Effect of electrode temperature on measurements of transcutaneous carbon dioxide partial pressure and oxygen partial pressure in very low birth weight infants / 中国当代儿科杂志

OBJECTIVES@#To evaluate the accuracy and safety of measurements of transcutaneous carbon dioxide partial pressure (TcPCO@*METHODS@#A total of 45 very low birth weight infants were enrolled. TcPCO@*RESULTS@#There was no significant difference in TcPCO@*CONCLUSIONS@#Lower electrode temperatures (38-41℃) can accurately measure blood carbon dioxide partial pressure in very low birth weight infants, and thus can be used to replace the electrode temperature of 42°C. Transcutaneous measurements at the lower electrode temperatures may be helpful for understanding the changing trend of blood oxygen partial pressure.

Análisis de diversas variables polisomnográficas y su relación con la severidad del síndrome de apnea e hipoapnea obstructiva del sueño / The analysis of polysomnographic variables and their relation with severity of obstructive sleep apnea and hypopnea syndrome

genera obstrucción de la vía aérea superior, y el estándar de oro para su diagnóstico es la polisomnografía (PSG). Objetivo: esclarecer la relación que existe entre las variables polisomnográficas y la severidad de la enfermedad, para tener más elementos objetivos al determinar el manejo y el seguimiento médico. Diseño: estudio observacional analítico de corte transversal. Metodología: se analizaron las variables polisomnográficas de 575 pacientes mediante el software STATA® VE 15.0; con la prueba Kruskal Wallis se evaluó la relación entre estas y la severidad. Resultados: la prevalencia de SAHOS en la cohorte fue de 73,04 %; a mayor duración media de apnea MAD se encontraron peores datos de SaO2. La media de Ct90 en pacientes sanos fue 2,55 %. La MAD en pacientes con SAHOS moderado y severo fue de 21 segundos, mientras que el REM IAH, el Ct90 y la duración máxima de apneas tuvieron buena relación con el IAH. Conclusiones: los microdespertares, el Ct90, la SaO2 mínima, la MAD y la frecuencia cardíaca máxima están relacionados de manera importante con la severidad de la enfermedad. El WASO, la duración mínima de apneas, la vigilia antes del sueño y la frecuencia cardíaca mínima no están relacionados. Las apneas de larga duración por encima de 18,5 segundos se asociaron significativamente a peores cifras de oxigenación. Los números de microdespertares tienen una relación fuerte con la severidad de la enfermedad y la más fuerte con los datos de peor oxigenación.

Introduction: The obstructive sleep apnea/Hypopnea syndrome (OSAHS) generates obstruction of the upper air way and the gold standard for its diagnosis is the polysomnography. Objective: To clarify the relation between the polysomnographic variables and the severity of the condition in order to have more objective elements to help choose the best management and medical follow up. Design: Cross-Sectional, analytical and observational study. Methodology: The polysomnographic variables of 575 patients were analyzed using STATA® VE 15.0 software. The relation between the variables and their severity were evaluated using the Kruskall Wallis Test. Results: The prevalence of the (OSAHS) in the cohort was 73.04 %, to longer MADs lowest SaO2 data, the media of Ct90 in healthy patients was 2.55 %. The media MAD for patients with moderate and severe OSA was 21 seconds. The REM IAH, Ct90 and maximum duration of apnea had a strong relation with the IAH. Conclusions: The arousals, the Ct90, the lowest SaO2, the MAD and the maximum cardiac frequency are crucially related to the severity of the condition. The WASO, the minimum duration of the apneas, the vigil before sleep and the minimum cardiac frequency are not related. The apneas with the longest duration, above 18.5 seconds, are significantly associated with the worst numbers of oxygenation. The number of arousals is strongly linked to the severity of the disease being the most severe related to the data associated with the worst oxygenation.

Polydeoxyribonucleotide Improves Peripheral Tissue Oxygenation and Accelerates Angiogenesis in Diabetic Foot Ulcers

BACKGROUND: Polydeoxyribonucleotide (PDRN) is known to have anti-inflammatory and angiogenic effects and to accelerate wound healing. The aim of this study was to investigate whether PDRN could improve peripheral tissue oxygenation and angiogenesis in diabetic foot ulcers. METHODS: This was a prospective randomized controlled clinical trial. Twenty patients with a non-healing diabetic foot ulcer were randomly distributed into a control group (n=10) and a PDRN group (n=10). Initial surgical debridement and secondary surgical procedures such as a split-thickness skin graft, primary closure, or local flap were performed. Between the initial surgical debridement and secondary surgical procedures, 0.9% normal saline (3 mL) or PDRN was injected for 2 weeks by the intramuscular (1 ampule, 3 mL, 5.625 mg, 5 days per week) and perilesional routes (1 ampule, 3 mL, 5.625 mg, 2 days per week). Transcutaneous oxygen tension (TcPO2) was evaluated using the Periflux System 5000 with TcPO2/CO2 unit 5040 before the injections and on days 1, 3, 7, 14, and 28 after the start of the injections. A pathologic review (hematoxylin and eosin stain) of the debrided specimens was conducted by a pathologist, and vessel density (average number of vessels per visual field) was calculated. RESULTS: Compared with the control group, the PDRN-treated group showed improvements in peripheral tissue oxygenation on day 7 (P < 0.01), day 14 (P < 0.001), and day 28 (P < 0.001). The pathologic review of the specimens from the PDRN group showed increased angiogenesis and improved inflammation compared with the control group. No statistically significant difference was found between the control group and the PDRN group in terms of vessel density (P=0.094). Complete healing was achieved in every patient. CONCLUSIONS: In this study, PDRN improved peripheral tissue oxygenation. Moreover, PDRN is thought to be effective in improving inflammation and angiogenesis in diabetic foot ulcers.

