• Journal of Trauma and Injury
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• v.25 no.1
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• pp.17-24
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• 2012

Purpose: This study was performed to investigate whether therapeutic hypercapnia could attenuate systemic inflammatory responses in hemorrhagic shock in rats. Methods: Male Sprague-Dawley rats were mechanically ventilated and underwent pressure-controlled (mean arterial pressure: $38{\pm}1$ mmHg) hemorrhagic shock. At 10 minutes after the induction of hemorrhagic shock, the rats were divided into the normocapnia ($PaCO_2$=35-45 mmHg, n=10) and the hypercapnia ($PaCO_2$=60-70 mmHg) groups. The $PaCO_2$ concentration was adjusted by using the concentration of inhaled $CO_2$ gas. After 90 minutes of hemorrhagic shock, rats were resuscitated with shed blood for 10 minutes and were observed for 2 hours. The mean arterial pressure (MAP) and the heart rate were monitored continuously, and the results of arterial blood gas analyses, as well as the plasma concentrations of interleukin (IL)-6, IL-10, and nitrite/nitrate were compared between the normocapnia and the hypercapnia groups. Results: The MAP and the heart rate were not different between the two groups. The plasma concentration of IL-6 was significantly lower in the hypercapnia group than in the normocapnia group (p<0.05). The IL-10 concentration was not different and the IL-6 to IL-10 ratio was significantly lower in the hypercapnia group compared to the normocapnia group. The plasma nitrite/nitrate concentration of the hypercapnia group was lower than that of the normocapnia group. Conclusion: Therapeutic hypercapnia attenuates systemic inflammatory responses in hemorrhagic shock.

• Journal of Yeungnam Medical Science
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• v.32 no.2
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• pp.98-101
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• 2015

Bronchiolitis obliterans (BO), which is associated with graft-versus-host disease after allogenic hematopoietic stem cell transplantation, is a major obstacle to survival after bone marrow transplantation due to its gradual progress, eventually leading to respiratory failure. Pumpless extracorporeal interventional lung assist (iLA) is effective in treatment of reversible hypercapnic respiratory failure. In this paper, we present a 23-year-old female patient who underwent allogeneic peripheral blood stem cell transplantation (PBSCT) for acute lymphocytic leukemia. After 6 months, she complained of shortness of breath and was diagnosed with BO. Five months later, she developed an upper respiratory tract infection that worsened her BO and caused life-threatening hypercapnia. Since mechanical ventilation failed to eliminate $CO_2$ effectively, iLA was applied as rescue therapy. Her hypercapnia and respiratory acidosis showed significant improvement within a few hours, and she was successfully weaned off iLA after 12 days. This is the first case report of iLA application for temporarily aggravated hypercapnia of PBSCT-associated BO followed by successful weaning. This rescue therapy should be considered in ventilator-refractory reversible hypercapnia in BO patients.

• Journal of Chest Surgery
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• v.29 no.5
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• pp.477-486
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• 1996

Endogenous analgesic systems are known to be activated by peripheral noxious stimulation as well as arterial carbon dioxide elevation. In the present study, neuronal Activities in the rostral ventrolateral med- ulla were identified and classified in according to their rhythmic activities, and their responses to noxious peripheral nerve stimulations before and after elevating the arterial carbon dioxide partial pressure were investigated Using extracellular recording technic, a total of 53 spontaneously active neurons were recorded from the rostral ventrolateral medulla in u-chloralose anesthetized cats. These were classified as cardiovascular (28), respiratory (16), both cardiovascular and respiratory (2) and noncardiovascular - nonrespiratory (7). - Among the 28 cardiovascular neurons eleven showed increased activities during arterial hypercapnia, thirteen showed decreased responses, and four showed no change. Nine respiratory neurons showed increased responses to arterial hypercapnia, six showed decreased responses and one showed no change. neither of the cardiovascular and respiratory neurons showed significant change in its activity during ar- terial hypercapnia, however, four of the noncardiovascular - nonrespiratory neurons exhibited decreased their activities in response to arterial hypercapnia while two exhibited increased activities. Arterial hypercapnia increased the responses of cardiovascular neurons to peripheral nerve stimulation with C-inteniity, while not changing the responses to Ak_stimulation significantly . From the above results it was conclllded that during arterial hypercapnia, some cardiovascular neurons and respiratory neurons have increased activities as well as increased reponses to C-Hber stimulation.

• Journal of Chest Surgery
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• v.52 no.1
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• pp.58-60
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• 2019

Herein, we report a case of lung transplantation in a patient with profound preoperative hypercapnia, focusing on the cardiopulmonary bypass strategy used for brain perfusion during the operation. We applied the pH-stat method for acid-base regulation, and thereby achieved the desired outcome without any neurologic deficit.

