scholarly journals Diagnostic Modalities in Critical Care: Point-of-Care Approach

Diagnostics ◽  
2021 ◽  
Vol 11 (12) ◽  
pp. 2202
Author(s):  
Sasa Rajsic ◽  
Robert Breitkopf ◽  
Mirjam Bachler ◽  
Benedikt Treml
Keyword(s):  
Critical Care ◽  
Early Recognition ◽  
Point Of Care ◽  
Prehospital Care ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Special Focus ◽  
Icu Patients ◽  
Care Approach ◽  
Diagnostic Modalities

The concept of intensive care units (ICU) has existed for almost 70 years, with outstanding development progress in the last decades. Multidisciplinary care of critically ill patients has become an integral part of every modern health care system, ensuing improved care and reduced mortality. Early recognition of severe medical and surgical illnesses, advanced prehospital care and organized immediate care in trauma centres led to a rise of ICU patients. Due to the underlying disease and its need for complex mechanical support for monitoring and treatment, it is often necessary to facilitate bed-side diagnostics. Immediate diagnostics are essential for a successful treatment of life threatening conditions, early recognition of complications and good quality of care. Management of ICU patients is incomprehensible without continuous and sophisticated monitoring, bedside ultrasonography, diverse radiologic diagnostics, blood gas analysis, coagulation and blood management, laboratory and other point-of-care (POC) diagnostic modalities. Moreover, in the time of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, particular attention is given to the POC diagnostic techniques due to additional concerns related to the risk of infection transmission, patient and healthcare workers safety and potential adverse events due to patient relocation. This review summarizes the most actual information on possible diagnostic modalities in critical care, with a special focus on the importance of point-of-care approach in the laboratory monitoring and imaging procedures.

scholarly journals Management of Coagulopathy in Bleeding Patients

2021 ◽  
Vol 11 (1) ◽  
pp. 1
Author(s):  
Stefan Hofer ◽  
Christoph J. Schlimp ◽  
Sebastian Casu ◽  
Elisavet Grouzi
Keyword(s):  
Early Recognition ◽  
Point Of Care ◽  
Oral Anticoagulants ◽  
Direct Oral Anticoagulants ◽  
Coagulation Factor ◽  
Blood Gas Analysis ◽  
Coagulation Factors ◽  
Gas Analysis ◽  
Coagulation Management ◽  
Reversal Agents

Early recognition of coagulopathy is necessary for its prompt correction and successful management. Novel approaches, such as point-of-care testing (POC) and administration of coagulation factor concentrates (CFCs), aim to tailor the haemostatic therapy to each patient and thus reduce the risks of over- or under-transfusion. CFCs are an effective alternative to ratio-based transfusion therapies for the correction of different types of coagulopathies. In case of major bleeding or urgent surgery in patients treated with vitamin K antagonist anticoagulants, prothrombin complex concentrate (PCC) can effectively reverse the effects of the anticoagulant drug. Evidence for PCC effectiveness in the treatment of direct oral anticoagulants-associated bleeding is also increasing and PCC is recommended in guidelines as an alternative to specific reversal agents. In trauma-induced coagulopathy, fibrinogen concentrate is the preferred first-line treatment for hypofibrinogenaemia. Goal-directed coagulation management algorithms based on POC results provide guidance on how to adjust the treatment to the needs of the patient. When POC is not available, concentrate-based management can be guided by other parameters, such as blood gas analysis, thus providing an important alternative. Overall, tailored haemostatic therapies offer a more targeted approach to increase the concentration of coagulation factors in bleeding patients than traditional transfusion protocols.

StatPal II pH and Blood Gas Analysis System evaluated

1994 ◽  
Vol 40 (1) ◽  
pp. 124-129 ◽  
Author(s):  
R J Wong ◽  
J J Mahoney ◽  
J A Harvey ◽  
A L Van Kessel
Keyword(s):  
Point Of Care ◽  
Blood Gases ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Portable Instrument ◽  
Blood Gas ◽  
Target Value ◽  
Analysis System