Polydeoxyribonucleotide Improves Peripheral Tissue Oxygenation and Accelerates Angiogenesis in Diabetic Foot Ulcers

BACKGROUND: Polydeoxyribonucleotide (PDRN) is known to have anti-inflammatory and angiogenic effects and to accelerate wound healing. The aim of this study was to investigate whether PDRN could improve peripheral tissue oxygenation and angiogenesis in diabetic foot ulcers. METHODS: This was a prospective randomized controlled clinical trial. Twenty patients with a non-healing diabetic foot ulcer were randomly distributed into a control group (n=10) and a PDRN group (n=10). Initial surgical debridement and secondary surgical procedures such as a split-thickness skin graft, primary closure, or local flap were performed. Between the initial surgical debridement and secondary surgical procedures, 0.9% normal saline (3 mL) or PDRN was injected for 2 weeks by the intramuscular (1 ampule, 3 mL, 5.625 mg, 5 days per week) and perilesional routes (1 ampule, 3 mL, 5.625 mg, 2 days per week). Transcutaneous oxygen tension (TcPO2) was evaluated using the Periflux System 5000 with TcPO2/CO2 unit 5040 before the injections and on days 1, 3, 7, 14, and 28 after the start of the injections. A pathologic review (hematoxylin and eosin stain) of the debrided specimens was conducted by a pathologist, and vessel density (average number of vessels per visual field) was calculated. RESULTS: Compared with the control group, the PDRN-treated group showed improvements in peripheral tissue oxygenation on day 7 (P < 0.01), day 14 (P < 0.001), and day 28 (P < 0.001). The pathologic review of the specimens from the PDRN group showed increased angiogenesis and improved inflammation compared with the control group. No statistically significant difference was found between the control group and the PDRN group in terms of vessel density (P=0.094). Complete healing was achieved in every patient. CONCLUSIONS: In this study, PDRN improved peripheral tissue oxygenation. Moreover, PDRN is thought to be effective in improving inflammation and angiogenesis in diabetic foot ulcers.

Interference of heart and transcutaneous oxygen monitoring in the measurement of bioelectrical impedance analysis in preterm newborns / Interferência da monitoração cardíaca e transcutânea de oxigênio na aferição da bioimpedância elétrica em recém-nascidos pré-termo

Abstract Objective: To verify if the connection of electrodes for heart and transcutaneous oxygen monitoring interfere with the measurement of electrical bioimpedance in preterm newborns. Methods: This was a prospective, blinded, controlled, cross-sectional, crossover study that assessed and compared paired measures of resistance (R) and reactance (Xc) by BIA, obtained with and without monitoring wires attached to the preterm newborn. The measurements were performed in immediate sequence, after randomization to the presence or absence of electrodes. The sample size calculated was 114 measurements or tests with monitoring wires and 114 without monitoring wires, considering for a difference between the averages of 0.1 ohms, with an alpha error of 10% and beta error of 20%, with significance <0.05. Results: No differences were observed between the R (677.37 ± 196.07 vs. 677.46 ± 194.86) and Xc (31.15 ± 9.36 vs. 31.01 ± 9.56) values obtained with and without monitoring wires, respectively, with good correlation between them (R: 0.997 and Xc: 0.968). Conclusion: The presence of heart and/or transcutaneous oxygen monitoring wires connected to the preterm newborn did not affect the values of R or Xc measured by BIA, allowing them to be carried out in this population without risks.

