enrolled to analyze the hemodynamic outcomes. RESULTS Thirty patients with COPD that were undergoing a pulmonary rehabilitation program and were regularly receiving NPV were enrolled. Cardiac output (p < .001) and heart rate (p < .001) showed a significant decrease after NPV. Stroke volume did not demonstrate significant change (p = .15). There was a significant decrease in thoracic fluid content (p = .016) and a significant increase in stroke volume variation (p = .038) systemic vascular resistance (p < .001) and left ventricular ejection time (p < .001). Other hemodynamic parameters were all comparable before and after NPV. CONCLUSIONS Negative pressure ventilation demonstrated an impact on hemodynamics in patients with chronic obstructive pulmonary disease undergoing pulmonary rehabilitation. Electrical cardiometry is a feasible method of determining the hemodynamic effects of negative pressure ventilation. Thoracic fluid content significantly decreased immediately after the NPV.
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Affiliation(s)
- Ke-Yun Chao
- Department of Respiratory, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yasser Nassef
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Chao KY, Lin YW, Chiang CE, Tseng CW, Mu SC. Sustained inflation: The lung recruitment maneuvers for neonates. Paediatr Respir Rev 2020; 36:142-150. [PMID: 32386887 DOI: 10.1016/j.prrv.2019.09.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Revised: 07/11/2019] [Accepted: 09/07/2019] [Indexed: 10/25/2022]
Abstract
Establishing effective respiration is vital in the transition from fetal to neonatal life. Respiratory support mainly facilitates and creates functional residual capacity and maintains adequate gas exchange. Sustained inflation (SI) delivers prolonged inflation and rapidly creates and establishes the functional residual capacity. The use of SI in preterm infants in the delivery room is still controversial. The optimum settings of SI remain unknown. Animal studies and clinical reports have demonstrated the advantages and disadvantages of SI. In this article, the current literature was reviewed to examine the efficacy of SI in infants.
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Affiliation(s)
- Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan; School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University, Taoyuan, Taiwan
| | - Yu-Wen Lin
- Department of Nursing, Fu Jen Catholic University Hospital, Fu Jen University, New Taipei City, Taiwan
| | - Chen-En Chiang
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chi-Wei Tseng
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Medical College, Fu Jen Catholic University, New Taipei City, Taiwan.
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Abstract
Smoke inhalation injury (SII) is a major morbidity and cause of mortality in patients with burns. Damage caused by inhalation of thermal or chemical irritants, including toxic fumes and chemicals, leads to respiratory cilia and epithelial cell injuries, which turn to severe bronchospasm and alveolar damage and results in acute respiratory distress syndrome. Respiratory management plays a vital role in the treatment of SII. In this review, we provide an overview of SII with emphasis on respiratory management, including aerosol therapy, bronchial hygiene therapy, advanced ventilation modes, and heated humidified high-flow nasal cannula. In summary, the information may be helpful for further improvements in outcomes.
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Affiliation(s)
- Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan.,School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Taoyuan, Taiwan
| | - Yu-Wen Lin
- Department of Nursing, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chen-En Chiang
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Chi-Wei Tseng
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University, New Taipei City, Taiwan
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13
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Affiliation(s)
- Sa-Bi Lin
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University , New Taipei City, Taiwan
| | - Chen-En Chiang
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University , New Taipei City, Taiwan
| | - Chi-Wei Tseng
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University , New Taipei City, Taiwan
| | - Wei-Lun Liu
- Department of Emergency and Critical Care Medicine, Fu Jen Catholic University Hospital, Fu Jen Catholic University , New Taipei City, Taiwan.,School of Medicine, College of Medicine, Fu Jen Catholic University , New Taipei City, Taiwan
| | - Ke-Yun Chao
- Department of Respiratory Therapy, Fu Jen Catholic University Hospital, Fu Jen Catholic University , New Taipei City, Taiwan.,School of Physical Therapy, Graduate Institute of Rehabilitation Sciences, Chang Gung University , Taoyuan, Taiwan
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14
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Chao KY, Chen YL, Tsai LY, Chien YH, Mu SC. The Role of Heated Humidified High-flow Nasal Cannula as Noninvasive Respiratory Support in Neonates. Pediatr Neonatol 2017; 58:295-302. [PMID: 28223010 DOI: 10.1016/j.pedneo.2016.08.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2016] [Revised: 08/06/2016] [Accepted: 08/15/2016] [Indexed: 11/26/2022] Open
Abstract
Recently, heated humidified high-flow nasal cannula (HHHFNC) has been introduced and applied as a noninvasive respiratory support in neonates. Although HHHFNC is widely used in neonates presenting with respiratory distress, the efficiency and safety when compared with nasal continuous positive airway pressure or noninvasive positive pressure ventilation are still controversial. This review aims to evaluate the performance and applications of HHHFNC in neonates.
