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.
Blood Gas Monitoring, Transcutaneous ; Carbon Dioxide ; Electrodes ; Humans ; Infant ; Infant, Newborn ; Infant, Very Low Birth Weight ; Oxygen ; Partial Pressure ; Temperature

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.
Angiogenesis Modulating Agents ; Blood Gas Monitoring, Transcutaneous ; Debridement ; Diabetic Foot* ; Eosine Yellowish-(YS) ; Foot Ulcer ; Humans ; Inflammation ; Oxygen* ; Polydeoxyribonucleotides ; Prospective Studies ; Skin ; Transplants ; Ulcer* ; Wound Healing

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.
Angiogenesis Modulating Agents ; Blood Gas Monitoring, Transcutaneous ; Debridement ; Diabetic Foot* ; Eosine Yellowish-(YS) ; Foot Ulcer ; Humans ; Inflammation ; Oxygen* ; Polydeoxyribonucleotides ; Prospective Studies ; Skin ; Transplants ; Ulcer* ; Wound Healing

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.
3' Untranslated Regions ; Atrioventricular Block/complications/*diagnosis ; Blood Gas Monitoring, Transcutaneous ; Chromosomes, Human, Pair 9 ; Electrocardiography ; Female ; Humans ; Infant, Newborn ; Myotonic Dystrophy/complications/*diagnosis/genetics ; Myotonin-Protein Kinase/genetics ; Trinucleotide Repeats

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.
Bandages ; Blood Gas Monitoring, Transcutaneous ; Foot* ; Ischemia ; Negative-Pressure Wound Therapy* ; Oxygen* ; Partial Pressure ; Perfusion ; Reading ; Suction ; Wound Healing ; Wounds and Injuries

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.
Blood Gas Analysis ; Blood Gas Monitoring, Transcutaneous ; Carbon Dioxide ; Humans ; Medical Records ; Neuromuscular Diseases ; Organothiophosphorus Compounds ; Respiration, Artificial ; Respiratory Insufficiency ; Retention (Psychology) ; Retrospective Studies ; Ventilators, Mechanical

OBJECTIVETo 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.

METHODSAll 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.

RESULTSThe 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).

CONCLUSIONSIn 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.

Aged ; Aged, 80 and over ; Blood Gas Monitoring, Transcutaneous ; Capnography ; Humans ; Male ; Middle Aged ; Oximetry ; Pulmonary Disease, Chronic Obstructive ; blood ; complications ; physiopathology ; Respiratory Insufficiency ; blood ; etiology ; physiopathology ; Tidal Volume

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.
Adult ; Blood Gas Monitoring, Transcutaneous ; Carbon ; Carbon Dioxide ; Catheters ; Critical Illness ; Humans ; Organothiophosphorus Compounds ; Oxygen ; Reference Values ; Respiration ; Rivers ; Shock

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.
Abdominal Pain ; prevention & control ; Adult ; Blood Gas Monitoring, Transcutaneous ; Carbon Dioxide ; Colonoscopy ; adverse effects ; methods ; Female ; Humans ; Male ; Middle Aged ; Safety

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.
Asthma/mortality/*physiopathology ; Blood Gas Monitoring, Transcutaneous ; Decision Making ; *Disabled Persons ; Female ; Follow-Up Studies ; Forced Expiratory Volume ; Health Status Indicators ; Hospitals, University/statistics & numerical data ; Humans ; Korea/epidemiology ; Male ; Middle Aged ; Pulmonary Disease, Chronic Obstructive/mortality/*physiopathology ; Retrospective Studies ; Severity of Illness Index ; Time Factors ; Tuberculosis, Pulmonary/mortality/*physiopathology