Resumo Objetivo Verificar se a conexão de eletrodos e os fios de monitoração cardíaca e transcutânea de oxigênio interferem na aferição da bioimpedância elétrica em recém-nascidos pré-termo (RNPT). Metodologia Estudo prospectivo, cego, randomizado, transversal, crossover, em que foram mensuradas e comparadas medidas pareadas de resistência (R) e reatância (Xc) por meio da BIA, obtidas com e sem os fios de monitoração acoplados aos RNPT. As medidas foram feitas em sequência imediata, após aleatorização para a presença ou ausência dos eletrodos. O tamanho amostral calculado foi de 114 aferições ou exames com fios de monitoração e 114 sem fios de monitoração, foi calculado para uma diferença entre as médias de 0,1 ohms, com erro alfa de 10% e erro beta de 20%, com significância < 0,05. Resultados Não foram observadas diferenças entre os valores de resistência (677,37 ± 196,07 vs. 677,46 ± 194,86) e reatância (31,15 ± 9,36 vs. 31,01 ± 9,56) obtidos com e sem fios de monitoração respectivamente, com boa correlação entre ambos (resistência: 0,997 e reatância: 0,968). Conclusão A presença de fios de monitoração cardíaca e/ou transcutânea de oxigênio não interferiu nos valores da resistência ou da reatância aferidos pela BIA em RNPT. Recomenda-se, então, a feitura desse exame, sem riscos, para essa população.

Pulsioximetría en la prueba marcha de seis minutos como predictor de alteración funcional respiratoria en trabajadores de minería artesanal del carbón / Pulse oximetry in six minutes walking test as a predictor of functional respiratory alteration in workers at artisanal coal mining

Objetivo: Evaluar prospectivamente y mediante comparación, durante la prueba de marcha de 6 minutos, el comportamiento de la saturación arterial de oxígeno (SPO2) y otras variables vitales, en dos grupos, uno de mineros del carbón (expuestos) y otro de trabajadores universitarios (controles). Materiales y métodos:Estudio prospectivo de cohortes. Se realizó la prueba (PM6M) en 72 trabajadores mineros y 46 trabajadores universitarios. Se midió minuto a minuto SPO2, frecuencia cardiaca y distancia recorrida. Resultados: Se encontró una significativa desaturación de oxígeno, ante un ejercicio moderado, en los trabajadores mineros, equivalente a una manifestación precoz de alteración funcional del intercambio alveolo-capilar. Conclusiones: La exposición respiratoria sostenida a polvo de carbón y sílice podría ocasionar alteración funcional del intercambio gaseoso alveolo capilar. La pulsioximetría en la prueba de marcha de 6 minutos se perfila como una herramienta útil y costo-efectiva en salud ocupacional para el seguimiento y control de la salud de los mineros del carbón.

Objective: To evaluate prospectively and through comparison the behavior of the arterial oxygen saturation (SPO2) and other vital variables in two groups, one of coal miners (exposed) and another formed by university workers (controls) during the test run of 6 minutes. Materials and methods: Prospective cohort study. The test (6MWT) was performed in 72 miners and 46 university workers. SpO2, heart rate and walked distance were estimated every minute. Results: A significant oxygen desaturation was found in the mineworkers when practicing a moderate exercise, which is equivalent to an early manifestation of functional impairment of the alveolar-capillary exchange. Conclusions: The sustained respiratory exposure to coal dust and silica may cause functional impairment of alveolar capillary gas exchange. The pulse oximetry in the 6 minutes walking test is emerging as a useful and cost-effective occupational health tool to monitor and health surveillance of coal miners.

Analysis of mean transcutaneous capnography in consecutive patients undergoing polysomnography / Análise da capnografia transcutânea média em indivíduos consecutivamente submetidos à polissonografia

Transcutaneous capnography is a noninvasive method useful for analysis of the behavioral tendency of transcutaneous CO2 pressure (PtcCO2) in patients undergoing polysomnography, to evaluate respiratory sleep disorders. Objective Determine normative PtcCO2 values in normal patients undergoing polysomnography. Method One hundred seventy-nine patients who underwent polysomnography with simultaneous PtcCO2 measurement were assessed by means of a transcutaneous capnograph (TCM4 series from Radiomiter). Results The group classified as normal (N=53) presented a apnea/hypopnea index (AHI) <5 events/per hour of sleep and their age groups varied between 7 and 76 years of age. Conclusion Global mean values of PtcCO2 in the normal group had a Gaussian distribution that varied between 33.1 and 50.0 mmHg (SD 4,363). Such findings allowed the establishment of normative PtcCO2 values for normal individuals. .

A capnografia transcutânea é um método não invasivo útil para análise da tendência comportamental da pressão de CO2 transcutânea (PtcCO2)1,2,3 em pacientes submetidos à polissonografia para análise de transtornos respiratórios do sono. Objetivo Determinar valores normativos da PtcCO2 em pacientes normais submetidos à polissonografia. Método Foram analisados 179 pacientes submetidos à polissonografia com medida concomitante da PtcCO2 através de um capnógrafo transcutâneo. Resultados O grupo classificado como normal (N=53) apresentou índice de apnéia/hipopnéia (AIH) <5 eventos/hora de sono e faixa etária variando de 7 a 76 anos. Conclusão Os valores da média global da PtcCO2 no grupo normal apresentaram distribuição gaussiana variando de 33,1 a 50,0 mmHg (DP 4.363). Tais achados permitiram a criação de valores normativos da PtcCO2 para indivíduos normais. .

