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Weimar Z, Smallwood N, Shao J, Chen XE, Moran TP, Khor YH. Arterial blood gas analysis or venous blood gas analysis for adult hospitalised patients with respiratory presentations: a systematic review. Intern Med J 2024; 54:1531-1540. [PMID: 38856155 DOI: 10.1111/imj.16438] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2023] [Accepted: 05/15/2024] [Indexed: 06/11/2024]
Abstract
BACKGROUND Identification of hypoxaemia and hypercapnia is essential for the diagnosis and treatment of acute respiratory failure. While arterial blood gas (ABG) analysis is standard for PO2 and PCO2 measurement, venous blood gas (VBG) analysis is increasingly used as an alternative. Previous systematic reviews established that VBG reporting of PO2 and PCO2 is less accurate, but the impacts on clinical management and patient outcomes are unknown. AIMS This study aimed to systematically review available evidence of the clinical impacts of using ABGs or VBGs and examine the arteriovenous difference in blood gas parameters. METHODS A comprehensive search of the MEDLINE, Embase and Cochrane Library databases since inception was conducted. Included studies were prospective or cross-sectional studies comparing peripheral ABG to peripheral VBG in adult non-critical care inpatients presenting with respiratory symptoms. RESULTS Of 15 119 articles screened, 15 were included. No studies were found that examined clinical impacts resulting from using VBG compared to ABG. Included studies focused on the agreement between ABG and VBG measurements of pH, PO2, PCO2 and HCO3 -. Due to the heterogeneity of the included studies, qualitative evidence synthesis was performed. While the arteriovenous difference in pH and HCO3 - was generally predictable, the difference in PO2 and PCO2 was more significant and less predictable. CONCLUSIONS Our study reinforces the notion that VBG is not comparable to ABG for physiological measurements. However, a key revelation from our research is the significant lack of data regarding the clinical implications of using VBG instead of ABG, a common scenario in clinical practice. This highlights a critical knowledge gap.
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Affiliation(s)
- Zoe Weimar
- Monash School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Natasha Smallwood
- Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory & Sleep Medicine, The Alfred Hospital, Melbourne, Victoria, Australia
| | - Jeffrey Shao
- Monash School of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Xinye E Chen
- Department of General Medicine, Eastern Health, Melbourne, Victoria, Australia
| | - Thomas P Moran
- Department of Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - Yet H Khor
- Respiratory Research@Alfred, School of Translational Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Faculty of Medicine, The University of Melbourne, Melbourne, Victoria, Australia
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Giani M, Fumagalli B, Rezoagli E, Cannizzo L, Giannini L, D'Amata D, Lucchini A, Rona R, Elli S, Foti G. Midline catheters for blood gas and acid/base monitoring in critical patients: A prospective observational study. J Vasc Access 2024; 25:1443-1449. [PMID: 36971402 DOI: 10.1177/11297298231163352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/14/2024] Open
Abstract
BACKGROUND Arterial lines and central venous catheter (CVC) allow to monitor patients' acid-base status and gas exchange. Their placement and maintenance may however be burdened by severe complications. Midline Catheters (MC) are peripheral venous accesses that are less invasive and easier to insert compared to CVC and arterial lines. METHODS A prospective observational study was performed including stabilized critical patients with clinical indication to midline positioning before intensive care unit (ICU) discharge. The primary aim was to assess if venous sampling from MCs can be a reliable alternative to CVC for pH and CO2 monitoring. The secondary aim was to evaluate the correlation between samplings from MC, CVC and arterial line with regards to pH, carbon dioxide tension (pCO2), lactates and electrolytes. Three samples from CVC, arterial line and MC were collected simultaneously. Agreement and correlation of the studied parameters between different sampling sites were explored. RESULTS 40 patients were included in the analysis. A good agreement for pH and pCO2 was recorded between MC and CVC: mean differences were 0.001 (95% CI -0.006 to 0.007) and 0.7 (-0.1 to 1.5), percentage error 0.4% and 11.2%, respectively. Correlation between MC and both central venous and arterial samples for pH, pCO2, lactates and electrolytes was found to be moderate-to-strong (Pearson's R coefficient range 0.59-0.99, p < 0.001 for all these parameters). CONCLUSIONS In stabilized critical patients, midline catheters represent a reliable alternative to CVC and arterial lines to monitor acid-base disturbances, CO2 levels and electrolytes. The present findings add to the known advantages of MC, which might be considered a first-line vascular access for non-critical or stabilized patients who do not require infusion of vesicant or irritant drugs.
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Affiliation(s)
- Marco Giani
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | | | - Emanuele Rezoagli
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Luigi Cannizzo
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Luciano Giannini
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Dario D'Amata
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Alberto Lucchini
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Roberto Rona
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Stefano Elli
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
| | - Giuseppe Foti
- School of Medicine and Surgery, University of Milano-Bicocca, Monza, Italy
- Department of Emergency and Intensive care, Fondazione IRCCS San Gerardo dei Tintori, Monza, Italy
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Lindstrom SJ, McDonald CF, Howard ME, O’Donoghue FJ, McMahon MA, Rautela L, Churchward T, Biesenbach P, Rochford PD. Venous blood gases in the assessment of respiratory failure in patients undergoing sleep studies: a randomized study. J Clin Sleep Med 2024; 20:1259-1266. [PMID: 38525926 PMCID: PMC11294137 DOI: 10.5664/jcsm.11128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 03/14/2024] [Accepted: 03/14/2024] [Indexed: 03/26/2024]
Abstract
STUDY OBJECTIVES Venous blood gases (VBGs) are not consistently considered suitable surrogates for arterial blood gases (ABGs) in assessing acute respiratory failure due to variable measurement error. The physiological stability of patients with chronic ventilatory failure may lead to improved agreement in this setting. METHODS Adults requiring ABGs for sleep or ventilation titration studies had VBGs drawn before or after each ABG, in a randomized order. Veno-arterial correlation and agreement were examined for carbon dioxide tension (PCO2), pH, oxygen tension (PO2), and oxygen saturation (SO2). RESULTS We analyzed 115 VBG-ABG pairs from 61 patients. Arterial and venous measures were correlated (P < .05) for PCO2 (r = .84) and pH (r = .72), but not for PO2 or SO2. Adjusted mean veno-arterial differences (95% limits of agreement) were +5.0 mmHg (-4.4 to +14.4) for PCO2; -0.02 (-0.09 to +0.04) for pH; -34.3 mmHg (-78.5 to +10.0) for PO2; and -23.9% (-61.3 to +13.5) for SO2. VBGs obtained from the dorsal hand demonstrated a lower mean PCO2 veno-arterial difference (P < .01). A venous PCO2 threshold of ≥ 45.8 mmHg was > 95% sensitive for arterial hypercapnia, so measurements below this can exclude the diagnosis without an ABG. A venous PCO2 threshold of ≥ 53.7 mmHg was > 95% specific for arterial hypercapnia, so such readings can be assumed diagnostic. The area under the receiver operating characteristic curve of 0.91 indicated high discriminatory capacity. CONCLUSIONS A venous PCO2 < 45.8 mmHg or ≥ 53.7 mmHg would exclude or diagnose hypercapnia, respectively, in patients referred for sleep studies, but VBGs are poor surrogates for ABGs where precision is important. CLINICAL TRIAL REGISTRATION Registry: Australian New Zealand Clinical Trials Register; Name: A comparison of arterial and blood gas analyses in sleep studies; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372717; Identifier: ACTRN12617000562370. CITATION Lindstrom SJ, McDonald CF, Howard ME, et al. Venous blood gases in the assessment of respiratory failure in patients undergoing sleep studies: a randomized study. J Clin Sleep Med. 2024;20(8):1259-1266.
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Affiliation(s)
- Steven James Lindstrom
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Victorian Respiratory Support Service, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- Barwon Health, Geelong, Victoria, Australia
- Deakin University, Geelong, Victoria, Australia
- Department of Intensive Care, Mercy Health, Melbourne, Victoria, Australia
- Alfred Health, Melbourne, Victoria, Australia
| | - Christine Faye McDonald
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Victorian Respiratory Support Service, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Mark Erskine Howard
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Victorian Respiratory Support Service, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Fergal James O’Donoghue
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Victorian Respiratory Support Service, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
- University of Melbourne, Melbourne, Victoria, Australia
| | - Marcus Anthony McMahon
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Victorian Respiratory Support Service, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Linda Rautela
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Victorian Respiratory Support Service, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Thomas Churchward
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Victorian Respiratory Support Service, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
| | - Peter Biesenbach
- Department of Emergency Medicine, Esbjerg University Hospital, Esbjerg, Denmark
| | - Peter Douglas Rochford
- Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia
- Victorian Respiratory Support Service, Melbourne, Victoria, Australia
- Institute for Breathing and Sleep, Melbourne, Victoria, Australia
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Arena A, Miller E. Respiratory Acid-Base Disorders. Emerg Med Clin North Am 2023; 41:863-875. [PMID: 37758429 DOI: 10.1016/j.emc.2023.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
Respiratory acid-base disorders are often not thought of as frequently as their metabolic cousins, which occur more frequently in the emergency department. Although most respiratory and acid-base disturbances are driven by lung pathology, central nervous system and other organ systems can and do play a role as well. Although managing the airway and appropriate mechanical ventilation may be necessary, it is akin to placing a band-aid on a large wound. It is crucial for the emergency clinician to discover the etiology of the disturbance as management depends on treating the underlying etiology to prevent worsening acid-base status.
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Affiliation(s)
- Alexander Arena
- Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7736, San Antonio, TX 78229-3900, USA.
| | - Emily Miller
- Department of Emergency Medicine, University of Texas Health Science Center at San Antonio, 7703 Floyd Curl Drive, Mail Code 7736, San Antonio, TX 78229-3900, USA
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Saberian L, Sharif M, Aarabi M, Broumand B, Shafiee MA. Arterial Versus Venous Blood Gas Analysis Comparisons, Appropriateness, and Alternatives in Different Acid/Base Clinical Settings: A Systematic Review. Cureus 2023; 15:e41707. [PMID: 37575851 PMCID: PMC10414547 DOI: 10.7759/cureus.41707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/10/2023] [Indexed: 08/15/2023] Open
Abstract
Arterial blood gases (ABGs) are routinely done in critical clinical settings to ascertain acid-base status. Due to difficulties and the potential side effects following arterial blood sampling, much research has been done to find the possibility of using venous samples as an alternative. However, this comparison needs to be evaluated in various contexts. Hence, this systematic review aims to explore the differences, appropriateness, and alternatives of arterial versus venous blood gas (VBG) analysis in different acid-base states. A comprehensive literature search was conducted through electronic databases using the terms "ABG," "VBG," "Arterial Blood Gas," "Venous Blood Gas," and "Gas analysis." Studies' qualities were assessed by using Newcastle - Ottawa Quality Assessment Scale. Of 531 articles, 22 were included in the study after title, abstract, and full-text screening. Based on the Newcastle - Ottawa Quality Assessment Scale, 23% of the studies had good quality (score ≥ 7), 77% fair quality (score 2-6), and none of the studies had poor quality (score ≤ 1). Moreover, 22.5% of the included articles found a strong correlation between ABG and VBG. 73% compared arterial and VBG parameters among patients with any clinical contexts, 22.5% in respiratory diseases, and 4.5% in metabolic conditions, and their results had a significant disparity. There was a considerable discrepancy among authors about the appropriateness and utilization of VBG as an alternative to ABG. Our findings suggest that those studies did not consider physiological differences between venous and arterial blood values and obviated the significance of sampling procedures.
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Affiliation(s)
- Lillian Saberian
- Medical Science, University of Toronto, Toronto, CAN
- Medicine, Shahrekord University of Medical Sciences, Shahrekord, IRN
| | | | - Mehdi Aarabi
- University Health Network, Toronto General Hospital, Toronto, CAN
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Copcuoglu Z, Oruc OA. Diagnostic Accuracy of Optic Nerve Sheath Diameter Measured With Ocular Ultrasonography in Acute Attack of Chronic Obstructive Pulmonary Disease. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2023; 42:989-995. [PMID: 36149357 DOI: 10.1002/jum.16106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 08/11/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
OBJECTIVE The study aimed to evaluate intracranial pressure changes by measuring ONSD before and after treatment in patients with chronic obstructive pulmonary disease (COPD). METHODS The study was designed as a prospective analysis, in which 56 COPD in acute exacerbation and 50 volunteers. COPD severity was determined by the Dyspnea Scale of Modified Medical Research Council (mMRC). Measurements were made with ocular ultrasonography and linear probe in both eyes. RESULTS Both the right and left ONSDs were higher in the patient compared to the control (P = .017) and regressed after the treatment (P = .021). In the ROC analysis for the predictability of COPD, right eye ONSDs showed a predictive potential for COPD with %75.7 specificity and %68.1 sensitivity at 0.455 cut-off (AUC: 0.727; P = .0001; %95CI: 0.609-0.833). Similar to the right eye, the left ONSD presented %74.4 specificity and %67 sensitivity at 0.505 cut-off value (AUC: 0.718; P = .0001; %95CI: 0.608-0.841). CONCLUSION The ONSD measurement that was with the help of ocular ultrasonography can be a useful diagnostic tool for symptomatic COPD presenting with an acute attack.