• Proceedings of the KOSOMBE Conference
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• v.1997 no.11
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• pp.91-94
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• 1997

In this paper, pseudo-random ternary sequence (PRTS) was used to investigate the cardiovascular and respiratory responses to hypoxia and hypercapnia. The actual input or this study was the changes in inhaled oxygen and carbon dioxide concentrations. It is hard to randomly change the concentration within a given breath. Since PRTS has almost the same statistical properties as Gaussian white noise, plus it is physically realizable, PRTS is used for this study. Using PRTS and Volterra kernels by Gram-Schmidt orthogonalization procedure, the cardiovascular and respiratory responses to hypoxia and hypercapnia were analyzed.

• Journal of Haehwa Medicine
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• v.15 no.2
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• pp.263-272
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• 2006

Purpose Brain vessles have autoregulation function, so even when perfusion pressure drops, cerebral blood flow remain stable by vasodilation. Latest research on this reserve of cerebral vessels is being done using TCD, which measures the reserve of the vessels. We did a research comparing cerebral vessel and peripheral vessel reserve between Taeumin, who are more likely to suffer CVA, and the normal. We observed blood flow of Internal carotid artery siphon and radial indicis artery of the two group with TCD. Method We picked 20 people out of patients diagnosed as cerebral infarction at Cheon-An Oriental hospital of Daejeon University. They were diagnosed as Taeumin with QSCCII questionnaire and constitutional differentiation. Using TCD, we measured highest blood flow rate, mean blood flow and asymmetric counting blood flow of Internal carotid artery siphon and radial indicis artery at rest. And then we measured again after stimulating cerebral vessels, by triggering hypercapnia by self apnea and peripheral vessels by palm heating. Result At rest, mean blood flow rate of Internal carotid artery siphon showed significant decrease compared to control group. Blood flow rate of Internal carotid artery siphon after hypercapnia showed significant decline in highest blood flow rate and mean blood flow compared to control group. Cerebral vessel reaction after the hypercapnia induction showed great change in experiment group than the control group. Peripheral vessel reaction after palm heating showed significant decline in experiment group compared to control group. Conclusion In conclusion, measuring the alteration of blood flow used in diagnosing cerebral infarction, is more sensitive when vessel stimulation is done. Non-invasive TCD is effective especially in case of Taeumin who are more likely to suffer vascular disorder than others.

• Journal of Veterinary Science
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• v.21 no.2
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• pp.27.1-27.10
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• 2020

The efficacies of a supraglottic airway device (SGAD) and an endotracheal tube (ETT) in cats under general anesthesia with volume-controlled ventilation (VCV) were compared. Thirty healthy cats were randomly allocated for airway control using either an SGAD or an ETT. Five tidal volumes (6, 8, 10, 12, and 14 mL/kg) were randomly tested, and respiratory rates were adjusted to achieve a minute ventilation of 100 mL/kg/min. The dose of propofol necessary to insert the SGAD or ETT, the static respiratory pressure, leakage during VCV, and end tidal CO₂ (ETCO₂) were recorded. Dosages of propofol and static respiratory measurements for the SGAD and ETT groups were compared using a t-test. The distribution of leakages and hypercapnia (ETCO₂ > 45 mmHg) were compared using Fisher's exact test. A significance level of p < 0.05 was established. No significant difference in dose of propofol was observed between the SGAD and ETT groups (7.1 ± 1.0, 7.3 ± 1.7 mg/kg; p = 0.55). Static resistance pressure of the SGAD (22.0 ± 8.1 cmH₂O/L/sec) was significantly lower than that of the ETT (36.6 ± 12.9 cmH₂O/L/sec; p < 0.01). Of the 75 trials, leakage was more frequent when using an SGAD (8 events) than when using an ETT (1 event; p = 0.03). Hypercapnia occurred more frequently with SGAD (18 events) than with ETT (3 events; p < 0.01). Although intubation with an ETT is the gold standard in small animal anesthesia, the use of an SGAD can reduce airway resistance and the work of breathing. Nonetheless, SGAD had more dead space and the tidal volume for VCV needs adjustment.