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Affiliation(s)
- Ke-Yun Chao
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; Department of Respiratory Therapy, Fu Jen Catholic University, Taipei, Taiwan; Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang Gung University Taoyuan, Taiwan
| | - Yi-Ling Chen
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Li-Yi Tsai
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; College of Public Health, Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsuan Chien
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Shu-Chi Mu
- Department of Pediatrics, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan; School of Medicine, Fu Jen Catholic University, Taipei, Taiwan.
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15
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Hwang YH, Chao KY, Chang CW, Hsiao FT, Chang HL, Han HZ. Lip lead as an alternative measure for lead exposure assessment of lead battery assembly workers. AIHAJ 2000; 61:825-31. [PMID: 11192215 DOI: 10.1080/15298660008984593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
This study investigated lead exposures of lead battery assembly workers in Taiwan. A special attempt was made to evaluate the use of lip lead as an alternative index for occupational lead exposure. Ninety-six of 113 workers from a lead battery plant were recruited as study subjects. Air lead; lead loadings on workers' sleeves, gloves, hands, cheeks, and lips; and blood lead were determined for exposure assessment. A questionnaire also was administered to collect information on work history, suspected exogenous lead sources, and personal behavior and activities. Geometric means of total air lead at different subareas ranged from 0.070 (2.5 geometric standard deviation [GSD]) to 0.159 (1.8 GSD) mg/m3. Geometric means of respirable air lead level for different subgroups of workers varied from 0.009 (2.0 GSD) to 0.032 (1.9 GSD) mg/m3, whereas those of the blood lead level ranged from 22.4 (1.3 GSD) to 44.5 (1.3 GSD) microg/dL. The heaviest lead loadings were found for plate-processing workers (e.g., 66.4 [1.5 GSD] on gloves, 0.80 [3.7 GSD] on cheeks, and 0.79 [3.2 GSD] microg/cm2) on bare-hands after washing. Blood lead level was significantly correlated with lead levels in air, lead loadings on lips, and bare hands after washing (r=0.24-0.30). Results of multiple regression analysis showed that only lip lead had a significant effect on the blood lead, whereas respirable air lead and personal behavior had only mild effects in this model. It was concluded that lip lead level may be used as an alternative index of lead exposure to facilitate the estimation of lead uptake through ingestion.
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Affiliation(s)
- Y H Hwang
- Institute of Occupational Medicine and Industrial Hygiene, College of Public Health, National Taiwan University, Taipei, ROC.