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Affiliation(s)
- Zeliha Copcuoglu
- Department of Emergency Medicine, Ministry of Health, Afyonkarahisar State Hospital, Afyonkarahisar, Turkey
| | - Oya Akpinar Oruc
- Department of Emergency Medicine, School of Medicine, Afyonkarahisar Health Sciences University, Afyonkarahisar, Turkey
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Qi YL, Wu Q, Li XQ, Zhou ZH, Xia C, Wang XH, Chen HS. The association of admission ionized calcium with outcomes of thrombolysed patients with anterior circulation ischemic stroke. Brain Behav 2023; 13:e2844. [PMID: 36479811 PMCID: PMC9847587 DOI: 10.1002/brb3.2844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Revised: 10/13/2022] [Accepted: 11/23/2022] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND AND PURPOSE The relationship between ionized calcium and prognosis of ischemic stroke is controversial. We aim to determine the relationship of admission ionized calcium levels with acute ischemic stroke (AIS) after intravenous thrombolysis (IVT). METHODS Consecutive anterior circulation AIS patients treated with recombinant tissue plasminogen activator (rt-PA) were retrospectively enrolled. According to ionized calcium quartiles, the patients were divided into four groups and clinical data were analyzed between groups. Ionized calcium was entered into logistic regression analysis in two models, separately: model 1, calcium as a continuous variable (per 1-mmol/L increase), and model 2, calcium as the four-categorized variable (being collapsed into quartiles: Q1-Q4). Early neurologic improvement (ENI) was defined as improvement of four or more points at 24 h after intravenous rt-PA, while long-term good outcome as the modified Rankin Scale (mRS) 0-1 at 90 days. RESULTS A total of 546 patients met the study criteria (mean age was 63.51 ± 11.26 years and 365 [66.8%] were men). The median admission National Institute of Health Stroke Scale was 9 (range 4 to 15). When not adjusted, in model 1: ionized calcium was related to good outcome (odds ratio [OR] 69.061, 95%CI: 1.638-2911.111, p=0.027), but not ENI (OR 14.097, 95%CI: 0.133-1492.596, p=0.266); in model 2: compared with Q4, while good outcome was less common in Q1 (OR 0.623, 95%CI: 0.388-0.999, p=0.049). After adjusting for confounding factors, calcium in Q2 (OR 0.502, 95%CI: 0.253-0.997, p=0.049) was independently associated with ENI, but no matter as a continuous variable or categorized variable, ionized calcium displayed no association with a good outcome. CONCLUSION The current results found that ionized calcium might be associated with early neurological improvement, but had no association with 3 months' outcome in anterior circulation AIS patients after IVT.
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Affiliation(s)
- Yan-Li Qi
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Qiong Wu
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Xiao-Qiu Li
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Zhong-He Zhou
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Cheng Xia
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Xin-Hong Wang
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
| | - Hui-Sheng Chen
- Department of Neurology, General Hospital of Northern Theater Command, Shenyang, People's Republic of China
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Tiwari D, Bhati BS, Al‐Turjman F, Nagpal B. Pandemic coronavirus disease (Covid-19): World effects analysis and prediction using machine-learning techniques. EXPERT SYSTEMS 2022; 39:e12714. [PMID: 34177035 PMCID: PMC8209956 DOI: 10.1111/exsy.12714] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 04/26/2021] [Indexed: 05/09/2023]
Abstract
Pandemic novel Coronavirus (Covid-19) is an infectious disease that primarily spreads by droplets of nose discharge when sneezing and saliva from the mouth when coughing, that had first been reported in Wuhan, China in December 2019. Covid-19 became a global pandemic, which led to a harmful impact on the world. Many predictive models of Covid-19 are being proposed by academic researchers around the world to take the foremost decisions and enforce the appropriate control measures. Due to the lack of accurate Covid-19 records and uncertainty, the standard techniques are being failed to correctly predict the epidemic global effects. To address this issue, we present an Artificial Intelligence (AI)-based meta-analysis to predict the trend of epidemic Covid-19 over the world. The powerful machine learning algorithms namely Naïve Bayes, Support Vector Machine (SVM) and Linear Regression were applied on real time-series dataset, which holds the global record of confirmed, recovered, deaths and active cases of Covid-19 outbreak. Statistical analysis has also been conducted to present various facts regarding Covid-19 observed symptoms, a list of Top-20 Coronavirus affected countries and a number of coactive cases over the world. Among the three machine learning techniques investigated, Naïve Bayes produced promising results to predict Covid-19 future trends with less Mean Absolute Error (MAE) and Mean Squared Error (MSE). The less value of MAE and MSE strongly represent the effectiveness of the Naïve Bayes regression technique. Although, the global footprint of this pandemic is still uncertain. This study demonstrates the various trends and future growth of the global pandemic for a proactive response from the citizens and governments of countries. This paper sets the initial benchmark to demonstrate the capability of machine learning for outbreak prediction.
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Affiliation(s)
- Dimple Tiwari
- Ambedkar Institute of Advanced Communication Technologies and Research, Govt of NCT of DelhiDelhiIndia
| | - Bhoopesh Singh Bhati
- Ambedkar Institute of Advanced Communication Technologies and Research, Govt of NCT of DelhiDelhiIndia
| | - Fadi Al‐Turjman
- Artificial Intelligence Engineering Department, Research Center for AI and IoTNear East UniversityNicosiaTurkey
| | - Bharti Nagpal
- Ambedkar Institute of Advanced Communication Technologies and Research, Govt of NCT of DelhiDelhiIndia
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Regueiro M, Jorge-Smeding E, Saravia A, López-Mazz C, Banchero G. Comparison between pulse oximetry and venous blood gas analyses to assess lamb asphyxia at parturition. Small Rumin Res 2022. [DOI: 10.1016/j.smallrumres.2022.106665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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10
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Ayaz F, Furrukh M, Arif T, Ur Rahman F, Ambreen S. Correlation of Arterial and Venous pH and Bicarbonate in Patients With Renal Failure. Cureus 2021; 13:e19519. [PMID: 34934543 PMCID: PMC8666679 DOI: 10.7759/cureus.19519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 11/21/2022] Open
Abstract
Background and objective Blood gas analysis plays a pivotal role in the management of various respiratory and metabolic disorders. Both arterial and venous samples can be used for blood gas analysis. Arterial blood sampling is technically difficult and is associated with more complications as compared to venous sampling. Many studies have shown the correlation of arterial and venous pH and bicarbonate levels in sepsis, diabetic ketoacidosis (DKA), chronic obstructive pulmonary disease (COPD), and circulatory failure. But, there is a paucity of data, pertaining specifically to the correlation of arterial blood gas (ABG) analysis and venous blood gas (VBG) analysis in patients with renal failure. The objective of this study was to look for any possible correlation between arterial and venous pH and bicarbonate values in patients with renal failure. Methods This cross-sectional study was carried out at a large tertiary care hospital in Rawalpindi, Pakistan. Over a period of eight months, 101 patients with renal failure were enrolled after obtaining informed consent. Arterial and venous samples from the patients were obtained, analyzed, and compared. Results Out of the total 101 patients, 53 (52.5%) were male while 48 (47.5%) were female. The mean age of the patients was 46.23 ±15.54 years. Mean arterial pH and venous pH were 7.35 and 7.28 respectively. The Pearson correlation coefficient between arterial and venous pH was found to be 0.857 (p<0.001). The mean arterial and venous bicarbonate values were 14.47 mEq/L and 15.51 mEq/L respectively. And the Pearson correlation coefficient between arterial and venous bicarbonate was found to be 0.842 (p<0.001). Conclusion Venous pH and bicarbonate levels correlate strongly with arterial pH and bicarbonate levels, respectively, in patients with renal failure.
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Affiliation(s)
- Fatima Ayaz
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
| | | | - Tehreem Arif
- Department of Nephrology, Holy Family Hospital, Rawalpindi, PAK
| | - Fazal Ur Rahman
- Department of Medicine, Rawalpindi Medical University, Rawalpindi, PAK
| | - Saima Ambreen
- Department of Medicine, Holy Family Hospital, Rawalpindi, PAK
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Gottlieb J, Capetian P, Hamsen U, Janssens U, Karagiannidis C, Kluge S, Nothacker M, Roiter S, Volk T, Worth H, Fühner T. German S3 Guideline: Oxygen Therapy in the Acute Care of Adult Patients. Respiration 2021; 101:214-252. [PMID: 34933311 DOI: 10.1159/000520294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 10/06/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Oxygen (O2) is a drug with specific biochemical and physiological properties, a range of effective doses and may have side effects. In 2015, 14% of over 55,000 hospital patients in the UK were using oxygen. 42% of patients received this supplemental oxygen without a valid prescription. Health care professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. METHODS A national S3 guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. A literature search was performed until February 1, 2021, to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System ("The Oxford 2011 Levels of Evidence") was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of evidence and for grading guideline recommendation, and a formal consensus-building process was performed. RESULTS The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are based depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. CONCLUSION This is the first national guideline on the use of oxygen in acute care. It addresses health care professionals using oxygen in acute out-of-hospital and in-hospital settings.
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Affiliation(s)
- Jens Gottlieb
- Department of Respiratory Medicine, Hannover Medical School, Hannover, Germany.,Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany
| | - Philipp Capetian
- Department of Neurology, University Hospital Würzburg, Wuerzburg, Germany
| | - Uwe Hamsen
- Department of General and Trauma Surgery, BG University Hospital Bergmannsheil, Bochum, Germany
| | - Uwe Janssens
- Medical Clinic and Medical Intensive Care Medicine, St. Antonius Hospital, Eschweiler, Germany
| | - Christian Karagiannidis
- Department of Pneumology and Critical Care Medicine, Cologne-Merheim Hospital, ARDS and ECMO Centre, Kliniken der Stadt Köln, Witten/Herdecke University Hospital, Cologne, Germany
| | - Stefan Kluge
- University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Monika Nothacker
- AWMF-Institute for Medical Knowledge Management, Marburg, Germany
| | - Sabrina Roiter
- Intensive Care Unit, Israelite Hospital Hamburg, Hamburg, Germany
| | - Thomas Volk
- Department of Anesthesiology, University Hospital of Saarland, Saarland University, Homburg, Germany
| | | | - Thomas Fühner
- Biomedical Research in Endstage and Obstructive Lung Disease Hannover (BREATH), Member of the German Center for Lung Research (DZL), Hannover, Germany.,Department of Respiratory Medicine, Siloah Hospital, Hannover, Germany
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12
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Gottlieb J, Capetian P, Hamsen U, Janssens U, Karagiannidis C, Kluge S, König M, Markewitz A, Nothacker M, Roiter S, Unverzagt S, Veit W, Volk T, Witt C, Wildenauer R, Worth H, Fühner T. [German S3 Guideline - Oxygen Therapy in the Acute Care of Adult Patients]. Pneumologie 2021; 76:159-216. [PMID: 34474487 DOI: 10.1055/a-1554-2625] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Oxygen (O2) is a drug with specific biochemical and physiologic properties, a range of effective doses and may have side effects. In 2015, 14 % of over 55 000 hospital patients in the UK were using oxygen. 42 % of patients received this supplemental oxygen without a valid prescription. Healthcare professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. METHODS A S3-guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. Literature search was performed until Feb 1st 2021 to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System ("The Oxford 2011 Levels of Evidence") was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used and for assessing the quality of evidence and for grading guideline recommendation and a formal consensus-building process was performed. RESULTS The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. CONCLUSION This is the first national guideline on the use of oxygen in acute care. It addresses healthcare professionals using oxygen in acute out-of-hospital and in-hospital settings. The guideline will be valid for 3 years until June 30, 2024.