• Tuberculosis and Respiratory Diseases
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• v.39 no.1
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• pp.7-14
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• 1992

Background: Cognitive deficit by hypoxia and/or hypercapnia is one of neuropsychological impairments frequently observed in patients with chronic obstructive pulmonary disease (COPD). The degree of cognitive deficit is variable among patients with similar level of hypoxia and/or hypercapnia, although a cause of this individual difference is well not known. COPD can be divided into two characteristic clinical entities including predominant emphysema and predominant bronchitis. This study was designed to evaluate the individual difference in cognitive deficit respond to hypoxia and/or hypercapnia in patients with COPD. Method: Sixteen patients with COPD (9 emphysema-dominant and 7 bronchitis-dominant) participated in this study. On admission arterial blood gas analysis and trail-making B (TMB) test for the evaluation of cognitive function were done in all patients. Mean TMB scores and the correlations between TMB scores and arterial blood gases were compared between two clinical groups. Results: 1) Mean TMB scores and arterial blood gases between two clinical groups were not different. 2) There was a tendency to be higher TMB score in hypoxemia, acidemia, and hypercapnia. However these findings were not statistically significant. 3) In emphysema-dominant group, $PaCO_2$ was mostly well correlated with TMB score (r=0.693). 4) In bronchitis-dominant group, arterial pH was mostly well correlated with TMB score (r=-0.526). Conclusion: Our data suggest that the individual difference in cognitive deficit respond to hypoxia and/or hypercapnia in patients with COPD may be dependent on their clinical entities, and arterial blood gases mostly well correlated with cognitive function that may be different according to their clinical entities.

• Neonatal Medicine
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• v.17 no.1
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• pp.34-43
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• 2010

Purpose : The aim of this study was to examine whether hypercapnia during the first seven days of life was associated with severe intraventricular hemorrhage (IVH) in preterm infants requiring mechanical ventilation. Methods : A matched pair analysis was performed for 19 preterm infants with severe IVH(grade$\geq$3) and 38 infants with no severe IVH (normal or grade 1), who required mechanical ventilation for more than seven days. The univariate and multivariate analysis of severe IVH with maximal and minimal $PaCO_2$, averag $PaCO_2$, SD of $PaCO_2$, and difference in the $PaCO_2$ were assessed. The major perinatal factors and maximal ventilator index (VI) were also compared. Results : Infants with severe IVH had a higher maximal $PaCO_2$ (86.1$\pm$18.4 mmHg vs. 60.1$\pm$ 11.6 mmHg, P <0.001) and mean $PaCO_2$ (47.5$\pm$5.6 mmHg vs. 41.2$\pm$6.3 mmHg, P=0.004) and a larger SD or difference in $PaCO_2$ (14.0$\pm$4.4 mmHg vs. 9.0$\pm$2.4 mmHg; 60.3$\pm$20.9 mmHg vs. 35.5$\pm$11.8 mmHg, P <0.001). However the minimal $PaCO_2$ values did not differ between the groups. Disseminated intravascular coagulation, pulmonary hemorrhage, and the air leak syndrome were more frequent in the IVH group than in the controls. The maximal VI on each day was higher in the IVH group. The multivariate logistic regression analysis after controlling for bleeding tendency showed that the air leak syndrome, maximal VI, and maximal $PaCO_2$ were independently associated with severe IVH [OR, 1.324 (95% CI, 1.011-1.733; P=0.041)]. Conclusion : Extreme hypercapnia was significantly associated with severe IVH in preterm infants, after adjustment for major perinatal risk factors. Frequent monitoring of the $PaCO_2$ may be important for early detection of inadvertent hypercapnia and prompt correction of high PaCOS levels.

• Annals of Clinical Neurophysiology
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• v.14 no.1
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• pp.20-24
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• 2012

Background: Migraine patients can be sensitive to external or internal stimuli, such as light, noise, or hormonal changes. Using transcranial Doppler ultrasonography (TCD) with breath-holding method, we evaluated the changes of cerebrovascular reactivity (CVR) to hypercapnia in women with migraine without aura between fasting and postprandial period. Methods: Twelve women with migraine without aura and the same number of age and sex-matched healthy controls with no significant history of headache participated in this study. Using TCD examinations, we studied mean flow velocity in middle cerebral artery with better temporal window. Each subject was examined consecutively before and after a standard meal, together with serum glucose level and blood pressure. CVR was evaluated with breath-holding index (BHI). Results: Postprandial-BHI (mean+SD) was significantly higher than fasting-BHI (mean+SD) in patients group but not in controls (in patient group; postprandial-BHI=1.38, fasting-BHI=1.08, in control group; postprandial-BHI=1.25, fasting-BHI=1.18, P=0.021 and 0.239, respectively). After meal, serum glucose level was significantly enhanced but blood pressure was not in both groups. Serum glucose level of patients showed a tendency of mild positive correlation with BHIs (${\gamma}$=0.448, P=0.032). Conclusions: Although exact mechanisms are unclear, cerebrovascular reactivity of some women with migraine without aura may be influenced by prandial state.