Transient Complete Atrioventricular Block in a Preterm Neonate with Congenital Myotonic Dystrophy: Case Report

Congenital myotonic dystrophy (CMD) is an inherited neuromuscular disorder with cardiac rhythm abnormalities that may occur as a child grows. No report has described complete atrioventricular (AV) block detected in a neonate with CMD. We report a floppy infant of 31(+4) weeks gestation with complete AV block at birth, who was diagnosed with CMD by Southern analysis. She recovered from complete AV block 32 hr after temporary transcutaneous pacing was applied. To the best our knowledge, this is the first recorded case of a complete AV block accompanied by CMD during the neonatal period. When a newborn has a complete AV block, the physician should consider the possibility of the CMD and conduct a careful physical examination.

Influence of Negative-Pressure Wound Therapy on Tissue Oxygenation of the Foot

BACKGROUND: Negative-pressure wound therapy (NPWT) is believed to accelerate wound healing by altering wound microvascular blood flow. Although many studies using laser Doppler have found that NPWT increases perfusion, recent work using other modalities has demonstrated that perfusion is reduced. The purpose of this study was to investigate the influence of NPWT on tissue oxygenation of the foot, which is the most sensitive region of the body to ischemia. METHODS: Transcutaneous partial pressure of oxygen (TcpO2) was used to determine perfusion beneath NPWT dressings of 10 healthy feet. The sensor was placed on the tarso-metatarsal area of the foot and the NPWT dressing was placed above the sensor. TcpO2 was measured until it reached a steady plateau state. The readings obtained at the suction-on period were compared with the initial baseline (pre-suction) readings. RESULTS: TcpO2 decreased significantly immediately after applying NPWT, but gradually increased over time until reaching a steady plateau state. The decrease in TcpO2 from baseline to the steady state was 2.9 to 13.9 mm Hg (mean, 9.3+/-3.6 mm Hg; 13.5+/-5.8%; P<0.01). All feet reached a plateau within 20 to 65 minutes after suction was applied. CONCLUSIONS: NPWT significantly decrease tissue oxygenation of the foot by 2.9 to 13.9 mm Hg. NPWT should be used with caution on feet that do not have adequate tissue oxygenation for wound healing.

The Significance of Transcutaneous Continuous Overnight CO2 Monitoring in Determining Initial Mechanical Ventilator Application for Patients with Neuromuscular Disease

OBJECTIVE: To reveal the significance of continuous transcutaneous carbon dioxide (CO2) level monitoring through reviewing cases which showed a discrepancy in CO2 levels between arterial blood gas analysis (ABGA) and continuous transcutaneous blood gas monitoring. METHOD: Medical record review was conducted retrospectively of patients with neuromuscular diseases who had started home mechanical ventilation between June 2008 and May 2010. The 89 patients underwent ABGA at the 1st hospital day, and changes to their CO2 level were continuously monitored overnight with a transcutaneous blood gas analysis device. The number of patients who initially appeared to show normal PaCO2 through ABGA, yet displayed hypercapnea through overnight continuous monitoring, was counted. RESULTS: 36 patients (40.45%) presented inconsistent CO2 level results between ABGA and continuous overnight monitoring. The mean CO2 level of the 36 patients using ABGA was 37.23+/-5.11 mmHg. However, the maximum and mean CO2 levels from the continuous monitoring device were 52.25+/-6.87 mmHg and 46.16+/-6.08 mmHg, respectively. From the total monitoring period (357.28+/-150.12 minutes), CO2 retention over 45 mmHg was detected in 198.97 minutes (55.69%). CONCLUSION: Although ABGA only reflects ventilatory status at the puncturing moment, ABGA results are commonly used to monitor ventilatory status in most clinical settings. In order to decide the starting point of home mechanical ventilation in neuromuscular patients, continuous overnight monitoring should be considered to assess latent CO2 retention.

Application of capnography and SpO2 measurement in the evaluation of respiratory failure in patients with chronic obstructive pulmonary disease / 南方医科大学学报