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Affiliation(s)
- Jens Gottlieb
- Klinik für Pneumologie, Medizinische Hochschule Hannover.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
| | - Philipp Capetian
- Klinik für Neurologie, Neurologische Intensivstation, Universitätsklinikum Würzburg
| | - Uwe Hamsen
- Fachbereich für Unfallchirurgie und Orthopädie, Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil, Bochum
| | - Uwe Janssens
- Innere Medizin und internistische Intensivmedizin, Sankt Antonius Hospital GmbH, Eschweiler
| | - Christian Karagiannidis
- Abteilung für Pneumologie und Beatmungsmedizin, ARDS/ECMO Zentrum, Lungenklinik Köln-Merheim
| | - Stefan Kluge
- Klinik für Intensivmedizin, Universitätsklinikum Eppendorf, Hamburg
| | - Marco König
- Deutscher Berufsverband Rettungsdienst e. V., Lübeck
| | - Andreas Markewitz
- ehem. Klinik für Herz- und Gefäßchirurgie Bundeswehrzentralkrankenhaus Koblenz
| | - Monika Nothacker
- Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V., Marburg
| | | | | | - Wolfgang Veit
- Bundesverband der Organtransplantierten e. V., Marne
| | - Thomas Volk
- Klinik für Anästhesiologie, Intensivmedizin und Schmerztherapie, Universitätsklinikum des Saarlandes, Homburg/Saar
| | - Christian Witt
- Seniorprofessor Innere Medizin und Pneumologie, Charité Berlin
| | | | | | - Thomas Fühner
- Krankenhaus Siloah, Klinik für Pneumologie und Beatmungsmedizin, Klinikum Region Hannover.,Biomedical Research in End-stage and Obstructive Lung Disease Hannover (BREATH) im Deutschen Zentrum für Lungenforschung (DZL)
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13
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Chong WH, Saha BK, Medarov BI. Comparing Central Venous Blood Gas to Arterial Blood Gas and Determining Its Utility in Critically Ill Patients: Narrative Review. Anesth Analg 2021; 133:374-378. [PMID: 33780397 DOI: 10.1213/ane.0000000000005501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Arterial blood gas (ABG) analysis is used in critical care units to determine the degree of oxygenation, adequacy of ventilation, and the presence and severity of acid-base disturbances in the body. However, arterial puncture may result in complications, and the difficulty in acquiring arterial blood may delay care. Central venous blood gas (VBG) is a potentially more accessible alternative to ABG sampling. Current evidence suggests that pH and Pco2 obtained via peripheral VBG correlate well with ABG measurement. Nevertheless, the value of using central VBG to guide clinical decisions or as a surrogate for ABG is unclear. The purpose of this review is to explore the relationship between ABGs and central VBGs in critically ill patients. We performed a MEDLINE search using the following search terms: venous blood gas, arterial blood gas, and central venous blood gas. We excluded studies that did not involve human subjects, and only pH and Pco2 values were reviewed and examined from the studies included. All cited references from included studies were also reviewed to identify relevant literature. We identified 7 studies that met our criteria. In studies of hemodynamically stable patients, the mean difference between arterial and central venous pH and Pco2 was 0.03 units and 4-6.5 mm Hg, respectively. However, in patients with circulatory failure, the difference between central venous and arterial pH/Pco2 was 4-fold greater. We concluded that central VBG parameters of pH and Pco2 are potentially good surrogates for determining arterial pH and Pco2 in a stable patient without severe acid-base disturbances. Furthermore, central VBG can be used as a useful screening tool for arterial hypercapnia. In addition, we derived an adjustment formula for ABG conversion from central VBG: (1) arterial pH = venous pH + 0.05 units and (2) arterial Pco2 = venous Pco2 - 5 mm Hg.
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Affiliation(s)
- Woon H Chong
- From the Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, New York
| | - Biplab K Saha
- Department of Pulmonary and Critical Care, Ozarks Medical Center, West Plains, Missouri
| | - Boris I Medarov
- From the Department of Pulmonary and Critical Care Medicine, Albany Medical Center, Albany, New York
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14
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Ress KL, Koerbin G, Li L, Chesher D, Bwititi P, Horvath AR. Reference intervals for venous blood gas measurement in adults. Clin Chem Lab Med 2020; 59:947-954. [PMID: 33554517 DOI: 10.1515/cclm-2020-1224] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 11/18/2020] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Venous blood gas (VBG) analysis is becoming a popular alternative to arterial blood gas (ABG) analysis due to reduced risk of complications at phlebotomy and ease of draw. In lack of published data, this study aimed to establish reference intervals (RI) for correct interpretation of VBG results. METHODS One hundred and 51 adult volunteers (101 females, 50 males, 18-70 years) were enrolled after completion of a health questionnaire. Venous blood was drawn into safePICO syringes and analysed on ABL827 blood gas analyser (Radiometer Pacific Pty. Ltd.). A non-parametric approach was used to directly establish the VBG RI which was compared to a calculated VBG RI based on a meta-analysis of differences between ABG and VBG. RESULTS After exclusions, 134 results were used to derive VBG RI: pH 7.30-7.43, partial pressure of carbon dioxide (pCO2) 38-58 mmHg, partial pressure of oxygen (pO2) 19-65 mmHg, bicarbonate (HCO3-) 22-30 mmol/L, sodium 135-143 mmol/L, potassium 3.6-4.5 mmol/L, chloride 101-110 mmol/L, ionised calcium 1.14-1.29 mmol/L, lactate 0.4-2.2 mmol/L, base excess (BE) -1.9-4.5 mmol/L, saturated oxygen (sO2) 23-93%, carboxyhaemoglobin 0.4-1.4% and methaemoglobin 0.3-0.9%. The meta-analysis revealed differences between ABG and VBG for pH, HCO3-, pCO2 and pO2 of 0.032, -1.0 mmol/L, -4.2 and 39.9 mmHg, respectively. Using this data along with established ABG RI, calculated VBG RI of pH 7.32-7.42, HCO3- 23 - 27 mmol/L, pCO2 36-49 mmHg (female), pCO2 39-52 mmHg (male) and pO2 43-68 mmHg were formulated and compared to the VBG RI of this study. CONCLUSIONS An adult reference interval has been established to assist interpretation of VBG results.
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Affiliation(s)
- Kirsty L Ress
- Department of Chemical Pathology, NSW Health Pathology, Prince of Wales Hospital, Sydney, Australia.,School of Biomedical Sciences, Charles Sturt University, Sydney, Australia
| | | | - Ling Li
- Australian Institute of Health Innovation, Centre for Health Systems and Safety Research, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
| | - Douglas Chesher
- Department of Chemical Pathology, NSW Health Pathology, Royal North Shore Hospital, Sydney, Australia
| | - Phillip Bwititi
- School of Biomedical Sciences, Charles Sturt University, Sydney, Australia
| | - Andrea R Horvath
- Department of Chemical Pathology, NSW Health Pathology, Prince of Wales Hospital, Sydney, Australia.,Australian Institute of Health Innovation, Centre for Health Systems and Safety Research, Faculty of Medicine and Health Sciences, Macquarie University, Sydney, Australia
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15
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Schütz N, Roth D, Schwameis M, Röggla M, Domanovits H. Can Venous Blood Gas Be Used as an Alternative to Arterial Blood Gas in Intubated Patients at Admission to the Emergency Department? A Retrospective Study. Open Access Emerg Med 2019; 11:305-312. [PMID: 31920407 PMCID: PMC6934126 DOI: 10.2147/oaem.s228420] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Accepted: 11/15/2019] [Indexed: 11/23/2022] Open
Abstract
Objective Blood gas analysis plays an important role in both diagnosis and subsequent treatment of critically ill patients in the emergency department and the ICU. Historically, arterial blood is predominantly used for blood gas analysis. The puncture is painful and complications may occur. The purpose of the present study was to evaluate the agreement between arterial and venous blood gas analysis and whether the sole use of venous blood gas analysis would have changed therapy. Methods Adult patients who were intubated in the field and received an arterial and venous blood gas analysis within 15 mins after admission to the ED were eligible for inclusion. The values for pH, pCO2, HCO3-, base excess and lactate levels were collected retrospectively. Mean differences were calculated by subtracting venous from arterial values. The agreement between venous and arterial measurements was assessed using the method of Bland and Altman. Blood gases were assessed by two independent physicians using a standardized questionnaire to determine whether the use of venous blood gases would have led to a different interpretation of the situation (other diagnostic path) or a change of therapy (eg. respirator adjustment). Acceptable limits were defined before the collection of data started. Results Fifty patients (62% male, median age 63years) who were treated at the Emergency Department between June 1, 2014 and December 31, 2014 were included in the study. Following average differences and limits of agreement (LOA) were documented: pH 0.02312 with LOA from −0.048 to 0.094; pCO2 −3.612 mmHg with LOA from −15 to 8.1 mmHg; BE −0.154 mmol/l with LOA from −3.7 to 3.4 mmol/l; HCO3−0.338 mmol/l with LOA from −2.27 to 2.9 mmol/l; Lactate −0.124 mg/dl with LOA from −2.28 to 2.03 mg/dl. Using venous blood gas results 100% of the patients with metabolic alkalosis were correctly diagnosed. Metabolic acidosis was detected with a high sensitivity (80.64%), specificity (89.47%) and positive predictive value (92.59%). The answers to lactate and acidosis due to AKI showed a specificity and positive predictive value of 100%. The respiratory adjustment showed a high sensitivity (91.89%) but a low specificity (38.46%). Conclusion For pH, bicarbonate, BE and lactate venous blood gases can be used as surrogates for arterial measurements. Venous pCO2 can be used for screening of hypercapnia and trending. Respirator adjustments may be done too often if the venous blood gas is used.
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Affiliation(s)
- Nikola Schütz
- Department of Emergency Medicine, Medical University of Vienna, Vienna A-1090, Austria
| | - Dominik Roth
- Department of Emergency Medicine, Medical University of Vienna, Vienna A-1090, Austria
| | - Michael Schwameis
- Department of Emergency Medicine, Medical University of Vienna, Vienna A-1090, Austria
| | - Martin Röggla
- Department of Emergency Medicine, Medical University of Vienna, Vienna A-1090, Austria
| | - Hans Domanovits
- Department of Emergency Medicine, Medical University of Vienna, Vienna A-1090, Austria
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16
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Baumstark A, Pleus S, Jendrike N, Liebing C, Hinzmann R, Haug C, Freckmann G. Proof of Concept Study to Assess the Influence of Oxygen Partial Pressure in Capillary Blood on SMBG Measurements. J Diabetes Sci Technol 2019; 13:1105-1111. [PMID: 30841739 PMCID: PMC6835173 DOI: 10.1177/1932296819833369] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Measurement results provided by blood glucose monitoring systems (BGMS) can be affected by various influencing factors. For some BGMS using glucose oxidase (GOx)-based test strips, one of these factors is the oxygen partial pressure (pO2) of the applied blood sample. Because assessing the potential influence of pO2 when measuring capillary blood samples is not straight-forward, we performed a proof of concept study. METHOD Influence of pO2 was investigated for two GOx-based BGMS (BGMS A and B). Measurement results of the GOx-based BGMS were compared with measurement results from a pO2-independent BGMS (BGMS C). A total of 119 samples from 60 subjects were measured, twice with BGMS C, then 6 times each with BGMS A and BGMS B or vice versa, and again twice with BGMS C. Immediately afterward, pO2 was determined. Linear regression analysis based on relative differences between results from BGMS A or BGMS B and results from BGMS C was performed to estimate the degree of pO2 influence. RESULTS The relative bias between the lowest and highest pO2 values differed by 14.3% for BGMS A, indicating a pO2 influence that might be clinically relevant, and by 9.7% for BGMS B, indicating that pO2 influence may be too small to be reliably detected because of the BGMS' imprecision. CONCLUSIONS This proof of concept study showed that with the procedures used, a potentially clinically relevant influence of pO2 in capillary blood samples on GOx-based BGMS could be detected. Further larger-scale studies are needed to verify this influence.