Abstract We evaluated a new portable instrument, the PPG StatPal II pH and Blood Gas Analysis System, designed for "point-of-care" measurements of blood gases and pH. Inaccuracy (% of target value) and imprecision (CV%) were assessed by blood tonometry and comparison with a Corning 178. Within-day results for PCO2 inaccuracy and imprecision ranged from 98.2% to 102.9% and 3.3% to 3.9%, respectively; for PO2, these were 95.5% to 102.3% and 2.3% to 3.0%, respectively. Between-day results for PCO2 inaccuracy and imprecision ranged from 99.2% to 99.3% and from 2.9% to 3.2%, respectively; for PO2, the ranges were 96.2% to 98.2% and 2.6% to 3.0%, respectively. Two PCO2 outliers (in 645 samples = 0.3%) were observed. In general, tonometry recovery, measurement stability, and pH bias results for the StatPal II and Corning 178 were comparable. We conclude that the StatPal II performs within acceptable ranges of inaccuracy and imprecision.

scholarly journals Be cautious during the interpretation of arterial blood gas analysis performed outside the intensive care unit

2020 ◽  
Author(s):  
Lukasz Krzych ◽  
Olga Wojnarowicz ◽  
Paweł Ignacy ◽  
Julia Dorniak
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Point Of Care ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Acid Base Balance ◽  
Arterial Blood Gas ◽  
Arterial Blood ◽  
The Impact

Introduction. Reliable results of an arterial blood gas (ABG) analysis are crucial for the implementation of appropriate diagnostics and therapy. We aimed to investigate the differences (Δ) between ABG parameters obtained from point-of-care testing (POCT) and central laboratory (CL) measurements, taking into account the turnaround time (TAT). Materials and methods. A number of 208 paired samples were collected from 54 intensive care unit (ICU) patients. Analyses were performed using Siemens RAPIDPoint 500 Blood Gas System on the samples just after blood retrieval at the ICU and after delivery to the CL. Results. The median TAT was 56 minutes (IQR 39-74). Differences were found for all ABG parameters. Median Δs for acid-base balance ere: ΔpH=0.006 (IQR –0.0070–0.0195), ΔBEef=–0.9 (IQR –2.0–0.4) and HCO3–act=–1.05 (IQR –2.25–0.35). For ventilatory parameters they were: ΔpO2=–8.3 mmHg (IQR –20.9–0.8) and ΔpCO2=–2.2 mmHg (IQR –4.2––0.4). For electrolytes balance the differences were: ΔNa+=1.55 mM/L (IQR 0.10–2.85), ΔK+=–0.120 mM/L (IQR –0.295–0.135) and ΔCl–=1.0 mM/L (IQR –1.0–3.0). Although the Δs might have caused misdiagnosis in 51 samples, Bland-Altman analysis revealed that only for pO2 the difference was of clinical significance (mean: –10.1 mmHg, ±1.96SD –58.5; +38.3). There was an important correlation between TAT and ΔpH (R=0.45, p<0.01) with the safest time delay for proper assessment being less than 39 minutes. Conclusions. Differences between POCT and CL results in ABG analysis may be clinically important and cause misdiagnosis, especially for pO2. POCT should be advised for ABG analysis due to the impact of TAT, which seems to be the most important for the analysis of pH.

scholarly journals A paradigmatic case of haemolysis and pseudohyperkalemia in blood gas analysis

2018 ◽  
Vol 29 (1) ◽  
pp. 169-172
Author(s):  
Gian Luca Salvagno ◽  
Davide Demonte ◽  
Giuseppe Lippi
Keyword(s):  
Reference Range ◽  
Point Of Care ◽  
Venous Blood ◽  
Blood Gas Analysis ◽  
Plasma Potassium ◽  
Gas Analysis ◽  
Blood Gas ◽  
High Potassium ◽  
Plastic Tube ◽  
History Of

A 51-year old male patient was admitted to the hospital with acute dyspnea and history of chronic asthma. Venous blood was drawn into a 3.0 mL heparinized syringe and delivered to the laboratory for blood gas analysis (GEM Premier 4000, Instrumentation Laboratory), which revealed high potassium value (5.2 mmol/L; reference range on whole blood, 3.5-4.5 mmol/L). This result was unexpected, so that a second venous blood sample was immediately drawn by direct venipuncture into a 3.5 mL lithium-heparin blood tube, and delivered to the laboratory for repeating potassium testing on Cobas 8000 (Roche Diagnostics). The analysis revealed normal plasma potassium (4.6 mmol/L; reference range in plasma, 3.5-5.0 mmol/L) and haemolysis index (5; 0.05 g/L). Due to suspicion of spurious haemolysis, heparinized blood was transferred from syringe into a plastic tube and centrifuged. Potassium and haemolysis index were then measured in this heparinized plasma, confirming high haemolysis index (50; 0.5 g/L) and pseudohyperkalemia (5.5 mmol/L). Investigation of this case revealed that spurious haemolysis was attributable to syringe delivery in direct ice contact for ~15 min. This case emphasizes the importance of avoiding sample transportation in ice and the need of developing point of care analysers equipped with interference indices assessment.