<p><b>OBJECTIVE</b>To investigate the accuracy and potential error range of noninvasive estimation of CO2 pressure (PCO2), arterial O2 pressure (PaO2), and oxygenation index (OI) by measuring the end-tidal CO2 pressure (PETCO2) and pulse oxygen saturation (SpO2) in patients with chronic obstructive pulmonary disease (COPD) and respiratory failure, and assess the feasibility of this method for dynamic monitoring of arterial CO2 pressure (PaCO2) and PaO2 in the primary care facilities where arterial blood gases analysis is not available.</p><p><b>METHODS</b>All the 30 patients with COPD and respiratory failure received routine clinical treatment including bronchodilators, mucolytics, glucocorticosteroid, antibiotics and oxygen therapy (titrated to keep SpO2 above 90%) for 5-7 days. A subgroup of the patients also received NIPPV treatment. All the patients were tested with both the eupnea method and prolonged expiratory method before and after the treatment to obtain the data of PCO2 and SpO2 were respectively performed before and after treatment.</p><p><b>RESULTS</b>The PETCO2 with eupnea (PETCO2(Q)) was 50.72-/+8.93 mmHg, significantly lower than PaCO2 (71.25-/+9.08 mmHg, Plt;0.01), but the PETCO2(P) (70.35-/+8.91 mmHg) was comparable with PaCO2 (P>0.05). Similar results were obtained after the treatment. The PETCO2(P) before treatment and after treatment was positively correlated to PaCO2 (r=0.96 and 0.97, respectively, P<0.01). The PaO2(Y) before the treatment derived from the oxygen dissociation curve based on SpO2 measurement was close to SpO2 (59.96-/+1.42 mmHg vs 59.07-/+2.22 mmHg, P>0.05). The OI derived from PaO2 and OI(Y) from PaO2 (Y) was also similar (215.70-/+22.77 vs 219.15-/+24.63, P>0.05). Linear regression analysis showed positive correlations between PaO2(Y) to PaO2 (r=0.81, P<0.01) and between OI(Y) and OI (r=0.95, P<0.01).</p><p><b>CONCLUSIONS</b>In patients with COPD (especially those with also type II respiratory failure), the modified monitoring method of PCO2 and maintenance of SpO2 above 90% can precisely estimate PaCO2 and PaO2. This method is feasible for clinical noninvasive and dynamic evaluation of respiratory failure in COPD patients, especially in primary care facilities where arterial blood gases analysis is not available.</p>

An oximetry-based method for monitoring reactions of autistic subjects under music auditions / Metodologia baseada em oximetria para monitoramento das reações de sujeitos autistas em audções musicais

This work aims to create a methodology to analyse the physiological effects of people exposed to sounds, specifically music and its elements, using techniques of data acquisition and signal processing to provide objective information on the subjects’reactions, in order to help the use of music in music therapy for autistics. We used a pulse oximeter with data transmission capability, data acquisition and signal processing software. The subjects and/or groups were exposed to several types of music, varying its elements, and the physiologic measurement signals were made. The acquired information data base was then converted into graphics representative of heart rate and arterial hemoglobin saturation. During the measurements, the subjects’ behaviour has been observed to relate subjective and objective results. Two groups of subjects (six non autistics and six autistics with diagnosis established) participated on this research, with ages ranging from 7 to 24 years old. As the majority of autistics are male, only boys have been invited to participate of this study. An observation protocol based on autistics behaviour was developed, the vital signals and the subjects reactions were observed and recorded. The results allow to identify and establish in an objective way any influence of music in human behaviour through sound stimulation and vital signals monitoring: SpO2 and HR.

O objetivo deste trabalho foi criar uma metodologia que possibilite analisar os efeitos fisiológicos produzidos pela exposição de pessoas à música e seus elementos, utilizando princípios de detecção, aquisição de dados e processamento de sinais, obtendo-se informações objetivas sobre as reações dos sujeitos, para dar subsídios ao emprego da música na musicoterapia com autistas. Foram utilizados um oxímetro de pulso com capacidade de transmissão de dados e aplicativos para aquisição de dados e processamento dos sinais. Foram realizados experimentos com a exposição dos sujeitos a vários tipos de músicas, com a variação de seus elementos, criando-se, assim, um banco de dados com as medições realizadas, a seguir transformando essa informação em gráficos representativos da evolução dos sinais de FC e de SpO2. Durante as medições, o comportamento dos sujeitos foi observado para que o resultado da análise subjetiva fosse relacionado com as medições objetivas. Os sujeitos desta pesquisa encontram-se na faixa etária entre 7 e 24 anos, sendo que a amostra estabelecida foi composta por seis indivíduos não autistas e seis indivíduos com diagnóstico de autismo estabelecido. Como o maior percentual de autistas é do sexo masculino, apenas de sujeitos do sexo masculino participaram. Foi desenvolvido um protocolo de observação baseado no comportamento de autistas, e os sinais vitais foram adquiridos e processados. Como resultado, foi identificada de forma objetiva a influência da música no comportamento humano pelo monitoramento dos estímulos sonoros e dos sinais vitais de SpO2 e FC.

Changes in near infrared spectroscopy during deep hypothermic circulatory arrest.