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Affiliation(s)
- Annette Baumstark
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Stefan Pleus
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
- Stefan Pleus, MSc, Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Lise-Meitner-Straße 8/2, D-89081 Ulm, Germany.
| | - Nina Jendrike
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Christina Liebing
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | | | - Cornelia Haug
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
| | - Guido Freckmann
- Institut für Diabetes-Technologie, Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Ulm, Germany
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17
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Wong EKC, Lee P(CS, Ansary S, Asha S, Wong KKH, Yee BJ, Ng AT. Role of venous blood gases in hypercapnic respiratory failure chronic obstructive pulmonary disease patients presenting to the emergency department. Intern Med J 2019; 49:834-837. [DOI: 10.1111/imj.14186] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Eric Ka Cheong Wong
- Centre for Sleep Disorders and Respiratory FailureSt George Hospital Sydney New South Wales Australia
| | - Philip (Cheuk Shing) Lee
- Centre for Sleep Disorders and Respiratory FailureSt George Hospital Sydney New South Wales Australia
| | - Saidul Ansary
- Centre for Sleep Disorders and Respiratory FailureSt George Hospital Sydney New South Wales Australia
| | - Stephen Asha
- Emergency DepartmentSt George Hospital Sydney New South Wales Australia
| | - Keith K. H. Wong
- Department of Respiratory MedicineRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - Brendon J. Yee
- Department of Respiratory MedicineRoyal Prince Alfred Hospital Sydney New South Wales Australia
| | - Andrew T. Ng
- Centre for Sleep Disorders and Respiratory FailureSt George Hospital Sydney New South Wales Australia
- University of New South Wales, St George and Sutherland Clinical School Sydney New South Wales Australia
- LUCAS Institute Sydney New South Wales Australia
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18
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Martha SR, Fraser JF, Pennypacker KR. Acid-Base and Electrolyte Changes Drive Early Pathology in Ischemic Stroke. Neuromolecular Med 2019; 21:540-545. [PMID: 31280473 DOI: 10.1007/s12017-019-08555-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Accepted: 07/01/2019] [Indexed: 12/19/2022]
Abstract
Emergent large vessel occlusion accounts for 20-40% of ischemic strokes and is the most debilitating form of stroke. Some of the earliest changes in response to ischemic stroke occur in blood gases and electrolytes. These biochemical changes occur within minutes after occlusion in experimental models of stroke and can be utilized to predict stroke outcomes. The majority of ELVO stroke patients are middle-aged to elderly and are of both sexes, revealing that there is an age and sex mismatch between ischemic stroke patients and animal models, since most experimental studies use young male rats. Rethinking of the animal models should be considered, especially in encouraging the use of aged male and female rats with comorbidities to more closely mirror human populations. Mechanical thrombectomy provides a unique opportunity for researchers to further this work by expanding the collection and analysis of blood samples that are adjacent to the thrombus. To understand the complexity of stroke, researchers can analyze these tissues for different molecular targets that occur in response to ischemic stroke. This information may aid in the reduction of symptom burden for individuals diagnosed with ischemic stroke. Investigators should also focus on data from ischemic stroke patients and attempt to discover target molecules and then in animal models to establish mechanism, which will aid in the development of new stroke therapies. This review discusses the translation of these studies to the human patient to develop the capability to predict stroke outcomes. Future studies are needed to identify molecular targets to predict the risk of worsened long-term outcomes and/or increased risk for mortality.
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Affiliation(s)
- Sarah R Martha
- College of Nursing, University of Kentucky, Lexington, KY, USA
| | - Justin F Fraser
- Department of Neurology, University of Kentucky, Center for Advanced Translational Stroke Science, Building BBSRB, Office B377, Lexington, KY, 40536, USA.,Department of Neurosurgery, University of Kentucky, Lexington, KY, USA.,Department of Neuroscience, University of Kentucky, Lexington, KY, USA.,Department of Radiology, University of Kentucky, Lexington, KY, USA
| | - Keith R Pennypacker
- Department of Neurology, University of Kentucky, Center for Advanced Translational Stroke Science, Building BBSRB, Office B377, Lexington, KY, 40536, USA. .,Department of Neuroscience, University of Kentucky, Lexington, KY, USA.
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19
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Parlak EŞ. Can Venous Blood Gases be Used instead of Arterial Blood Gases in Department of Chest Diseases? ANKARA MEDICAL JOURNAL 2019. [DOI: 10.17098/amj.542129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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20
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Alsobayil FA, El-Shafaey ES, Sadan M, Alshoshan AA. Evaluation of Sevoflurane Anesthesia in Donkeys (Equus asinus) Premedicated With Xylazine and Induced With Thiopental. J Equine Vet Sci 2019; 77:50-56. [PMID: 31133316 DOI: 10.1016/j.jevs.2019.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 02/11/2019] [Accepted: 02/11/2019] [Indexed: 11/19/2022]
Abstract
Sevoflurane is a volatile anesthetic agent that has become popular in the field of large animal anesthesia. The aim of this study was to evaluate the use of sevoflurane in adult healthy donkeys. Six male, adult, healthy donkeys were premedicated with xylazine (1 mg/kg IV), induced with thiopental (5 mg/kg IV), and then maintained for 90 minutes with sevoflurane in 100% oxygen at a flow rate of 6 L/min with spontaneous breathing. Rectal temperature (RT), respiratory rate, heart rate (HR), oxygen hemoglobin saturation (OHS), and mean arterial blood pressure (MBP) were measured before and 20 minutes after the administration of xylazine, 10 minutes after the injection of thiopental, and then continuously every 10 minutes until recovery. Times for various signs of recovery, total duration of recovery, and quality of recovery were recorded. Jugular blood samples were collected from each donkey and complete blood counts and venous blood gases including concentrations of oxygen (PO2) and carbon dioxide (PCO2) were measured. In addition, the concentrations of sodium, potassium, calcium, lactate, bicarbonate, and glucose in venous blood were measured. Results showed that during the anesthesia maintained with sevoflurane, there was a significant decrease in HR, MBP, RT, red blood corpuscles, hematocrit, total white blood cells, neutrophils, and lymphocytes, whereas the levels of OHS and glucose significantly increased. The concentrations of PO2, PCO2, and lactate in venous blood significantly increased, whereas the pH significantly decreased. The levels of calcium significantly decreased immediately following the recovery. Sternal recumbency and standing occurred 15.8 ± 2.6 minutes and 28.2 ± 2.2 minutes, respectively, after turning off the vaporizer. Overall, the quality of recovery was good and relatively quick. It was concluded that sevoflurane appears to provide safe and effective anesthesia in donkeys, with relatively rapid induction and recovery.
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Affiliation(s)
- Fahd Abdullah Alsobayil
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Qassim, Saudi Arabia
| | - El-Sayed El-Shafaey
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Qassim, Saudi Arabia; Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt.
| | - Madeh Sadan
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Qassim, Saudi Arabia; Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, South Valley University, Qena, Egypt
| | - Abdel-Aziz Alshoshan
- Department of Veterinary Medicine, College of Agriculture and Veterinary Medicine, Qassim University, Qassim, Saudi Arabia
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21
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Valizad Hassanloei M, Mahoori A, Karami N, Sina V. The Relationship between Arterial and Central Venous Blood Gases Values in Patients Undergoing Mechanical Ventilation after Cardiac Surgery. Anesth Pain Med 2018; 8:e74243. [PMID: 30214888 PMCID: PMC6119237 DOI: 10.5812/aapm.74243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 06/08/2018] [Accepted: 06/11/2018] [Indexed: 11/19/2022] Open
Abstract
Background The most straightforward method of ascertaining arterial PO2, PCO2, and other components of blood gas is to measure them directly from a blood sample. In situations in which arterial puncture cannot be achieved or may be technically difficult, the venous blood sample can be used. Methods In a prospective analytical study, 80 patients undergoing mechanical ventilation after open-heart surgery in the intensive care unit were evaluated. Simultaneous, matched arterial and central venous blood gas samples were taken from radial artery line and central vein, respectively, when the ABG (arterial blood gases) assessment was needed. Arterial and central venous blood samples were analyzed and data were expressed as mean and ± SD. Results The Pearson correlation coefficient for pH, PCO2, HCO3, and SatO2 was 0.898, 0.940, 0.840, and 0.567, respectively. There was a significant correlation between arterial and central venous values of pH, PCO2, and HCO3 (P < 0.0001). The mean difference between arterial and central venous PCO2 was -2.44 ± 2.6 mmHg, and the mean venous pH value was only 0.021 ± 0.037 units lower than the mean arterial value. In addition, the calculated mean bicarbonate concentration in venous blood was only about 0.06 ± 1.5 mEq.L higher than the mean arterial value. Conclusions The central venous PCO2, pH, and HCO3 measured during mechanical ventilation in the intensive care unit approximate arterial values closely enough to permit the estimation of the adequacy of ventilation and acid-base status. The central venous Sat O2 does not reliably parallel the arterial Sat O2. In conclusion, venous blood sampling can potentially reduce the requirement for ABG sampling in special situations.
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Affiliation(s)
| | - Alireza Mahoori
- Anesthesiology Department of Urmia University of Medical Sciences, Urmia, Iran
| | - Nazli Karami
- Anesthesiology Department of Urmia University of Medical Sciences, Urmia, Iran
- Corresponding author: Nazli Karami, Imam Khomeini Teaching Hospital, Ershad St. Urmia, Iran. Tel: +98-9122179344, Fax: +98-44 33468967, E-mail:
| | - Venus Sina
- Anesthesiology Department of Urmia University of Medical Sciences, Urmia, Iran
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22
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Differences in the intrinsic chondrogenic potential of equine umbilical cord matrix and cord blood mesenchymal stromal/stem cells for cartilage regeneration. Sci Rep 2018; 8:13799. [PMID: 30217993 PMCID: PMC6138671 DOI: 10.1038/s41598-018-28164-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 06/13/2018] [Indexed: 12/15/2022] Open
Abstract
Umbilical cord blood mesenchymal stromal/stem cells (UCB-MSCs) and umbilical cord matrix MSCs (UCM-MSCs) have chondrogenic potential and are alternative sources to standard surgically derived bone marrow or adipose tissue collection for cartilage engineering. However, the majority of comparative studies explore neonatal MSCs potential only on ISCT benchmark assays accounting for some bias in the reproducibility between in vitro and in clinical studies. Therefore, we characterized equine UCB-MSCs and UCM-MSCs and investigated with particular attention their chondrogenesis potential in 3D culture with BMP-2 + TGF-ß1 in normoxia or hypoxia. We carried out an exhaustive characterization of the extracellular matrix generated by both these two types of MSCs after the induction of chondrogenesis through evaluation of hyaline cartilage, hypertrophic and osteogenic markers (mRNA, protein and histology levels). Some differences in hypoxia sensitivity and chondrogenesis were observed. UCB-MSCs differentiated into chondrocytes express an abundant, dense and a hyaline-like cartilage matrix. By contrast, despite their expression of cartilage markers, UCM-MSCs failed to express a relevant cartilage matrix after chondrogenic induction. Both MSCs types also displayed intrinsic differences at their undifferentiated basal status, UCB-MSCs expressing higher levels of chondrogenic markers whereas UCM-MSCs synthesizing higher amounts of osteogenic markers. Our results suggest that UCB-MSCs should be preferred for ex-vivo horse cartilage engineering. How those results should be translated to in vivo direct cartilage regeneration remains to be determined through dedicated study.
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Lumholdt M, Damgaard KA, Christensen EF, Leutscher PDC. Mathematical arterialisation of peripheral venous blood gas for obtainment of arterial blood gas values: a methodological validation study in the clinical setting. J Clin Monit Comput 2018; 33:733-740. [PMID: 30196470 DOI: 10.1007/s10877-018-0197-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2018] [Accepted: 09/04/2018] [Indexed: 10/28/2022]
Abstract
Arterial blood gas (ABG) analysis is an essential tool in the clinical assessment of acutely ill patients. Venous to arterial conversion (v-TAC), a mathematical method, has been developed recently to convert peripheral venous blood gas (VBG) values to arterialized VBG (aVBG) values. The aim of this study was to test the validity of aVBG compared to ABG in an emergency department (ED) setting. Twenty ED patients were included in this study. ABG and three aVBG samples were collected from each patient. The aVBG samples were processed in three different ways to investigate appropriate sample handling. All VBG samples were arterialized using the v-TAC method. ABG and aVBG samples were compared using Lin's concordance correlation coefficient (CCC), Bland-Altman plots and misclassification analysis. Clinical acceptable threshold of aVBG value deviance from ABG values were ± 0.05 pH units, ± 0.88 kPa pCO2 and ± 0.88 kPa pO2. CCC revealed an agreement in pH and pCO2 parameters for both aVBG in comparison to ABG. In all aVBG samples, an overestimation of pO2 compared to ABG was observed. Bland-Altman plot revealed clinically acceptable mean difference and limits-of-agreement intervals between ABG and aVBG pH and pCO2, but not between ABG and aVBG pO2. Arterialization of VBG using v-TAC is a valid method for measuring pH and pCO2, but not for pO2. Larger clinical studies are required to evaluate the applicability of v-TAC in different patient subpopulations.