23 NEONATAL SUPPORT THERAPY AND BLOOD GAS EVALUATION IN CLONED AND ARTIFICIAL INSEMINATION-DERIVED NEWBORN CALVES

2015 ◽  
Vol 27 (1) ◽  
pp. 104
Author(s):  
P. Fantinato-Neto ◽  
A. T. Zanluchi ◽  
M. M. Yasuoka ◽  
F. J. M. Marchese ◽  
J. R. V. Pimentel ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Point Of Care ◽  
Respiratory Acidosis ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Oxygenation ◽  
Blood Gas ◽  
Acid Base Balance ◽  
Reproductive Techniques ◽  
Newborn Calves

Offspring derived from artificial reproductive techniques are already known to present several postnatal undesirable phenotypes and clinical disorders. Despite its benefits, cloning by somatic cell nuclear transfer (SCNT) is extremely inefficient. The birth rate in cattle is around 5% of the transferred blastocysts, and ~50% of delivered calves die in the first 48 h. Neonatal respiratory distress is reported to be one of the main causes of such deaths. Veterinary intervention is often needed to promote or improve blood oxygenation, avoiding respiratory acidosis and improving carbon dioxide delivery from blood/lungs to the environment. This study aimed to evaluate a neonatal support therapy over the blood gas and acid-base balance on newborn calves derived from SCNT or AI. Four cloned and 3 AI-derived calves delivered by Caesarean section were used for the experiment. Postnatal therapeutic procedures were comprised 4 doses of 400 mg of intratracheal surfactant every 15 min, 25 mg of oral sildenafil every 8 h for 3 days, and 5 L min–1 intranasal oxygen. Blood collections were performed within 30 min (T0), at 12 (T12), 24 (T24) and 48 (T48) hours after delivery. Blood samples were collected from the caudal auricular artery with a butterfly and a blood gas syringe. Oxygen saturation (sO2), arterial pressure of oxygen (PaO2) and carbon dioxide (PaCO2), pH, and bicarbonate (HCO3–) were evaluated with a portable blood gas analyzer (i-STAT, Abbott Point of Care Inc., Princeton, NJ, USA). Data obtained were submitted to ANOVA (Proc MIXED; SAS/STAT, version 9; SAS Institute Inc., Cary, NC, USA). There were significant differences between groups in blood pH (P = 0.0182) and between groups (P = 0.0281) and time of collection (P = 0.0303) in blood bicarbonate (HCO3–). The AI calves were born with normal pH (7.468 ± 0.033) and the cloned calves were born in acidosis (7.216 ± 0.166). These calves were stabilised in T48 (7.427 ± 0.017) using their own HCO3– that increased over time. Although there were no differences in sO2 (P = 0.4525), PaO2 (P = 0.3086), or PaCO2 (P = 0.2514), sO2 and PaO2 were numerically increased at the same time that PaCO2 decreased in both groups. In the cloned calves, the sO2, PaO2, and PaCO2 at T0 were 61.3 ± 28.6%, 39.8 ± 18.5 mmHg, and 65.8 ± 29.3 mmHg, respectively and reached 90.0 ± 3.4%, 57.7 ± 15.8 mmHg, and 42.0 ± 3.7 mmHg. In the AI calves, T0 blood gas analysis were 79.8 ± 19.4%, 56.1 ± 42.1 mmHg, and 39.1 ± 4.8 mmHg, and at T48 were 89.0 ± 2.6%, 82.3 ± 43.5 mmHg, and 43.0 ± 4.9 mmHg for sO2, PaO2, and PaCO2 respectively. The neonate support therapy improved calves' oxygenation and helped to eliminate the carbon dioxide from the blood. In our experience, the neonatal treatment was essential in supporting the lives of the cloned calves.Funding support was received from FAPESP 2011/19543–9.