Monitoring cerebral oxygenation with near infrared spectroscopy may identify periods of cerebral desaturation and thereby the patients at risk for perioperative neurocognitive issues. Data regarding the performance of near infrared spectroscopy monitoring during deep hypothermic circulatory arrest are limited. The current study presents data regarding use of a commercially available near infrared spectroscopy monitor during deep hypothermic circulatory arrest in paediatric patients undergoing surgery for congenital heart disease. The cohort included 8 patients, 2 weeks to 6 months of age, who required deep hypothermic circulatory arrest for repair of congenital heart disease. The baseline cerebral oxygenation was 63 +/- 11% and increased to 88 +/- 7% after 15 min of cooling to a nasopharyngeal temperature of 17-18 degrees C on cardiopulmonary bypass. In 5 of 8 patients, the cerebral oxygenation value had achieved its peak value (either >or=90% or no change during the last 2-3 min of cooling on cardiopulmonary bypass). In the remaining 3 patients, additional time on cardiopulmonary bypass was required to achieve a maximum cerebral oxygenation value. The duration of deep hypothermic circulatory arrest varied from 36 to 61 min (43.4 +/- 8 min). After the onset of deep hypothermic circulatory arrest, there was an incremental decrease in cerebral oxygenation to a low value of 53 +/- 11%. The greatest decrease occurred during the initial 5 min of deep hypothermic circulatory arrest (9 +/- 3%). Over the entire period of deep hypothermic circulatory arrest, there was an average decrease in the cerebral oxygenation value of 0.9% per min (range of 0.5 to 1.6% decline per minute). During cardiopulmonary bypass, cooling and deep hypothermic circulatory arrest, near infrared spectroscopy monitoring followed the clinically expected parameters. Such monitoring may be useful to identify patients who have not achieved the highest possible cerebral oxygenation value despite 15 min of cooling on cardiopulmonary bypass. Future studies are needed to define the cerebral oxygenation value at which neurological damage occurs and if interventions to correct the decreased cerebral oxygenation will improve perioperative outcomes.

Non-invasive Monitoring of Oxygen and Carbon Dioxide Tension: Accuracy of Transcutaneous O2 and CO2 and Endtidal CO2

PURPOSE: To determine the concordance of transcutaneous CO2 (PtcCO2) versus arterial CO2 (PaCO2), end-tidal CO2 (PetCO2) versus PaCO2, and transcutaneous O2 (PtcO2) versus arterial O2 (PaCO2) among healthy adult volunteers, and to determine the normal values of the PtcCO2/PtcO2 and PtcO2/PaO2 that will be used as early signs of shock or as prognostic factors for critically ill patients. METHODS: We measured the PtcO2, PtcCO2, PetCO2, PaO2, and PaCO2 from 11 healthy volunteers while breathing room air or O2 at a flow rate of 6 L/min via nasal cannula. The PtcO2 and PtcCO2 were measured using a Radiometer's transcutaneous sensor that interfaced with the Solar 8000 patient monitor system. The PetCO2 was measured using a side stream capnometer that sampled air from a nasal catheter. The PaO2 and PaCO2 were measured from arterial blood samples. The concordances of the PtcCO2 versus the PaCO2, the PtcO2 versus the PaO2, and the PetCO2 versus the PaCO2 were analyzed using a Bland-Altman plot. We defined the normal values of the P(a-tc)CO2, PtcO2/PaO2, and PtcCO2/PtcO2. RESULTS: Twenty-two pairs of the PtcCO2 versus PaCO2, PtcO2 versus PaO2, and PetCO2 versus PaCO2 were obtained. The mean (+/-SD) values of the P(a-tc)CO2, P(atc) O2, and P(a-et)CO2 were 0(+/-2.2) mmHg, 35.4(+/-24.1) mmHg, and 1.4(+/-1.3) mmHg, respectively (p=0.947, p<0.001, and p<0.001 by paired t-test, respectively). The P(a-tc)CO2 and P(a-et)CO2 showed a high concordance of 95.5% within a range of +/-4 mmHg. The median (25~75%) values of the PtcCO2/PtcO2 and PtcO2/PaO2 at room air were 54.8%(46.8%~62.7%), respectively. CONCLUSION: The PtcCO2 and PetCO2 had a reliable concordance with the PaCO2. However, the PtcO2 was discordant with the PaO2 and this discordance was increased when inspiring O2. Therefore, the absolute values of the PtcO2 cannot be used as a surrogate measurement of the PaO2. However, because the O2 supply did not increase the PtcCO2, but rather the PtcO2, we can use the trend in the change in the PtcCO2/PtcO2 or PtcO2/PaO2 in shock patients.

Safety and efficacy of carbon dioxide insufflation during colonoscopy / 中南大学学报(医学版)

OBJECTIVE@#To assess the safety and efficacy of carbon dioxide (CO(2)) in colonoscopy examination.@*METHODS@#We randomized 349 patients to undergo colonoscopy with insufflation of air (n=175) or CO(2) (n=174). At colonoscopy, p (ET CO(2)) was observed at 4 time points: before the exam, arrived caecum, back rectum, and after the exam. Patient's experience of pain in the end and after the examination at 1, 3, 6, and 24 h was registered using a visual analog scale (VAS). Sedation was not used routinely.@*RESULTS@#The groups were similar in age, sex, inspection time, and caecal intubation rate (all P>0.05). There were no significant differences in p (ET CO(2)) values between the 2 groups before and after the procedure (all P>0.05). VAS scores in the CO(2) group at various time points after the examination were significantly lower than those in the air group (all P<0.05). The percent of VAS scores of 0 in the CO(2) group after 1, 3, 6, and 24 h was significantly higher than that in the air group (all P<0.01).@*CONCLUSION@#Injection of CO(2) for colonoscopy will not cause CO(2) retention, and it may significantly reduce the pain, which is safe and effective.