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Affiliation(s)
- Mads Lumholdt
- Department of Anaesthesiology, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark. .,Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark. .,Clinical Institute, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark. .,, Hals, Denmark.
| | - Kjeld Asbjørn Damgaard
- Department of Anaesthesiology, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark
| | - Erika Frischknecht Christensen
- Centre for Prehospital and Emergency Research, Clinical Institute, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
| | - Peter Derek Christian Leutscher
- Centre for Clinical Research, North Denmark Regional Hospital, Bispensgade 37, 9800, Hjørring, Denmark.,Clinical Institute, Aalborg University, Søndre Skovvej 11, 9000, Aalborg, Denmark
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Martha SR, Collier LA, Davis SM, Seifert HA, Leonardo CC, Ajmo CT, Foran EA, Fraser JF, Pennypacker KR. Translational Evaluation of Acid/Base and Electrolyte Alterations in Rodent Model of Focal Ischemia. J Stroke Cerebrovasc Dis 2018; 27:2746-2754. [PMID: 30068479 DOI: 10.1016/j.jstrokecerebrovasdis.2018.05.045] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Revised: 04/27/2018] [Accepted: 05/28/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND PURPOSE Acid/base and electrolytes could provide clinically valuable information about cerebral infarct core and penumbra. We evaluated associations between acid/base and electrolyte changes and outcomes in 2 rat models of stroke, permanent, and transient middle cerebral artery occlusion. METHODS Three-month old Sprague-Dawley rats underwent permanent or transient middle cerebral artery occlusion. Pre- and post-middle cerebral artery occlusion venous samples for permanent and transient models provided pH, carbon dioxide, oxygen, glucose, and electrolyte values of ionized calcium, potassium, and sodium. Multiple regression determined predictors of infarct volume from these values, and Kaplan-Meier curve analyzed morality between permanent and transient middle cerebral artery occlusion models. RESULTS Analysis indicated significant differences in the blood gas and electrolytes between pre- to post-middle cerebral artery occlusion. A decrease in pH and sodium with increases in carbon dioxide, potassium, ionized calcium, and glucose changes were found in both middle cerebral artery occlusion models; while hematocrit and hemoglobin were significant in the transient model. pH and ionized calcium were predictors of infarct volume in the permanent model, as changes in pH and ionized calcium decreased, infarct volume increased. CONCLUSIONS There are acute changes in acid/base balance and electrolytes during stroke in transient and permanent rodent models. Additionally, we found pH and ionized calcium changes predicted stroke volume in the permanent middle cerebral artery occlusion model. These preliminary findings are novel, and warrant further exploration in human conditions.
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Affiliation(s)
- Sarah R Martha
- College of Nursing, University of Kentucky, Lexington, Kentucky.
| | - Lisa A Collier
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Stephanie M Davis
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Hilary A Seifert
- Department of Neurology, School of Medicine, Oregon Health & Science University, Portland, Oregon
| | - Christopher C Leonardo
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of Southern Florida, Tampa, Florida
| | - Craig T Ajmo
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of Southern Florida, Tampa, Florida
| | - Elspeth A Foran
- Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of Southern Florida, Tampa, Florida
| | - Justin F Fraser
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, Kentucky; Department of Neurosurgery, College of Medicine, University of Kentucky, Lexington, Kentucky; Department of Neuroscience, College of Medicine, University of Kentucky, Lexington, Kentucky; Department of Radiology, College of Medicine, University of Kentucky, Lexington, Kentucky
| | - Keith R Pennypacker
- Department of Neurology, College of Medicine, University of Kentucky, Lexington, Kentucky; Department of Neuroscience, College of Medicine, University of Kentucky, Lexington, Kentucky
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Bingheng L, Jianxin C, Yu C, Yijuan Y. Comparison of peripheral venous and arterial blood gas in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD): a meta-analysis. Notf Rett Med 2018. [DOI: 10.1007/s10049-018-0469-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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26
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The Relationship between Arterial and Central Venous Blood Gases Values in Patients Undergoing Mechanical Ventilation after Cardiac Surgery. Anesth Pain Med 2018. [DOI: 10.5812/aapm.10.5812/aapm.74243] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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White HD, Vazquez-Sandoval A, Quiroga PF, Song J, Jones SF, Arroliga AC. Utility of venous blood gases in severe sepsis and septic shock. Proc (Bayl Univ Med Cent) 2018; 31:269-275. [PMID: 29904286 DOI: 10.1080/08998280.2018.1460133] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 02/26/2018] [Accepted: 02/28/2018] [Indexed: 01/31/2023] Open
Abstract
Acid-base status is frequently assessed in severe sepsis and septic shock. Venous blood gas sampling is proposed as a less-invasive modality but lacks evidence within this population. The objective of this study was to evaluate the correlation and agreement between arterial blood gas (ABG), peripheral venous blood gas (pVBG), and central venous blood gas (cVBG) in severe sepsis and septic shock. We conducted a prospective, observational cohort study in subjects admitted to the medical intensive care unit. Simultaneous blood gas samples, including ABG, pVBG, and cVBG, were analyzed for correlation and agreement. Severity of illness scores revealed a mean (±SD) Sequential Organ Failure Assessment score of 7.9 ± 3.3, Simplified Acute Physiology II score of 49.3 ± 16.5, and a mortality rate of 11.9% in the intensive care unit and 16.4% in the hospital. We found a strong intraclass correlation (>0.85) for pH, partial pressure of carbon dioxide (pCO2), bicarbonate, and base excess for ABG/pVBG, ABG/cVBG, and pVBG/cVBG comparisons. Agreement by the Bland-Altman method was found for pH (bias ± SD, 0.03 ± 0.04, 0.03 ± 0.02, and 0.00 ± 0.03) but not for pCO2, partial pressure of oxygen, bicarbonate, base excess, and oxyhemoglobin saturation. In conclusion, adequate correlation and agreement between ABG/pVBG, ABG/cVBG, and pVBG/cVBG comparisons was found only for pH. The current level of evidence does not support the use of venous blood gas sampling in this setting.
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Affiliation(s)
- Heath D White
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor Scott & White Health, Temple, Texas
| | - Alfredo Vazquez-Sandoval
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor Scott & White Health, Temple, Texas
| | - Pedro F Quiroga
- Division of Pulmonary and Critical Care Medicine, Maricopa Medical Center, Phoenix, Arizona
| | - Juhee Song
- Department of Biostatistics, Baylor Scott & White Health, Temple, Texas
| | - Shirley F Jones
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor Scott & White Health, Temple, Texas
| | - Alejandro C Arroliga
- Division of Pulmonary, Critical Care, and Sleep Medicine, Baylor Scott & White Health, Temple, Texas
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Estimating Arterial Partial Pressure of Carbon Dioxide in Ventilated Patients: How Valid Are Surrogate Measures? Ann Am Thorac Soc 2018; 14:1005-1014. [PMID: 28570147 DOI: 10.1513/annalsats.201701-034fr] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The arterial partial pressure of carbon dioxide (PaCO2) is an important parameter in critically ill, mechanically ventilated patients. To limit invasive procedures or for more continuous monitoring of PaCO2, clinicians often rely on venous blood gases, capnography, or transcutaneous monitoring. Each of these has advantages and limitations. Central venous Pco2 allows accurate estimation of PaCO2, differing from it by an amount described by the Fick principle. As long as cardiac output is relatively normal, central venous Pco2 exceeds the arterial value by approximately 4 mm Hg. In contrast, peripheral venous Pco2 is a poor predictor of PaCO2, and we do not recommend using peripheral venous Pco2 in this manner. Capnography offers measurement of the end-tidal Pco2 (PetCO2), a value that is close to PaCO2 when the lung is healthy. It has the advantage of being noninvasive and continuously available. In mechanically ventilated patients with lung disease, however, PetCO2 often differs from PaCO2, sometimes by a large degree, often seriously underestimating the arterial value. Dependence of PetCO2 on alveolar dead space and ventilator expiratory time limits its value to predict PaCO2. When lung function or ventilator settings change, PetCO2 and PaCO2 can vary in different directions, producing further uncertainty. Transcutaneous Pco2 measurement has become practical and reliable. It is promising for judging steady state values for PaCO2 unless there is overt vasoconstriction of the skin. Moreover, it can be useful in conditions where capnography fails (high-frequency ventilation) or where arterial blood gas analysis is burdensome (clinic or home management of mechanical ventilation).
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Rudkin SE, Anderson CL, Grogan TR, Elashoff DA, Treger RM. Assessing Acid–Base Status in Circulatory Failure: Relationship Between Arterial and Peripheral Venous Blood Gas Measurements in Hypovolemic Shock. J Intensive Care Med 2018. [DOI: 10.1177/0885066618762335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Background and Objectives: In severe circulatory failure agreement between arterial and mixed venous or central venous values is poor; venous values are more reflective of tissue acid–base imbalance. No prior study has examined the relationship between peripheral venous blood gas (VBG) values and arterial blood gas (ABG) values in hemodynamic compromise. The objective of this study was to examine the correlation between hemodynamic parameters, specifically systolic blood pressure (SBP) and the arterial–peripheral venous (A-PV) difference for all commonly used acid–base parameters (pH, Pco 2, and bicarbonate). Design, Setting, Participants, and Measurements: Data were obtained prospectively from adult patients with trauma. When an ABG was obtained for clinical purposes, a VBG was drawn as soon as possible. Patients were excluded if the ABG and VBG were drawn >10 minutes apart. Results: The correlations between A-PV pH, A-PV Pco 2, and A-PV bicarbonate and SBP were not statistically significant ( P = .55, .17, and .09, respectively). Although patients with hypotension had a lower mean arterial and peripheral venous pH and bicarbonate compared to hemodynamically stable patients, mean A-PV differences for pH and Pco 2 were not statistically different ( P = .24 and .16, respectively) between hypotensive and normotensive groups. Conclusions: In hypovolemic shock, the peripheral VBG does not demonstrate a higher CO2 concentration and lower pH compared to arterial blood. Therefore, the peripheral VBG is not a surrogate for the tissue acid–base status in hypovolemic shock, likely due to peripheral vasoconstriction and central shunting of blood to essential organs. This contrasts with the selective venous respiratory acidosis previously demonstrated in central venous and mixed venous measurements in circulatory failure, which is more reflective of acid–base imbalance at the tissue level than arterial blood. Further work needs to be done to better define the relationship between ABG and both central and peripheral VBG values in various types of shock.
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Affiliation(s)
- Scott E. Rudkin
- Department of Emergency Medicine, University of California, Irvine, CA, USA
| | - Craig L. Anderson
- Department of Emergency Medicine, University of California, Irvine, CA, USA
| | - Tristan R. Grogan
- Department of Medicine Statistics Core, University of California, Los Angeles, CA, USA
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - David A. Elashoff
- Department of Medicine Statistics Core, University of California, Los Angeles, CA, USA
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Richard M. Treger
- David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
- Division of Nephrology, Greater Los Angeles Veterans Affairs Healthcare System, Los Angeles, CA, USA
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Guang Y, Jie Z, Feng D, Hui L. Surrogate scale for evaluating respiratory function based on complete blood count parameters. J Clin Lab Anal 2018; 32:e22385. [PMID: 29333619 DOI: 10.1002/jcla.22385] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2017] [Accepted: 12/19/2017] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND In this study, we aimed to identify a simple method for evaluating respiratory function using complete blood count parameters. METHODS The complete blood count parameters, including red blood cell (RBC) count, hemoglobin (Hb) level, lymphocyte (Lym) and platelet (Plt) count, and partial pressure of oxygen (PO2 ) level, were measured using automated analyzers in patients with chronic obstructive pulmonary disease (COPD), aged subjects, and young subjects (control group). The red cell index (RCI) was calculated using the following equation: (RBC × Hb)/(Lym × Plt); in theory, the RCI is inversely proportional to the respiratory function. RESULTS We observed a significant relationship between the RCI and PCO2 values, and between the RCI and FEV1/FVC values (P < .05). The RCI in the COPD, and aged subject groups were all significantly higher than that in the control group (P < .05). The cutoff value for normal respiratory function was 2.3. The positive rates for an abnormal increase in RCI were also considerably higher in each observation group than in the control group (P < .05). CONCLUSION The RCI can be considered as a simple and effective tool for evaluating respiratory function.
