Relationship of End tidal PCO2 a n d Arterial PCO2 in Acute Critically Ill Patients

BACKGROUND: The CO2 concentration in exhaled gases is intrinsically linked to tissue metabolism, ventilation, and pulmonary circulation. In hemodynamically stable patients, the end-tidal CO2(PetCO2) is known to be a good index of arterial CO2 (PaCO2). However, the PetCO2 has some limitations in predicting PaCO2 in emergent patients with unstable vital signs. OBJECTIVE: We evaluated the relationship of PetCO2 and PaCO2 and the validity of the difference between PetCO2 and PaCO2(PaCO2-PetCO2) for various clinical situations. MATERIAL AND METHOD: A prospective analysis was performed in endotracheally intubated patients, who presented at the Korea University Emergency Medical Center during a 14-month period from January 2003 to February 2004. Patients were divided into three groups; respiratory insufficiency of cardiopulmonary cause (Group A), respiratory insufficiency of extracardiopulmonary cause (Group B), cardiac arrest with any cause (Group C). Group A was subdivided into two subgroups; A1 with a history of chronic lung disease disease and A2 with no history of chronic lung disease history. In each group, the mean of PaCO2-PetCO2 was calculated and multiple comparison was performed in each groups by using a one-way ANOVA test, and the 95% confidence interval of PaCO2 - PetCO2 was calculated. P a C O2 and PetCO2 were evaluated by using a linear regression analysis. The calculation was performed using the SPSS for windows version 10.0, and p values of less than 0.05 were considered significant. RESULT: A total of 59 patients were included in this study. Twenty-five patients were in Group A, (18 in A1 and 7 in A2), 26 in Group B, and 8 in Group C. The linear regression data showed the relation between PaCO2 and PetCO2 to be statistically significant in the Groups A2, B, and C. The values of the difference of PaCO2-PetCO2 were 22.1+/-3.26 mmHg in Group A, 33.7+/-7.21 mmHg in Group A1, 17.6+/-3.06 mmHg in Group A2, 5.3+/-1.45 mmHg in Group B, and 21.2+/-4.73 mmHg in Group C. The 95% confidence intervals of PaCO2-PetCO2 were 15.37- 28.81 mmHg in Group A, in group A1, 16.07-51.35 mmHg in group A1, 11.11-24.03 mmHg in Group A2, 2.33-8.31 mmHg in Group B, and 10.03-32.42 mmHg in Group C. CONCLUSION: In patients with chronic pulmonary disease, who are endotracheally intubated for assisted ventilation, the PetCO2 do not reflect the PaCO2 and also the value of PaCO2-PetCO2 is not a good parameter for determining pathological status. However, in patients with acute cardiopulmonary disease and during cardiopulmonary resusciatation, the PetCO2 does not reflect the quantitative value of PaCO2, but may be used in predicting the tendency of PaCO2 to increase. In endotracheally intubated patients with extracardiopulmonary cause, PetCO 2 reflects the quantitative index of PaCO2 and the value of PaCO2-PetCO2 may be a good index for monitoring pathological conditions.

Limited Motion of Arms in Uncommunicable Children

PURPOSE: The study was designed to identify the necessity of radiographs and to decrease overutilization of radiographs in uncommunicable children who do not move their arms. This study provides clinical guidelines on radiographic evaluation and treatment of children with limited motion in the upper extremity. METHODS: The cases of one hundred thirteen pediatric patients under 36 months of age, who had visited the Emergency Center of Korea University Ansan Hospital from January 2000 to December 2001, were retrospectively reviewed. Pediatric patients with upper extremity injuries due to multiple trauma, laceration or motor vehicle accident were excluded. Parameters analyzed were age, sex, mechanism of injury, physical findings, radiographic finding, and injuried upper extremity region. We described focal tenderness and regional edema as physical finding. Each patient without regional edema was classified into an improved or a not-improved group depending on the outcomes after manual reduction. All statistical tests were conducted with twotailed levels of 0.05. RESULTS: Of the 113 patients, the mean age was 18.6+/-0.89 months. The most common injury mechanisms were unknown and traction. Minimal edema in the elbow joint was seen in 5 cases, and supracondylar fractures due to short falls were seen in 4 (80%) of those cases (p<0.05). The improved group was finally confined to radial head subluxation in 88 patients. Although all the not-improved-group patients had received radiographs, no abnormal findings were seen in the elbow. However, clavicle fracture due to fall above or from a level surface were seen in 4 cases (20%) of the not-improved group (p<0.05). No difference of injury mechanism existed between the improved and the not-improved groups. CONCLUSION: Recommand Radiographic evaluations in Children not-used arm with regional edema before manual reduction. But without regional edema, manual reduction of elbow is first. If children without regional edema do not improve after manual reduction of elbow and they are injuried due to fall, children should be assessed for fractures of clavicle.

Lack of IL-10 Release from Human Polymorphonuclear Leukocytes

PURPOSE: Polymorphonuclear leukocytes (PMNs) are the first line of cellular response for host defense during acute inflammation. The ability of PMNs to produce and release numerous pro-inflammatory cytokines is now estabilished and plays an important role in triggering and maintaining the inflammatory response. We studied the autocrine downregulation of this process by invesgating the potential production by human PMNs of the major anti-inflammatory cytokine, interleukine 10 (IL-10). METHODS: Human PMNs were isolated from the peripheral blood of health volunteers by using the modified boyum method. Human PMNs were incubated at 37 degrees Cwith and without formyl Met-Leu-Phe (fMLP) for 30 minute, 2 hours, 4 hours, and 20 hours. The level of IL-10 was determined in each of the cell-free supernatants by using the enzyme linked immunosorbent assay (ELISA) method. RESULTS: Non-stimulated PMNs generated 1.40 +/- 1.791pg/mL to 3.46 +/- 1.607 pg/mL of IL-10 over the time course. Stimulation with fMLP resulted in an increase in the constitutive PMN-derived IL-10 by 2.74 +/- 0.762 pg/mL, 1.27 +/- 0.262 pg/mL, 1.19 +/- 0.364 pg/mL, and 2.44 +/- 1.317 pg/mL at 30 min, 2 hr, 4 hr, and 20 hr after stimulation, respectively, but these increases were not statiscally significant. CONCLUSION: Human PMNs seem unable to induce release of the most potent anti-inflammatory cytokine, IL-10, and down-regulate inflammatory response due to the autocrine mechanism. This could partly account for the persistence of local inflammation, when PMNs are the main infiltrating cells.