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Mismatch of arterial and central venous blood gas analysis during haemorrhage


Theusinger, O M; Thyes, C; Frascarolo, P; Schramm, S; Seifert, B; Spahn, D R (2010). Mismatch of arterial and central venous blood gas analysis during haemorrhage. European Journal of Anaesthesiology, 27(10):890-896.

Abstract

BACKGROUND AND OBJECTIVE: Arterial base excess and lactate levels are key parameters in the assessment of critically ill patients. The use of venous blood gas analysis may be of clinical interest when no arterial blood is available initially. METHODS: Twenty-four pigs underwent progressive normovolaemic haemodilution and subsequent progressive haemorrhage until the death of the animal. Base excess and lactate levels were determined from arterial and central venous blood after each step. In addition, base excess was calculated by the Van Slyke equation modified by Zander (BEz). Continuous variables were summarized as mean +/- SD and represent all measurements (n = 195). RESULTS: Base excess according to National Committee for Clinical Laboratory Standards for arterial blood was 2.27 +/- 4.12 versus 2.48 +/- 4.33 mmol l for central venous blood (P = 0.099) with a strong correlation (r = 0.960, P < 0.001). Standard deviation of the differences between these parameters (SD-DIFBE) did not increase (P = 0.355) during haemorrhage as compared with haemodilution. Arterial lactate was 2.66 +/- 3.23 versus 2.71 +/- 2.80 mmol l in central venous blood (P = 0.330) with a strong correlation (r = 0.983, P < 0.001). SD-DIFLAC increased (P < 0.001) during haemorrhage. BEz for central venous blood was 2.22 +/- 4.62 mmol l (P = 0.006 versus arterial base excess according to National Committee for Clinical Laboratory Standards) with strong correlation (r = 0.942, P < 0.001). SD-DIFBEz/base excess increased (P < 0.024) during haemorrhage. CONCLUSION: Central venous blood gas analysis is a good predictor for base excess and lactate in arterial blood in steady-state conditions. However, the variation between arterial and central venous lactate increases during haemorrhage. The modification of the Van Slyke equation by Zander did not improve the agreement between central venous and arterial base excess.

BACKGROUND AND OBJECTIVE: Arterial base excess and lactate levels are key parameters in the assessment of critically ill patients. The use of venous blood gas analysis may be of clinical interest when no arterial blood is available initially. METHODS: Twenty-four pigs underwent progressive normovolaemic haemodilution and subsequent progressive haemorrhage until the death of the animal. Base excess and lactate levels were determined from arterial and central venous blood after each step. In addition, base excess was calculated by the Van Slyke equation modified by Zander (BEz). Continuous variables were summarized as mean +/- SD and represent all measurements (n = 195). RESULTS: Base excess according to National Committee for Clinical Laboratory Standards for arterial blood was 2.27 +/- 4.12 versus 2.48 +/- 4.33 mmol l for central venous blood (P = 0.099) with a strong correlation (r = 0.960, P < 0.001). Standard deviation of the differences between these parameters (SD-DIFBE) did not increase (P = 0.355) during haemorrhage as compared with haemodilution. Arterial lactate was 2.66 +/- 3.23 versus 2.71 +/- 2.80 mmol l in central venous blood (P = 0.330) with a strong correlation (r = 0.983, P < 0.001). SD-DIFLAC increased (P < 0.001) during haemorrhage. BEz for central venous blood was 2.22 +/- 4.62 mmol l (P = 0.006 versus arterial base excess according to National Committee for Clinical Laboratory Standards) with strong correlation (r = 0.942, P < 0.001). SD-DIFBEz/base excess increased (P < 0.024) during haemorrhage. CONCLUSION: Central venous blood gas analysis is a good predictor for base excess and lactate in arterial blood in steady-state conditions. However, the variation between arterial and central venous lactate increases during haemorrhage. The modification of the Van Slyke equation by Zander did not improve the agreement between central venous and arterial base excess.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > Epidemiology, Biostatistics and Prevention Institute (EBPI)
04 Faculty of Medicine > University Hospital Zurich > Institute of Anesthesiology
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:October 2010
Deposited On:30 Jul 2010 14:25
Last Modified:05 Apr 2016 14:12
Publisher:Lippincott Wiliams & Wilkins
ISSN:0265-0215
Publisher DOI:10.1097/EJA.0b013e32833adea8
PubMed ID:20601892
Permanent URL: http://doi.org/10.5167/uzh-35271

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