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Affiliation(s)
- Yang Guang
- College of Medical Laboratory, Dalian Medical University, Dalian, China
| | - Zhou Jie
- College of Medical Laboratory, Dalian Medical University, Dalian, China
| | - Dong Feng
- College of Medical Laboratory, Dalian Medical University, Dalian, China
| | - Liu Hui
- College of Medical Laboratory, Dalian Medical University, Dalian, China
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31
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Kelly AM. Agreement between Arterial and Venous Blood Gases In Emergency Medical Care: A Systematic Review. HONG KONG J EMERG ME 2017. [DOI: 10.1177/102490791302000307] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Aim The objectives of this review are to describe the agreement between arterial and venous blood gas values for pH, pCO2, bicarbonate and base excess. Methods MEDLINE search of papers published 1966-September 2012 for studies comparing arterial and peripheral venous blood gas values for any of pH, pCO2, bicarbonate and base excess in adult patients with any condition in an emergency department setting. The outcome of interest was mean difference weighted for study sample size. Results The weighted mean arterio-venous difference in pH was 0.034 pH units (n=2087), with narrow limits of agreement. The weighted mean arterio-venous difference for pCO2 was 6.2 mmHg (n=1043), but with 95% limits of agreement up to the order of ±20mmHg. Venous pCO2<45 mmHg has 100% sensitivity and negative predictive value for prediction of arterial hypercarbia (n=529). For bicarbonate, the weighted mean difference between arterial and venous values was −1.20 mEq/L (n=1403), with 95% limits of agreement of the order of ±5 mmol/L. Regarding base excess, the mean arterio-venous difference was 0.4 (n=295) but data are conflicting regarding the width of 95% limits of agreement. Conclusion For patients who are not in shock, venous pH and bicarbonate have sufficient agreement to be clinically interchangeable for arterial values. Agreement between arterial and venous pCO2 is too poor and unpredictable to be clinically useful as a one-off test but venous pCO2 may be useful to screen for arterial hypercarbia.
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JEONG DH, YANG JJ, LEE L, YEON SC. Prediction of arterial blood gas values from venous blood gas values in Asiatic black bears (Ursus thibetanus) anesthetized with intramuscular medetomidine and zolazepam-tiletamine. J Vet Med Sci 2017; 79:1757-1763. [PMID: 28890467 PMCID: PMC5658574 DOI: 10.1292/jvms.16-0596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2016] [Accepted: 08/17/2017] [Indexed: 11/22/2022] Open
Abstract
The objective of this study was to measure differences between arterial and venous blood gas parameters and to evaluate whether arterial blood gas values can be estimated from venous blood in Asiatic black bears (ABBs). Twelve healthy captive ABBs (8 males and 4 females; 8-16 years; 76.8-220 kg) were included in this study. The bears were immobilized with medetomidine and zolazepam-tiletamine using a dart gun. Arterial and venous samples were collected simultaneously at 5 and 35 min after recumbency (5- and 35-min points). Partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), pH, bicarbonate (HCO3-), total carbon dioxide (TCO2), oxygen saturation of hemoglobin (SO2) and base excess (BEecf) were analyzed using a portable blood gas analyzer. There was no marked difference in measured and calculated variables over time in both venous and arterial blood except for PO2. However, arterial PO2, SO2 and pH were significantly higher and arterial PCO2, TCO2 and HCO3- were lower than those of venous samples at both 5- and 35-min points. In the regression analysis to estimate arterial values from venous values, PCO2, TCO2, HCO3-, BEecf and pH significantly showed over 0.45 in coefficient of determination value (R2), and there were little differences between actual and predicted arterial values. Although there were limits in venous gas values replaced those of arterial blood, if we could not get the arterial samples, the regression formulas for arterial values from venous blood in this study would be useful clinically, except for PO2 and SO2.
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Affiliation(s)
- Dong-Hyuk JEONG
- Species Restoration Technology Institute of Korea National
Park Service, Gurye 542-853, Republic of Korea
| | - Jeong-Jin YANG
- Species Restoration Technology Institute of Korea National
Park Service, Gurye 542-853, Republic of Korea
| | - Lyon LEE
- Laboratory of Veterinary Anesthesia and Pain Management,
College of Veterinary Medicine, Western University, Pormona, CA 91766, U.S.A
| | - Seong-Chan YEON
- Laboratory of Veterinary Surgery and Behavior, College of
Veterinary Medicine, Gyeongsang National University, Jinju 660-701, Republic of
Korea
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Tang R, Yang H, Choi JR, Gong Y, You M, Wen T, Li A, Li X, Xu B, Zhang S, Mei Q, Xu F. Capillary blood for point-of-care testing. Crit Rev Clin Lab Sci 2017; 54:294-308. [PMID: 28763247 DOI: 10.1080/10408363.2017.1343796] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Clinically, blood sample analysis has been widely used for health monitoring. In hospitals, arterial and venous blood are utilized to detect various disease biomarkers. However, collection methods are invasive, painful, may result in injury and contamination, and skilled workers are required, making these methods unsuitable for use in a resource-limited setting. In contrast, capillary blood is easily collected by a minimally invasive procedure and has excellent potential for use in point-of-care (POC) health monitoring. In this review, we first discuss the differences among arterial blood, venous blood, and capillary blood in terms of the puncture sites, components, sample volume, collection methods, and application areas. Additionally, we review the most recent advances in capillary blood-based commercial products and microfluidic instruments for various applications. We also compare the accuracy of microfluidic-based testing with that of laboratory-based testing for capillary blood-based disease diagnosis at the POC. Finally, we discuss the challenges and future perspectives for developing capillary blood-based POC instruments.
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Affiliation(s)
- Ruihua Tang
- a School of Life Sciences , Northwestern Polytechnical University , Xi'an , P.R. China.,b Key Laboratory for Space Bioscience and Biotechnology , Northwestern Polytechnical University , Xi'an , P.R. China.,c Bioinspired Engineering and Biomechanics Center (BEBC) , Xi'an Jiaotong University , Xi'an , P.R. China.,d College of Bioresources Chemical and Materials Engineering , Shaanxi University of Science and Technology , Xi'an , China
| | - Hui Yang
- a School of Life Sciences , Northwestern Polytechnical University , Xi'an , P.R. China.,b Key Laboratory for Space Bioscience and Biotechnology , Northwestern Polytechnical University , Xi'an , P.R. China
| | - Jane Ru Choi
- c Bioinspired Engineering and Biomechanics Center (BEBC) , Xi'an Jiaotong University , Xi'an , P.R. China
| | - Yan Gong
- c Bioinspired Engineering and Biomechanics Center (BEBC) , Xi'an Jiaotong University , Xi'an , P.R. China.,e The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology , Xi'an Jiaotong University , Xi'an , P.R. China.,f Xi'an Diandi Biotech Company , Xi'an , P.R. China
| | - MinLi You
- c Bioinspired Engineering and Biomechanics Center (BEBC) , Xi'an Jiaotong University , Xi'an , P.R. China.,e The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology , Xi'an Jiaotong University , Xi'an , P.R. China
| | - Ting Wen
- f Xi'an Diandi Biotech Company , Xi'an , P.R. China
| | - Ang Li
- g Key Laboratory of Shaanxi Province for Craniofacial Precision Medicine Research, College of Stomatology , Xi'an Jiaotong University , Xi'an , P.R. China
| | - XiuJun Li
- h Department of Chemistry , University of Texas at El Paso , El Paso , TX , USA
| | - Bo Xu
- i School of Finance and Economics , Xi'an Jiaotong University , Xi'an , P.R. China
| | - Sufeng Zhang
- d College of Bioresources Chemical and Materials Engineering , Shaanxi University of Science and Technology , Xi'an , China
| | - Qibing Mei
- a School of Life Sciences , Northwestern Polytechnical University , Xi'an , P.R. China.,b Key Laboratory for Space Bioscience and Biotechnology , Northwestern Polytechnical University , Xi'an , P.R. China
| | - Feng Xu
- c Bioinspired Engineering and Biomechanics Center (BEBC) , Xi'an Jiaotong University , Xi'an , P.R. China.,e The Key Laboratory of Biomedical Information Engineering of Ministry of Education, School of Life Science and Technology , Xi'an Jiaotong University , Xi'an , P.R. China
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Esmaeilivand M, Khatony A, Moradi G, Najafi F, Abdi A. Agreement and Correlation between Arterial and Central Venous Blood Gas Following Coronary Artery Bypass Graft Surgery. J Clin Diagn Res 2017; 11:OC43-OC46. [PMID: 28511435 DOI: 10.7860/jcdr/2017/23473.9547] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2016] [Accepted: 10/14/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Arterial blood sampling, used to assess patients in acute conditions, may result in complications such as thrombosis and embolism. However, it can be replaced by venous blood sampling, but there is a dearth of information on this. AIM To assess the correlation and agreement between the arterial and central venous blood gases analyses in patients undergoing elective Coronary Artery Bypass Graft (CABG) surgery. MATERIALS AND METHODS In this cross-sectional study, 100 ICU patients undergoing elective CABG surgery were recruited. 2 mm arterial and a 2 mm venous blood samples were obtained from each patient's arterial and central venous lines, respectively. To predict Arterial Blood Gas (ABG) values based on central Venous Blood Gas (VBG) values, the linear regression analysis was used and for evaluating their agreement Bland-Altman method was used. RESULTS In total of 200 samples were obtained. The mean and Standard Deviation (SD) of age was 58.9±9.1 years and 51% of the participants were female. There was a strong correlation between ABG and central VBG values regarding pH, partial Pressure of Carbon Dioxide (PCO2), Bicarbonate (HCO3) and Base Excess (BE) (r= 0.73, r=0.74, r=0.67 and r=0.71, respectively; p<0.001); however, the correlation between the arterial and venous Partial Pressure of Oxygen (PO2) and Oxygen Saturation (SO2) was moderate (r=0.29, p=0.005 and r=0.27, p=0.006, respectively). The Bland-Altman analysis showed an excellent agreement between all the variables (p<0.001). CONCLUSION Central VBG analysis cannot replace ABG analysis in measuring exact PO2 status, necessitating arterial sampling in some matters, but with respect to the accuracy of pulse oximetry measurements in determining the exact PO2 status, for the rest of the indices a central VBG rather than an ABG can be utilised for determining patient's acid-base status. Particularly in patients who are hospitalised for a long time and have a central venous catheter in place like patients who have undergone CABG, thus reducing the risk and need for invasive arterial sampling.
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Affiliation(s)
- Masoumeh Esmaeilivand
- Lecturer, Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Associate Professor, Department of Nursing, Nursing and Midwifery School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Gholamreza Moradi
- Assistant Professor, Department of Anesthesiology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Farid Najafi
- Professor, Department of Epidemiology, Research Center for Environmental Determinants of Health (RCEDH), Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Assistant Professor, Department of Nursing, School of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Zeserson E, Goodgame B, Hess JD, Schultz K, Hoon C, Lamb K, Maheshwari V, Johnson S, Papas M, Reed J, Breyer M. Correlation of Venous Blood Gas and Pulse Oximetry With Arterial Blood Gas in the Undifferentiated Critically Ill Patient. J Intensive Care Med 2016; 33:176-181. [PMID: 27283009 DOI: 10.1177/0885066616652597] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
RATIONALE Blood gas analysis is often used to assess acid-base, ventilation, and oxygenation status in critically ill patients. Although arterial blood gas (ABG) analysis remains the gold standard, venous blood gas (VBG) analysis has been shown to correlate with ABG analysis and has been proposed as a safer less invasive alternative to ABG analysis. OBJECTIVE The purpose of this study was to evaluate the correlation of VBG analysis plus pulse oximetry (SpO2) with ABG analysis. METHODS We performed a prospective cohort study of patients in the emergency department (ED) and intensive care unit (ICU) at a single academic tertiary referral center. Patients were eligible for enrollment if the treating physician ordered an ABG. Statistical analysis of VBG, SpO2, and ABG data was done using paired t test, Pearson χ2, and Pearson correlation. MAIN RESULTS There were 156 patients enrolled, and 129 patients completed the study. Of the patients completing the study, 53 (41.1%) were in the ED, 41 (31.8%) were in the medical ICU, and 35 (27.1%) were in the surgical ICU. The mean difference for pH between VBG and ABG was 0.03 (95% confidence interval: 0.03-0.04) with a Pearson correlation of 0.94. The mean difference for pCO2 between VBG and ABG was 4.8 mm Hg (95% confidence interval: 3.7-6.0 mm Hg) with a Pearson correlation of 0.93. The SpO2 correlated well with PaO2 (the partial pressure of oxygen in arterial blood) as predicted by the standard oxygen-hemoglobin dissociation curve. CONCLUSION In this population of undifferentiated critically ill patients, pH and pCO2 on VBG analysis correlated with pH and pCO2 on ABG analysis. The SpO2 correlated well with pO2 on ABG analysis. The combination of VBG analysis plus SpO2 provided accurate information on acid-base, ventilation, and oxygenation status for undifferentiated critically ill patients in the ED and ICU.