An easy method for interpreting the results of arterial blood gas analysis

2001 ◽  
Vol 21 (5) ◽  
pp. 49-54 ◽  
Author(s):  
KM Kirksey ◽  
M Holt-Ashley ◽  
BK Goodroad
Keyword(s):  
Critical Care ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Critical Care Nurses ◽  
Blood Gas ◽  
Easy Method ◽  
Arterial Blood Gas ◽  
Confidence Levels ◽  
Arterial Blood ◽  
Arterial Blood Gas Analysis

Interpretation of acid-base disturbances is an essential skill for critical care nurses. Using the H model makes this process easy. When students and novice critical care nurses feel competent with certain skills, their confidence levels are greatly enhanced. One of us (K.M.K.) has been using the H model for many years to teach students how to interpret the results of arterial blood gas analysis. The students are often amazed at how easy and fun the model makes learning a subject many perceive as complex.

VENOUS BLOOD GAS ANALYSIS CAN BE USED TO MONITOR ACID/BASE HOMEOSTASIS IN SURGICAL ICU PATIENTS

1993 ◽  
Vol 21 (Supplement) ◽  
pp. S203
Author(s):  
Andrew Kenler ◽  
Ken Campbell ◽  
David Driscoll ◽  
Peter Marcello ◽  
Betsy Tuttle-Newhall ◽  
...  
Keyword(s):  
Venous Blood ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Acid Base ◽  
Icu Patients ◽  
Surgical Icu ◽  
Venous Blood Gas ◽  
Venous Blood Gas Analysis

High altitude arterialised capillary earlobe blood gas measurement using the Abbott i-STAT

2018 ◽  
Vol 164 (5) ◽  
pp. 335-337 ◽  
Author(s):  
Christopher T Lewis ◽  
W L Malein ◽  
I Chesner ◽  
S Clarke
Keyword(s):  
Partial Pressure ◽  
High Altitude ◽  
Point Of Care ◽  
Extreme Environments ◽  
Blood Gases ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Blood Gas ◽  
Clinical Environment ◽  
Gas Measurements

IntroductionMeasurement of physiological parameters in extreme environments is essential to advancing knowledge, prophylaxis and treatment of altitude sickness. Point-of-care testing facilitates investigation in non-specialist and remote settings, as well as becoming increasingly popular at the bedside for real-time results in the clinical environment. Arterialised capillary earlobe blood gases are recommended as a valid alternative to arterial sampling in research. This study aimed to test the feasibility of obtaining and analysing daily earlobe samples at high altitude.MethodsFrom 17 to 24 January 2016, 24 participants on a research expedition to Ecuador underwent daily earlobe blood gas measurements including pH, partial pressure of oxygen and partial pressure of carbon dioxide to 5043 m. Samples were analysed using an Abbott i-STAT blood gas analyser and G3+ cartridges.ResultsDaily measurements were successfully obtained and analysed at the point of care in 23/24 participants and were well tolerated with no adverse events. 12% (27/220) cartridges failed and required repeat sampling.ConclusionsDaily earlobe blood gas analysis using the Abbott i-STAT is feasible in a protected environment at high altitude. Participants and equipment should be kept warm before and during testing. Spare cartridges should be available. This methodology may be useful for both research and therapeutic measurements in remote, rural and wilderness medicine.

scholarly journals Point-of-Care Diagnostics in Coagulation Management

Sensors ◽  
2020 ◽  
Vol 20 (15) ◽  
pp. 4254
Author(s):  
Sebastian D. Sahli ◽  
Julian Rössler ◽  
David W. Tscholl ◽  
Jan-Dirk Studt ◽  
Donat R. Spahn ◽  
...  
Keyword(s):  
Point Of Care ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Coagulation Management ◽  
Point Of Care Diagnostics ◽  
Reliable Assessment ◽  
Coagulation Tests ◽  
Visualization Technology ◽  
Patient’S Outcome ◽  
Routine Coagulation

This review provides a comprehensive and up-to-date overview of point-of-care (POC) devices most commonly used for coagulation analyses in the acute settings. Fast and reliable assessment of hemostasis is essential for the management of trauma and other bleeding patients. Routine coagulation assays are not designed to visualize the process of clot formation, and their results are obtained only after 30–90 m due to the requirements of sample preparation and the analytical process. POC devices such as viscoelastic coagulation tests, platelet function tests, blood gas analysis and other coagulometers provide new options for the assessment of hemostasis, and are important tools for an individualized, goal-directed, and factor-based substitution therapy. We give a detailed overview of the related tests, their characteristics and clinical implications. This review emphasizes the evident advantages of the speed and predictive power of POC clot measurement in the context of a goal-directed and algorithm-based therapy to improve the patient’s outcome. Interpretation of viscoelastic tests is facilitated by a new visualization technology.

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