Early goal-directed therapy in moderate to high-risk cardiac surgery patients.

Early goal-directed therapy is a term used to describe the guidance of intravenous fluid and vasopressor/inotropic therapy by using cardiac output or similar parameters in the immediate post-cardiopulmonary bypass in cardiac surgery patients. Early recognition and therapy during this period may result in better outcome. In keeping with this aim in the cardiac surgery patients, we conducted the present study. The study included 30 patients of both sexes, with EuroSCORE >or=3 undergoing coronary artery bypass surgery under cardiopulmonary bypass. The patients were randomly divided into two groups, namely, control and early goal-directed therapy (EGDT) groups. All the subjects received standardized care; arterial pressure was monitored through radial artery, central venous pressure through a triple lumen in the right internal jugular vein, electrocardiogram, oxygen saturation, temperature, urine output per hour and frequent arterial blood gas analysis. In addition, cardiac index monitoring using FloTrac and continuous central venous oxygen saturation using PreSep was used in patients in the EGTD group. Our aim was to maintain the cardiac index at 2.5-4.2 l/min/m2 , stroke volume index 30-65 ml/beat/m2 , systemic vascular resistance index 1500-2500 dynes/s/cm5/m2 , oxygen delivery index 450-600 ml/min/m2 , continuous central venous oximetry more than 70%, stroke volume variation less than 10%; in addition to the control group parameters such as central venous pressure 6-8 mmHg, mean arterial pressure 90-105 mmHg, normal arterial blood gas analysis values, pulse oximetry, hematocrit value above 30% and urine output more than 1 ml/kg/h. The aims were achieved by altering the administration of intravenous fluids and doses of inotropic or vasodilator agents. Three patients were excluded from the study and the data of 27 patients analyzed. The extra volume used (330+/-160 v/s 80+/-80 ml, P=0.043) number of adjustments of inotropic agents (3.4+/-1.5 v/s 0.4+/-0.7, P=0.026) in the EGDT group were significant. The average duration of ventilation (13.8+/-3.2 v/s 20.7+/-7.1 h), days of use of inotropic agents (1.6+/-0.9 v/s 3.8+/-1.6 d), ICU stay (2.6+/-0.9 v/s 4.9+/-1.8 d) and hospital stay (5.6+/-1.2 v/s 8.9+/-2.1 d) were less in the EGDT group, compared to those in the control group. This study is inconclusive with regard to the beneficial aspects of the early goal-directed therapy in cardiac surgery patients, although a few benefits were observed.

[Effects of intratracheal suctioning on hemodynamic parameters and arterial oxygen]

intubated patients with the aim of cleaning airway for good oxygenation. The aim of this study was to evaluate the effects of intratracheal suctioning on blood pressure, heart rate, and arterial oxygen saturation. Intratracheal suctioning is a standard method of nursing care for admitted to intensive care unit of Kashani teaching center of Shahr-e-kord University in 2005. The data were collected by a questionnaire form 35 patient by observation and measurement of blood pressure, heart rate and arterial oxygen saturation. This was a semi-experimental research in which the patients and heart rate increased and arterial oxygen saturation decreased significantly, when compared with pre-suctioning period. The same occurred when these parameters were compared between pre-suctioning period and 1 minute post-suction, except for arterial oxygen saturation that had not statistically significant decline, 1 minute after suctioning. The parameters under study remained increased [including arterial oxygen saturation that decreased during suctioning] 3 minutes after suctioning, but this increase was not statistically significant when compared with pre-suctioning period. The study showed that parameters in 1 and 3 minutes after suctioning were also significantly different from those of suctioning period. The findings showed that during suctioning, systolic pressure, diastolic pressure, pressure and heart rate [increase] and arterial oxygen saturation [decrease] occurs during suctioning and maximum changes of blood pressure and heart rate [decrease] and arterial oxygen saturation [increase] occurs 3 minutes after suctioning. Therefore, hyper oxygenation, hemodynamic and SpO2 monitoring before, during and after suctioning are recommended. The finding of this research showed that the maximum changes of blood

[Effect of neonatal position on oxygen saturation in Hospitalized premature infants with respiratory distress syndrome]