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Affiliation(s)
- Eli Zeserson
- 1 Department of Emergency Medicine, Christiana Care Health System, Newark, DE, USA
| | - Ben Goodgame
- 1 Department of Emergency Medicine, Christiana Care Health System, Newark, DE, USA
| | - J Daniel Hess
- 1 Department of Emergency Medicine, Christiana Care Health System, Newark, DE, USA
| | - Kristine Schultz
- 1 Department of Emergency Medicine, Christiana Care Health System, Newark, DE, USA
| | - Cynthia Hoon
- 1 Department of Emergency Medicine, Christiana Care Health System, Newark, DE, USA
| | - Keith Lamb
- 2 Department of Respiratory Care, Unity Point Health, Des Moines, IA, USA
| | - Vinay Maheshwari
- 3 Department of Medicine, Christiana Care Health System, Newark, DE, USA
| | - Steven Johnson
- 4 Department of Surgery, Capital Health, Trenton, NJ, USA
| | - Mia Papas
- 5 Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE, USA
| | - James Reed
- 1 Department of Emergency Medicine, Christiana Care Health System, Newark, DE, USA
| | - Michael Breyer
- 6 Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA
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Suau SJ, DeBlieux PMC. Management of Acute Exacerbation of Asthma and Chronic Obstructive Pulmonary Disease in the Emergency Department. Emerg Med Clin North Am 2016; 34:15-37. [PMID: 26614239 DOI: 10.1016/j.emc.2015.08.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Acute asthma and chronic obstructive pulmonary disease (COPD) exacerbations are the most common respiratory diseases requiring emergent medical evaluation and treatment. Asthma and COPD are chronic, debilitating disease processes that have been differentiated traditionally by the presence or absence of reversible airflow obstruction. Asthma and COPD exacerbations impose an enormous economic burden on the US health care budget. In daily clinical practice, it is difficult to differentiate these 2 obstructive processes based on their symptoms, and on their nearly identical acute treatment strategies; major differences are important when discussing anatomic sites involved, long-term prognosis, and the nature of inflammatory markers.
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Affiliation(s)
- Salvador J Suau
- Louisiana State University, University Medical Center of New Orleans, 2000 Canal Street, D&T 2nd Floor - Suite 2720, New Orleans, LA 70112, USA.
| | - Peter M C DeBlieux
- Louisiana State University, University Medical Center of New Orleans, 2000 Canal Street, D&T 2nd Floor - Suite 2720, New Orleans, LA 70112, USA
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Saikia B, Kumar N, Sreenivas V. Prediction of extubation failure in newborns, infants and children: brief report of a prospective (blinded) cohort study at a tertiary care paediatric centre in India. SPRINGERPLUS 2015; 4:827. [PMID: 26753114 PMCID: PMC4695462 DOI: 10.1186/s40064-015-1607-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 12/13/2015] [Indexed: 12/03/2022]
Abstract
BACKGROUND Extubation failure (EF), defined as need for re-intubation within 24-72 h, is multifactorial. Factors predicting EF in adults generally are not useful in children. OBJECTIVE To determine the factors associated with EF and to facilitate prediction of EF in mechanically ventilated infants and children less than 12 years of age. MATERIAL AND METHODS Design Prospective cohort study. Setting PICU and NICU of a multispecialty tertiary care institute. Patients All consecutive newborns, infants and children, who remained on the ventilator for more than 12 h, were included. Patients with upper airway obstruction, neuromuscular disorders, complex anatomic malformations, accidental extubation, tracheostomy or death before extubation were excluded. Methods The pre-extubation clinical, laboratory and ventilatory parameters were collected for 92 cases over a one and half year period. The EF rate was calculated for each variable using STATA 9. All the treating physicians were blinded to the data collection procedure. MEASUREMENTS AND RESULTS Demographics were comparable between the extubation success and EF groups. Respiratory failure was the main cause requiring ventilation (46.74 %, 95 % CI 0.37-0.57) as well as EF (30.23 %, 95 % CI 0.08-0.23). 76.92 % (95 % CI 0.58-0.89) of patients that failed extubation had alterations in respiratory effort, 38.46 % (95 % CI 0.22-0.57) each had either poor or increased respiratory effort. Poor cough reflex (p = 0.001), thick endotracheal secretions (p = 0.02), failed spontaneous breathing trial (SBT) (p = 0.001) and higher rapid shallow breathing index (RSBI) (p = 0.001) were found to be associated with EF. CONCLUSIONS Paediatric EF is multifactorial. Increased or poor respiratory effort and failed SBT are potential factors in deciding re-intubation. Increased RSBI, poor cough reflex and thick.
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Affiliation(s)
- Bedangshu Saikia
- />Department of Paediatrics and Neonatology, St Stephens Hospital, Tis Hazari, New Delhi, 110054 India
| | - Nirmal Kumar
- />Department of Paediatrics and Neonatology, St Stephens Hospital, Tis Hazari, New Delhi, 110054 India
| | - Vishnubhatla Sreenivas
- />Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, 110029 India
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Ibrahim I, Yau YW, Ong L, Chan YH, Kuan WS. Arterial puncture using insulin needle is less painful than with standard needle: a randomized crossover study. Acad Emerg Med 2015; 22:315-20. [PMID: 25731215 DOI: 10.1111/acem.12601] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2014] [Revised: 09/17/2014] [Accepted: 09/22/2014] [Indexed: 11/29/2022]
Abstract
OBJECTIVES Arterial punctures are important procedures performed by emergency physicians in the assessment of ill patients. However, arterial punctures are painful and can create anxiety and needle phobia in patients. The pain score of radial arterial punctures were compared between the insulin needle and the standard 23-gauge hypodermic needle. METHODS In a randomized controlled crossover design, healthy volunteers were recruited to undergo bilateral radial arterial punctures. They were assigned to receive either the insulin or the standard needle as the first puncture, using blocked randomization. The primary outcome was the pain score measured on a 100-mm visual analogue scale (VAS) for pain, and secondary outcomes were rate of hemolysis, mean potassium values, and procedural complications immediately and 24 hours postprocedure. RESULTS Fifty healthy volunteers were included in the study. The mean (±standard deviation) VAS score in punctures with the insulin needle was lower than the standard needle (23 ± 22 mm vs. 39 ± 24 mm; mean difference = -15 mm; 95% confidence interval = -22 mm to -7 mm; p < 0.001). The rates of hemolysis and mean potassium value were greater in samples obtained using the insulin needle compared to the standard needle (31.3% vs. 11.6%, p = 0.035; and 4.6 ±0.7 mmol/L vs. 4.2 ±0.5 mmol/L, p = 0.002). Procedural complications were lower in punctures with the insulin needle both immediately postprocedure (0% vs. 24%; p < 0.001) and at 24 hours postprocedure (5.4% vs. 34.2%; p = 0.007). CONCLUSIONS Arterial punctures using insulin needles cause less pain and fewer procedural complications compared to standard needles. However, due to the higher rate of hemolysis, its use should be limited to conditions that do not require a concurrent potassium value in the same blood sample.
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Affiliation(s)
- Irwani Ibrahim
- The Emergency Medicine Department and Department of Surgery; National University Health System; Singapore
| | - Ying Wei Yau
- The Emergency Medicine Department and Department of Surgery; National University Health System; Singapore
| | - Lizhen Ong
- The Department of Laboratory Medicine; National University Health System; Singapore
| | - Yiong Huak Chan
- The Biostatistics Department; National University Health System; Singapore
| | - Win Sen Kuan
- The Emergency Medicine Department and Department of Surgery; National University Health System; Singapore
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Kurisu S, Watanabe N, Ikenaga H, Higaki T, Shimonaga T, Iwasaki T, Ishibashi K, Dohi Y, Fukuda Y, Kihara Y. Effects of Cardiac Hemodynamics on Agreement in the pH, HCO3- and Lactate Levels between Arterial and Venous Blood Samples in Patients with Known or Suspected Chronic Heart Failure. Intern Med 2015; 54:1841-7. [PMID: 26234223 DOI: 10.2169/internalmedicine.54.3995] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE Analyses of arterial blood gas parameters, including pH, HCO3- and lactate, play an important role in assessing the clinical status of patients with heart failure. In the present study, we evaluated the degree of agreement in the pH, HCO3- and lactate levels between arterial and venous blood samples according to the subset of the Forrester classification. METHODS The study population consisted of 128 patients with known or suspected heart failure. The subjects were divided into four groups based on the Forrester classification. Arterial blood samples were drawn from the radial or brachial artery, and venous blood samples were drawn from the pulmonary artery. RESULTS There were 59 patients with a Forrester subset I status, 32 patients with a subset II status, 21 patients with a subset III status and 16 patients with a subset IV status. The pH and HCO3- levels were similar between the four subsets. In all subsets, the pH values were significantly higher and the HCO3- values were significantly lower in the arterial blood samples than in the venous blood samples. There was good correlation and agreement in the pH and HCO3- levels between the arterial and venous blood samples. In contrast, there was a significant difference in the lactate levels in both the arterial and venous blood samples between the four subsets, and the lactate levels were highest in subset IV. In all subsets, there was good correlation and agreement in the lactate levels between the arterial and venous blood samples. CONCLUSION These data suggest that the venous pH, HCO3- and lactate levels are acceptable substitutes for arterial parameters, regardless of the cardiac hemodynamics.
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Affiliation(s)
- Satoshi Kurisu
- Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Japan
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40
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[Concordance between central venous and arterial blood gases in post-surgical myocardial revascularization patients in stable condition]. ARCHIVOS DE CARDIOLOGIA DE MEXICO 2014; 84:147-54. [PMID: 25113548 DOI: 10.1016/j.acmx.2013.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2013] [Revised: 09/30/2013] [Accepted: 11/14/2013] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE The concordance between the parameters of arterial and central venous blood gases has not been defined yet. We studied the concordance between both parameters in post-surgical myocardial revascularization patients in stable condition. METHODS Consecutive subjects were studied in a cross-sectional design. The position of the central venous catheter was performed and simultaneously we obtained arterial and central venous blood samples prior to discharge from the intensive care unit. Data are expressed according to Bland-Altman statistical method and the intraclass correlation coefficient. Statistical result was accepted at P<.05. RESULTS Two hundred and six samples were studied of 103 post-surgical patients, pH and lactate had a mean difference (limits of agreement) 0.029±0.048 (-0018, 0.077) and -0.12±0.22 (-0.57, 0.33) respectively. The magnitude of the intraclass correlation coefficient was 0.904 and 0.943 respectively. The values related to oxygen pressure were 27.86±6.08 (15.9, 39.8) and oxygen saturation 33.02±6.13 (21, 45), with magnitude of 0.258 and 0.418 respectively. CONCLUSION The best matching parameters between arterial and central venous blood samples were pH and lactate.
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Techniques for the Measurement and Monitoring of Carbon Dioxide in the Blood. Ann Am Thorac Soc 2014; 11:645-52. [DOI: 10.1513/annalsats.201311-387fr] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Schmid C, Baumstark A, Pleus S, Haug C, Tesar M, Freckmann G. Impact of partial pressure of oxygen in blood samples on the performance of systems for self-monitoring of blood glucose. Diabetes Technol Ther 2014; 16:156-65. [PMID: 24205977 PMCID: PMC3934604 DOI: 10.1089/dia.2013.0184] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
BACKGROUND The partial pressure of oxygen (pO2) in blood samples can affect glucose measurements with oxygen-sensitive systems. In this study, we assessed the influence of different pO2 levels on blood glucose (BG) measurements with five glucose oxidase (GOD) systems and one glucose dehydrogenase (GDH) system. All selected GOD systems were indicated by the manufacturers to be sensitive to increased oxygen content of the blood sample. MATERIALS AND METHODS Venous blood samples of 16 subjects (eight women, eight men; mean age, 52 years; three with type 1 diabetes, four with type 2 diabetes, and nine without diabetes) were collected. Aliquots of each sample were adjusted to the following pO2 values: ≤45 mm Hg, approximately 70 mm Hg, and ≥150 mm Hg. For each system, five consecutive measurements on each sample were performed using the same test strip lot. Relative differences between the mean BG value at a pO2 level of approximately 70 mm Hg, which was considered to be similar to pO2 values in capillary blood samples, and the mean BG value at pO2 levels ≤45 mm Hg and ≥150 mm Hg were calculated. RESULTS The GOD systems showed mean relative differences between 11.8% and 44.5% at pO2 values ≤45 mm Hg and between -14.6% and -21.2% at pO2 values ≥150 mm Hg. For the GDH system, the mean relative differences were -0.3% and -0.2% at pO2 values ≤45 mm Hg and ≥150 mm Hg, respectively. CONCLUSIONS The magnitude of the pO2 impact on BG measurements seems to vary among the tested oxygen-sensitive GOD systems. The pO2 range in which oxygen-sensitive systems operate well should be provided in the product information.