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16
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Abstract
The authors examined the reversibility of cognitive impairment caused by a mild increase in lead absorption among children. The results of our initial study revealed that air and soil outside a lead-recycling plant in Taiwan were seriously contaminated by lead, which was associated with lowered intelligence quotients of 32 children who attended a nearby kindergarten (i.e., kindergarten A). Thirty-five children-who were comparable with respect to age, sex, birth order, sibling number, and parental education level-from another kindergarten (i.e., kindergarten B) located 5 km from the plant were enrolled as the reference group. Following the initial study, kindergarten A school children moved 2 km from the lead-recycling plant. Twenty-eight children in each group were followed successfully 2.5 y later. Blood lead, intelligence quotient, and intelligence quotient-related factors were reassessed. The results showed that the average blood lead level of the exposed pupils dropped 6.9 microg/dl (standard deviation [SD] = 3.9 microg/dl) (p < .001), and the average intelligence quotient increased 11.7 points (SD = 13.2) (p < .01), compared with the results of the initial study. The average blood lead level of the reference group decreased by 1.7 microg/dl (SD = .1.3) (p < .001), whereas the average intelligence quotient increased by 4.2 points (SD = 13.8) (p = .115). There was a significant difference in intelligence quotients between the two groups during the initial study, but the difference subsequently disappeared during the follow up. The authors concluded that intelligence quotient impairment, caused by a mild subclinical elevation of blood lead (i.e., likely no more than 30 microg/dl) for a period of 1-3 y in 3- to 5-y-olds, is at least partially reversible.
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Affiliation(s)
- W T Soong
- Department of Psychiatry, College of Medicine and Institute of Epidemiology, College of Public Health, National Taiwan University, Republic of China
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17
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Abstract
BACKGROUND The blood lead concentrations of workers in lead battery factories are more than 4 times higher than those of the general population in Taiwan. Therefore, efforts are needed to reduce lead exposure in this high-risk population. A health promotion program on personal habits that reduce lead exposure has been carried out in a lead battery factory since 1991. This study investigated the longitudinal relationship of workers' blood lead concentrations and personal hygiene habits from 1991 through 1997. METHODS In each of the 7 years of the study, occupational physicians questioned workers regarding nine personal hygiene items, personal information, and medical history before their annual health examination. The relationship between blood lead concentrations and personal hygiene habits was analyzed by longitudinal multiple regression in a mixed effect model with adjustment for potential confounders. In addition, the risk ratio of a blood lead concentration exceeding 40 micrograms/dL in men and 30 micrograms/dL in women (the action levels set by the Department of Health, Taiwan) was estimated by generalized estimating equations. RESULTS Blood lead levels decreased significantly in the first 5 years of the study. The personal habits most closely related to blood lead concentrations were smoking at work sites (estimated coefficient = 3.13, P < 0.001), and eating at work sites (estimated coefficient = 1.38, P = 0.069). The risk ratio for workers with both these habits exceeding the action level of blood lead was 2.93 (95% CI 1.27-6.77). Difference in job titles, however, accounted for a major portion of the variance in blood lead. For example, working in "pasting" and "plate-cutting" was associated with blood lead elevations > 20 micrograms/dL in comparison to the "low- or no-exposure jobs." CONCLUSIONS Health promotion programs can decrease exposure of lead workers; reducing the practices of smoking and eating at work sites should be the core of such programs. However, a major reduction in lead exposure for some jobs (e.g., "pasting" and "plate cutting") in lead battery factories in Taiwan is unlikely to occur without major engineering changes.
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Affiliation(s)
- H Y Chuang
- Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA
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18
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Wang JD, Soong WT, Chao KY, Hwang YH, Jang CS. Occupational and environmental lead poisoning: case study of a battery recycling smelter in Taiwan. J Toxicol Sci 1998; 23 Suppl 2:241-5. [PMID: 9760474 DOI: 10.2131/jts.23.supplementii_241] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
The rapid industrialization in Taiwan has caused both prosperity and environmental pollution. The purpose of this study is to demonstrate a case of both occupational and environmental lead poisoning. A patient of lead poisoning initiated a survey of the battery recycling factory, which revealed that 31 of 64 workers suffered from lead poisoning. Children who attended a nearby kindergarten showed a significant increase of blood lead up to 15-25 micrograms/dl and a mild but significant decrease of IQ (intelligent quotient, by Binet-Simon scale) if compared with children of a nonexposed but socioeconomically comparable kindergarten. Outdoor workers of the nearby forging factory also showed a significant increase of blood lead if compared with indoor workers or workers of another nonexposed forging factory 20 Km away. Air sampling showed an average of more than 10 micrograms/m3 in the kindergarten. Soil sampling and analysis also revealed 400 folds increase of lead content, which decreased if the sample was taken deep down to 15-30 cm or 350 meters away from the battery recycling smelter. Moreover, after children were moved away from the pollution source, follow-up examination performed 2.5 years later showed a significant decrease of blood lead and partial recovery of IQ among them.