Rspiratory distress syndrome is one of the most important of mortality and morbidity in premature newborns. The aim of this study was to determine the effect of body position on oxygen saturation in hospitalized premature infants with respiratory distress syndrome [RDS]. In an interventional analytic study, 69 premature infants with RDS were evaluated. Patients had a mean gestational age [ +/- SD] of 31.4 [ +/- 2.41] weeks [range: 28-35 weeks] with a mean birth weight [ +/- SD] of 1446.6 [ +/- 218.90] gram [range: 850-2400 gram]. Infants were studied both supine and prone positions. Each posture was maintained for 3 hours. Oxygen saturation was monitored by trans-cutaneous paIsoxymeter and mean of oxygen saturation was measured for 3 hours. All patients were premature, oxygen pendent and had RDS. Mean [ +/- SD] of oxygen saturation during 3 hours in prone and supine positions were 92.54% [ +/- 2.24%] and 91.78% [ +/- 2.35%] respectively [p=0.001]. Also mean [ +/- SD] of oxygen saturation at the end of each 3-hours period prone and supine positions were 91.30% [ +/- 2.42%] and 90.30% [ +/- 3.15%] respectively [p=0.006]. These findings suggest that, in premature infants with RDS oxygen saturation was significantly higher in the prone compard with the supine posture

Clinical findings of the patients with legal pulmonary disability: Short-term follow-up at a tertiary university hospital in Korea

BACKGROUND/AIMS: Legal pulmonary disability in Korea is decided for chronic respiratory patients who have been diagnosed for a year or more, and the patients haven't gotten better after more than 2 months of sufficient treatment and they have shown no change in their pulmonary function within the two years after their original diagnosis. The purpose of this study was to investigate the clinical features and progress of those patients who have been diagnosed as having pulmonary disability. METHODS: We reviewed retrospectively the medical records of the patients who had been decided as having pulmonary disability at a tertiary university hospital from 2003 to 2004, and these patients could be followed up for more than 6 months. RESULTS: The number of enrolled patients was 118 (male : female = 95 : 23) and their mean age was 60+/-10 years. Their major underlying diseases were chronic obstructive pulmonary disease (n=45, 38%), tuberculous destroyed lung (n=29, 25%), and bronchial asthma (n=27, 23%). Of them, the number of patients with a class 1 pulmonary disability were 24 (20%), there were 28 class 2 patients (24%) and 66 class 3 patients (56%). The FEV1 could be followed up for 42 of these patients, of whom 20 patients showed no change or a decrease in their FEV1 but 22 showed an increased FEV1. Especially, some of them showed the increase of their FEV1 of 10% or more, and the 50% of them were patients with bronchial asthma. During the follow-up period, 6 patients died; 3 were class 1, 1 was class 2 and 2 were class 3. Five of these patients died of their underlying pulmonary diseases or combined pneumonia. CONCLUSIONS: It is necessary to decide the pulmonary disability after sufficient treatment and to perform periodic follow-up testing even after the disability decision for confirming that the disability is stable and also to adjust the class of the disability. Further studies are needed to observe the clinical progress and prognosis of patients with pulmonary disability by performing long-term follow-up for a large number of patients.

Transplantation of autologous bone marrow mononuclear cells for patients with lower limb ischemia / 中华医学杂志(英文版)

<p><b>BACKGROUND</b>Many treatment options for lower limb ischemia are difficult to apply for the patients with poor arterial outflow or with poor general conditions. The effect of medical treatment alone is far from ideal, especially in patients with diabetic foot. A high level amputation is inevitable in these patients. This study aimed to explore the effect of transplantation of autologous bone marrow mononuclear cells on the treatment of lower limb ischemia and to compare the effect of intra-arterial transplantation with that of intra-muscular transplantation.</p><p><b>METHODS</b>In this clinical trial, 32 patients with lower limb ischemia were divided into two groups. Group 1 (16 patients with 18 affected limbs) received transplantation of autologous bone marrow mononuclear cells by intra-muscular injection into the affected limbs; and group 2 (16 patients with 17 affected limbs) received transplantation of autologous bone marrow mononuclear cells by intra-arterial injection into the affected limbs. Rest pain, coldness, ankle/brachial index (ABI), claudication, transcutaneous oxygen pressure (tcPO(2)) and angiography (15 limbs of 14 patients) were evaluated before and after the mononuclear cell transplantation to determine the effect of the treatment.</p><p><b>RESULTS</b>Two patients died from heart failure. The improvement of rest pain was seen in 76.5% (13/17) of group 1 and 93.3% (14/15) of group 2. The improvement of coldness was 100% in both groups. The increase of ABI was 44.4% (8/18) in group 1 and 41.2% (7/17) in group 2. The value of tcPO(2) increased to 20 mmHg or more in 20 limbs. Nine of 15 limbs which underwent angiography showed rich collaterals. Limb salvage rate was 83.3% (15/18) in group 1 and 94.1% (16/17) in group 2. There was no statistically significant difference in the effectiveness of the treatment between the two groups.</p><p><b>CONCLUSIONS</b>Transplantation of autologous bone marrow mononuclear cells is a simple, safe and effective method for the treatment of lower limb ischemia, and the two approaches for the implantation, intra-muscular injection and intra-arterial injection, show similar results.</p>