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Affiliation(s)
- Christina Schmid
- Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm , Ulm, Germany
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Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. Peripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis. Respirology 2014; 19:168-175. [DOI: 10.1111/resp.12225] [Citation(s) in RCA: 93] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2013] [Revised: 10/09/2013] [Accepted: 11/03/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Anthony L Byrne
- Department of Respiratory Medicine; Prince of Wales Hospital; Randwick NSW Australia
| | - Michael Bennett
- Wales Anaesthesia; Prince of Wales Hospital; Randwick NSW Australia
- Faculty of Medicine; University of New South Wales; Sydney NSW Australia
| | - Robindro Chatterji
- Faculty of Medicine; University of New South Wales; Sydney NSW Australia
| | - Rebecca Symons
- Faculty of Medicine; University of New South Wales; Sydney NSW Australia
| | - Nathan L Pace
- Department of Anesthesiology; School of Medicine; University of Utah; Salt Lake City UT USA
| | - Paul S Thomas
- Department of Respiratory Medicine; Prince of Wales Hospital; Randwick NSW Australia
- Inflammation and Infection Research Centre (IIRC); Faculty of Medicine; University of New South Wales; Sydney NSW Australia
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Baumstark A, Schmid C, Pleus S, Haug C, Freckmann G. Influence of partial pressure of oxygen in blood samples on measurement performance in glucose-oxidase-based systems for self-monitoring of blood glucose. J Diabetes Sci Technol 2013; 7:1513-21. [PMID: 24351177 PMCID: PMC3876329 DOI: 10.1177/193229681300700611] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Partial pressure of oxygen (pO2) in blood samples can affect blood glucose (BG) measurements, particularly in systems that employ the glucose oxidase (GOx) enzyme reaction on test strips. In this study, we assessed the impact of different pO2 values on the performance of five GOx systems and one glucose dehydrogenase (GDH) system. Two of the GOx systems are labeled by the manufacturers to be sensitive to increased blood oxygen content, while the other three GOx systems are not. METHODS Aliquots of 20 venous samples were adjusted to the following pO2 values: <45, ~70, and ≥150 mmHg. For each system, five consecutive measurements on each sample aliquot were performed using the same test strip lot. Relative differences between the mean BG results at pO2 ~70 mmHg, which is considered to be similar to pO2 in capillary blood samples, and the mean BG result at pO2 <45 and ≥150 mmHg were calculated. RESULTS For all tested GOx systems, mean relative differences in the BG measurement results were between 6.1% and 22.6% at pO2 <45 mmHg and between -7.9% and -14.9% at pO2 ≥150 mmHg. For both pO2 levels, relative differences of all tested GOx systems were significant (p < .0001). The GDH system showed mean relative differences of -1.0% and -0.4% at pO2 values <45 and ≥150 mmHg, respectively, which were not significant. CONCLUSIONS These data suggest that capillary blood pO2 variations lead to clinically relevant BG measurement deviations in GOx systems, even in GOx systems that are not labeled as being oxygen sensitive.
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Affiliation(s)
- Annette Baumstark
- Institut für Diabetes-Technologie Forschungs- und Entwicklungsgesellschaft mbH an der Universität Ulm, Helmholtzstrasse 20, 89081 Ulm, Germany
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Bulucu F, Çakar M, Kurt Ö, Yeşildal F, Şarlak H. Blood total carbon dioxide content and bicarbonate can be used together to predict blood pH correctly in venous blood samples. Ren Fail 2013; 36:145-6. [PMID: 24059345 DOI: 10.3109/0886022x.2013.832855] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Blood gas analyses are needed to reveal any kind of acid-base imbalance in some patients. Traditionally, arterial punctures are performed to obtain the blood samples for blood gas analyses. Arterial puncture is not a completely safe procedure. It may cause serious problems including arterial thrombosis, arteriovenous fistula, pseudoaneurysms and hematoma. In this retrospective reviewing, it was aimed to yield novel formulations to predict the blood pH only from CtCO2 and HCO3 values which can easily be measured in venous blood samples obtained for other diagnostic and follow-up purposes.
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Affiliation(s)
- Fatih Bulucu
- Department of Internal Medicine, Gulhane Medical Faculty , Ankara , Turkey and
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Masip J, De Mendoza D, Planas K, Paez J, Sanchez B, Cancio B. Peripheral venous blood gases and pulse-oximetry in acute cardiogenic pulmonary oedema. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2013; 1:275-80. [PMID: 24062917 DOI: 10.1177/2048872612457087] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2012] [Accepted: 07/15/2012] [Indexed: 11/15/2022]
Abstract
BACKGROUND The role of venous blood gases as an alternative to arterial blood gases in patients with severe acute heart failure has not been established. OBJECTIVE To assess the correlation between arterial and peripheral venous blood gases together with pulse-oximetry (SpO2), as well as to estimate arterial values from venous samples in the first hours upon admission of patients with acute cardiogenic pulmonary oedema. METHODS Simultaneous venous and arterial blood samples were extracted on admission and over the next 1, 2, 3, 4, and 10 hours. SpO2 was also registered at the same intervals. RESULTS A total of 178 pairs of samples were obtained from 34 consecutive patients with acute cardiogenic pulmonary oedema. Arterial and venous blood gases followed a parallel course in the first hours, showing high correlation rates at all time intervals. Venous samples underestimated pH (mean difference -0.028) and overestimated CO2 (+5.1 mmHg) and bicarbonate (+1 mEq/l). Conversely, SpO2 tended to underestimate SaO2 (mean±SD: 93.1±9.1 vs. 94.2±8.4). Applying simple mathematical formulae based on these differences, arterial values were empirically calculated from venous samples, showing acceptable agreement in the Bland-Altman test. Likewise, a venous pH <7.32, pCO2 >51.3 mmHg, and bicarbonate <22.8 mEq/l could fairly identify arterial acidosis, either respiratory or metabolic, with a test accuracy of 92, 68, and 91%, respectively. CONCLUSIONS In patients with cardiogenic pulmonary oedema, arterial blood gas disturbances may be estimated from peripheral venous samples. By monitoring SpO2 simultaneously, arterial punctures could often be avoided.
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Affiliation(s)
- J Masip
- University of Barcelona, Barcelona, Spain
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Heatley JJ, Cary J, Russell KE, Voelker G. Clinicopathologic analysis of Passeriform venous blood reflects transitions in elevation and habitat. VETERINARY MEDICINE-RESEARCH AND REPORTS 2013; 4:21-29. [PMID: 32670840 PMCID: PMC7337179 DOI: 10.2147/vmrr.s43195] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Accepted: 04/23/2013] [Indexed: 11/23/2022]
Abstract
Jugular blood samples from 110 Passeriformes collected at several Texas locations were analyzed for multiple clinicopathologic parameters between April 2010 and August 2011. Electrolyte, blood gas, and select erythrocyte parameters were analyzed on site with a point of care analyzer, and gender, age, body condition score, location, and species were recorded. Many analytes exhibited a Gaussian distribution across species and are reported as a single range. Taxon affected electrolyte and red blood cell parameters, but not most blood gas or acid base variables. Migratory status affected select electrolytes but few blood gas variables. Red blood cell parameters were affected the most by variables of age, taxonomic group, and gender, but not migratory life history. We found significant changes in glucose and numerous acid base analytes in birds sampled from habitats with evolutionarily recent ecologic degradation. We advocate the use of these analytes, particularly venous blood gas values, as determined by a point of care analyzer, as reasonable biomarkers for determination of Passeriform population health, but also recommend that red blood cell parameters and electrolyte concentrations be controlled for age, species, and gender in future studies. Further, based on our investigation, venous blood gas values and acid base balance in Passeriformes can assess the health of an ecosystem.
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Affiliation(s)
- J Jill Heatley
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine and Biomedical Sciences
| | - Jennifer Cary
- Department of Wildlife and Fisheries Sciences and Texas A&M Biodiversity Research and Teaching Collections, Texas A&M University
| | - Karen E Russell
- Department of Pathobiology, College of Veterinary Medicine and Biomedical Sciences, College Station, TX, USA
| | - Gary Voelker
- Department of Wildlife and Fisheries Sciences and Texas A&M Biodiversity Research and Teaching Collections, Texas A&M University
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Kim BR, Park SJ, Shin HS, Jung YS, Rim H. Correlation between peripheral venous and arterial blood gas measurements in patients admitted to the intensive care unit: A single-center study. Kidney Res Clin Pract 2013; 32:32-8. [PMID: 26889435 PMCID: PMC4716110 DOI: 10.1016/j.krcp.2013.01.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 01/03/2013] [Accepted: 01/09/2013] [Indexed: 11/06/2022] Open
Abstract
Background The objective of this study was to examine the correlation between arterial blood gas (ABG) and peripheral venous blood gas (VBG) samples for all commonly used parameters in patients admitted to a medical intensive care unit (ICU). Methods A single-center, prospective trial was carried out in a medical ICU in order to determine the level of correlation of ABG and peripheral VBG measurements. A maximum of five paired ABG–VBG samples were obtained per patient to prevent a single patient from dominating the data set. Results Regression equations were derived to predict arterial values from venous values as follows: arterial pH=−1.108+1.145×venous pH+0.008×PCO2−0.012×venous HCO3+0.002×venous total CO2 (R2=0.655), arterial PCO2=88.6−10.888×venous pH+0.150×PCO2+0.812×venous HCO3+0.124×venous total CO2 (R2=0.609), arterial HCO3=−89.266+12.677×venous pH+0.042×PCO2+0.675×venous HCO3+0.185×venous total CO2 (R2=0.782). The mean ABG minus peripheral VBG differences for pH, PCO2, and bicarbonates were not clinically important for between–person heterogeneity. Conclusion Peripheral venous pH, PCO2, bicarbonates, and total CO2 may be used as alternatives to their arterial equivalents in many clinical contexts encountered in the ICU.
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Affiliation(s)
- Bo Ra Kim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Sae Jin Park
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Ho Sik Shin
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Yeon Soon Jung
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
| | - Hark Rim
- Department of Internal Medicine, Kosin University College of Medicine, Busan, Korea
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RETRACTED: Concordance between peripheral venous and arterial blood gas measurements in Korean Patients admitted to the intensive care unit: A single center study. Kidney Res Clin Pract 2012. [DOI: 10.1016/j.krcp.2012.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Improving the validity of peripheral venous blood gas analysis as an estimate of arterial blood gas by correcting the venous values with SvO₂. J Emerg Med 2012; 44:709-16. [PMID: 22921853 DOI: 10.1016/j.jemermed.2012.07.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2011] [Revised: 03/15/2012] [Accepted: 07/03/2012] [Indexed: 01/19/2023]
Abstract
BACKGROUND Peripheral venous blood gas (pVBG) analysis in replacement of arterial blood gas (ABG) is limited by the unpredictable differences between arterial and venous values, especially for PCO2 and pH (ΔPCO2 and ΔpH). OBJECTIVES We hypothesized that, using the theoretical relationship linking SvO2 and blood flow, we could diminish the effect of local circulatory conditions on ΔPCO2 and ΔpH and thereby increase pVBG validity. METHODS This was a prospective cross-sectional study performed in emergency patients requiring a blood gas analysis in which ABG and pVBG were performed simultaneously. The data of 50 randomly selected patients (model group) were used for developing two equations to correct PvCO2 and pHv according to the peripheral SvO2 (SpvO2) level. The formulas derived were PvCO2cor = PvCO2 - 0.30 × (75 - SpvO2), and pHvcor = pHv + 0.001 × (75 - SpvO2). The validity of the corrected values was then tested on the remaining population (validation group). RESULTS There were 281 patients included in the study, mainly for dyspnea. ΔPCO2 and ΔpH were strongly correlated with SpvO2 (r(2) = 0.62 and r(2) = 0.53, respectively, p < 0.001). Using the data of the model group, we developed equations that we applied on the validation group. We found that the corrected values were more valid than the raw values for detecting a PaCO2 > 45 mm Hg (AUC ROC = 0.96 ± 0.01 vs. 0.89 ± 0.02, p < 0.001), a PaCO2 < 35 mm Hg (AUC = 0.95 ± 0.02 vs. 0.84 ± 0.03, p < 0.001), a pHa < 7.35 (AUC = 0.97 ± 0.01 vs. 0.95 ± 0.02, p < 0.05), or a pHa > 7.45 (AUC = 0.91 ± 0.02 vs. 0.81 ± 0.04, p < 0.001). CONCLUSIONS The variability of ΔPCO2 and ΔpH is significantly lowered when the venous values are corrected according to the SpvO2 value, and pVBG is therefore more accurate and valid for detecting an arterial abnormality.
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