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Affiliation(s)
- J D Wang
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University, College of Public Health, Taipei
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19
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Jee SH, Chao KY, Sun CC, Wang JD. Outbreak of contact dermatitis related to Acticide EP paste in a paint manufacturing factory. J Formos Med Assoc 1996; 95:628-31. [PMID: 8870434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
An outbreak of severe itching, erythematous and edematous dermatitis over the extremities and upper back developed in 8 of 17 workers in the raw-materials department of a paint manufacturing factory. The outbreak occurred during a 2-month period when Acticide EP paste (Thor Chemical, Cheshire, UK) was used in place of Metatin as a microbiocide (Acima Chemical, Buchs, Switzerland). To evaluate the frequency and the etiologic agent of this outbreak, a plant walk-through, examination and review of photographs of skin lesions followed by statistical analysis for association between the development of dermatitis and exposure to Acticide paste were performed. Three guinea pigs were subjected to patch tests comparing the dermatotoxicity of Acticide EP and Metatin. The results showed that 8 out of 17 workers (47%) suffered from contact dermatitis during the 2-month period. Stratification by occupational exposure further confirmed the association between the development of dermatitis and exposure to the Acticide paste. The dermatotoxicity test on guinea pigs revealed the marked corrosive effect of the paste and the absence of dermatotoxicity of Metatin. After the removal of the paste from the raw material, there were no new cases of contact dermatitis at the 6 month follow-up. We conclude that Acticide EP paste was the responsible offending agent. Because isothiazolinone derivatives are well-known antigens and 2-n-octyl-4-isothiazolin-3-one is the active ingredient in Acticide EP paste, 2-n-octyl-4-isothiazolin-3-one is the likely cause of the dermatitis.
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Affiliation(s)
- S H Jee
- Department of Dermatology, National Taiwan University College of Medicine, Taipei, ROC
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Abstract
The objective of this study was to determine whether workers at a factory in Taiwan, adjacent to lead recycling plant, were affected by lead contamination. Workers at the lead recycling plant itself were found to suffer from lead poisoning; air and soil outside the plant were heavily contaminated by lead. Forty-one of the 45 workers in a forging factory next to the lead recycling plant were enrolled as the exposed group. A comparison group of 51 workers were selected from another forging factory about 20 km away. Each subject was interviewed about his lifestyle, work history, and residence, and blood was drawn for lead measurement by graphite furnace atomic absorption spectrometry. The results showed that two groups were compatible in age, sex, and smoking patterns. Blood lead of the exposed group was significantly higher than that of the comparison group (mean +/- SD: 20.4 +/- 9.4 micrograms/dl vs. 5.9 +/- 2.9 micrograms/dl). The difference was independent of sex and working zones. Blood lead levels were lower among exposed workers who had been employed less than 2 months compared with those employed longer. There was no difference among exposed workers in different outdoor working zones. Five months after improvement of pollution control and decrease in the production volume of the lead factory, 30 exposed workers were retested for blood lead. The blood lead of outdoor workers had an average decrease of 4.2 micrograms/dl while that of indoor workers showed no significant difference.(ABSTRACT TRUNCATED AT 250 WORDS)
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Affiliation(s)
- K Y Chao
- Center for Research of Environmental and Occupational Diseases, National Taiwan University College of Public Health, Taipei, Republic of China
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