The Advantages of Real-Time Oximetry over Intermittent Arterial Blood Gas Analyses in a Chest Department

Background Controversy exists regarding the utility of continuous monitoring of mixed venous oxygen saturation (STvo2) during cardiac surgery. During a multicenter, prospective, observational study in the Department of Veterans Affairs (Cooperative Study #5), frequency of use of standard pulmonary artery catheterization (PAC) and STvo2-PAC was recorded. Here the authors relate these data to clinical outcomes. Methods Logistic and Cox regression models evaluating the association of PAC type with mortality, one or more postoperative complications, cardiac complications, time to extubation, and intensive care unit length of stay were constructed. The number of thermodilution cardiac outputs and arterial blood gas analyses performed in the first 24 h postoperatively were compared. Results Data from 3,265 patients undergoing myocardial revascularization (81.7%) or valve replacement-repair (18.3%) were considered. STvo2-PAC was used in 49% and PAC in 51% of patients. In the 14 hospitals, STvo2-PAC was used in all patients in four, in some patients in four, and never in six. No association of STvo2-PAC use with outcome were observed aside from unexplained hospital level effects. A small but statistically significant reduction in the number of arterial blood gas analyses (8 +/- 3 vs. 10 +/- 4, P < 0.0001, STvo2-PAC vs. PAC, respectively) and thermodilution cardiac outputs (14 +/- 8 vs. 15 +/- 9, P < 0.0001, STvo2-PAC vs. PAC, respectively) was observed with use of STvo2-PAC. Conclusions Despite higher cost, STvo2-PAC was commonly used in this cohort. Our analysis failed to detect associations with improved outcomes aside from a small reduction in resource utilization. The precise role of STvo2-PAC remains uncertain.

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Hemodynamic responses to oxygen breathing in man

Journal of Applied Physiology ◽

10.1152/jappl.1962.17.1.75 ◽

1962 ◽

Vol 17 (1) ◽

pp. 75-79 ◽

Cited By ~ 72

Author(s):

G. W. N. Eggers ◽

H. W. Paley ◽

J. J. Leonard ◽

J. V. Warren

Keyword(s):

Blood Volume ◽

Blood Gas ◽

Peripheral Vascular ◽

Healthy Male ◽

Hemodynamic Responses ◽

Arterial Blood Gas ◽

Oxygen Breathing ◽

Arterial Blood ◽

Radioactive Indicator ◽

Blood Gas Analyses

Hemodynamic responses to breathing 100% oxygen for an average of 30 min were studied in eight healthy male volunteers. Cardiac output and related determinations were performed with central injections of a radioactive indicator and calculated by the method of Stewart and Hamilton. Arterial blood gas analyses were performed in each phase of the study. Slight but statistically significant decreases in cardiac index and heart rate were observed during oxygen breathing. There was no change in the central blood volume, but a masked increase in pulmonary blood volume may have occurred. Statistically significant increases in peripheral vascular resistance, mean arterial pressure, and both systolic and diastolic arterial pressures occurred during oxygen breathing and persisted at least 40 min after oxygen was discontinued. Submitted on May 1, 1961

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Effects of Administration of Intravenous Naloxone on Gas Exchange in Brain-Dead Lung Donors

Progress in Transplantation ◽

10.1177/152692480901900313 ◽

2009 ◽

Vol 19 (3) ◽

pp. 267-271 ◽

Cited By ~ 5

Author(s):

Christina Eagan ◽

Cesar A. Keller ◽

Maher A. Baz ◽

Michael Thibault

Keyword(s):

Lung Transplant ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Pulmonary Contusion ◽

Neurogenic Pulmonary Edema ◽

Blood Gas ◽

Arterial Blood Gas ◽

Arterial Blood ◽

Arterial Blood Gas Analysis ◽

Blood Gas Analyses

Objective To observe the effect of naloxone on the lung function of potential lung transplant donors with neurogenic pulmonary edema. Design and Interventions Donors aged 16 to 55 years without any factors to contraindicate lung donation (pneumonia, pulmonary contusion, etc) were included. Ventilator settings were standardized to a tidal volume of 10 to 12 mL/kg, an FiO2 of 0.40, and a respiratory rate that kept PCO2 between 35 and 45 mm Hg. Chest physiotherapy, nebulizer treatments, and frequent suctioning were undertaken. Baseline arterial blood gas analysis and an oxygen challenge were performed. The patients were then given 8 to 10 mg of naloxone. Oxygen challenges and arterial blood gas analyses were repeated every 4 to 6 hours. The data were analyzed by using a paired t test, and each patient served as his or her own control. Setting These interventions were performed on the 19 LifeQuest donors who met the set criteria from July 2002 to July 2004. Results The PaO2 on the oxygen challenge immediately after administration of naloxone increased from 329 (SD 177) to 363 (SD 191) mm Hg, although the increase from baseline was not significant. The PaO2 from the second oxygen challenge (median time, 7 hours after administration of naloxone) increased to 413 (SD 177) mm Hg ( P < .01).

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Iatrogenic Anaemia in the Critically Ill: A Survey of the Frequency of Blood Testing in a Teaching Hospital Intensive Care Unit

Journal of the Intensive Care Society ◽

10.1177/175114370901000413 ◽

2009 ◽

Vol 10 (4) ◽

pp. 279-281 ◽

Cited By ~ 1

Author(s):

Tim Astles

Keyword(s):

Intensive Care ◽

Critically Ill ◽

Teaching Hospital ◽

Blood Gas Analysis ◽

Gas Analysis ◽

Blood Gas ◽

Arterial Blood Gas ◽

Day Range ◽

Arterial Blood ◽

Blood Gas Analyses

Anaemia in the critically ill remains a contentious issue. Despite adoption of lower haemoglobin levels as transfusion triggers, many patients on intensive care units (ICUs) still require blood transfusions during their illness. One factor that contributes to the critically ill becoming anaemic is regular phlebotomy. Over a two week period, all blood tests performed on patients in a busy, teaching hospital ICU were surveyed to allow calculation of the total volume of blood that had been taken. On average, 52.4 mL of blood was taken per patient per day, and 366.8 mL per patient per week. The most frequently performed tests were arterial blood gas analyses, performed on average 5.8 times per patient per day (range 0–21 times per day). Arterial blood gas analysis alone accounted for taking of 29 mL of blood per patient per day, ie 203 mL per patient per week. Several methods for reducing the amount of blood taken from ICU patients have been identified and discussed. By implementing some of these simple changes in our institution, it would be possible to reduce the volume of blood taken by 43%.

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