使用数学动脉化静脉血气样本分析呼吸衰竭患者的外周静脉 PCO2 趋势,BMJ Open Respiratory Research

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使用数学动脉化静脉血气样本分析呼吸衰竭患者的外周静脉 PCO2 趋势
BMJ Open Respiratory Research ( IF 3.6 ) Pub Date : 2021-05-01 , DOI: 10.1136/bmjresp-2021-000896
Merle Weber ₁ , Grant Cave ₂

Affiliation

背景趋势静脉血气 (VBG) 已被建议作为呼吸衰竭患者动脉血气 (ABG) 的替代方法，但其实用性有限。本研究的目的是比较静脉二氧化碳分压 (pCO2) (pCO2v) 与数学动脉化 pCO2 (pCO2ca) 的趋势，并进一步评估 pCO2ca 是否更准确地跟随动脉 pCO2 (pCO2a) 的变化。方法我们分析了两个数据集。第一项是对入住重症监护室的呼吸衰竭患者的回顾性研究。使用 vTAC 方法对静脉样本进行数学动脉化。将 pCO2v 的两个连续样本之间的 pCO2 变化 (ΔpCO2) 与计算出的 pCO2ca 值的变化进行比较。在取自先前发表的工作的第二个数据集中，我们分析了 pCO2 变化的 82 个趋势点（连续样本之间的差异）。每个趋势点都有 pCO2v、pCO2a 和 pCO2ca 值。主要结果指标是 ΔpCO2 不同采样方法之间的 95% 一致限 (LOA)。结果在第一个数据集中，46 名患者有 203 个 VBG 结果，为 ΔpCO2 分析提供了 157 个趋势点。ΔpCO2ca 和 ΔpCO2v 的 95% LOA 为 -9.28 至 11.12 毫米汞柱。在第二个数据集中，ΔpCO2 的 95% LOA 为 ΔpCO2a 和 ΔpCO2v 的 -9.46 至 9.48 毫米汞柱，ΔpCO2ca 和 ΔpCO2v 的 -8.94 至 8.58 毫米汞柱，以及 ΔpCO2a 和 ca.pCO2 的 -4.54 至 4.91 毫米汞柱结论本研究表明，趋势 pCO2v 并不是预测呼吸衰竭患者 pCO2a 趋势的准确方法。通过 vTAC 获得的 ΔpCO2ca 与 ΔpCO2v 的趋势不同。我们的数据表明 pCO2ca 更准确地趋势 pCO2a。

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Trending peripheral venous PCO2 in patients with respiratory failure using mathematically arterialised venous blood gas samples

Background Trending venous blood gases (VBGs) has been suggested as an alternative to arterial blood gases (ABGs) in patients with respiratory failure, but there are limits to its utility. The aim of this study was to compare the trending of venous carbon dioxide partial pressure (pCO2) (pCO2v) with mathematically arterialised pCO2 (pCO2ca) and to further evaluate whether pCO2ca follows change in arterial pCO2 (pCO2a) more accurately. Methods We analysed two data sets. The first was a retrospective study of patients with respiratory failure admitted to the intensive care unit. Venous samples were mathematically arterialised using the vTAC method. The change in pCO2 between two consecutive samples (ΔpCO2) for pCO2v was compared with the change in calculated pCO2ca values. In the second data set taken from previously published work, we analysed 82 trend points (difference between consecutive samples) for change in pCO2. There were pCO2v, pCO2a and pCO2ca values for each trend point. The primary outcome measures were the 95% limits of agreement (LOAs) between different sampling methods for ΔpCO2. Results In the first data set, 46 patients had 203 VBG results giving 157 trend points for ΔpCO2 analysis. The 95% LOAs for ΔpCO2ca and ΔpCO2v were −9.28 to 11.12 mm Hg. In the second data set, 95% LOAs for ΔpCO2 were −9.46 to 9.48 mm Hg for ΔpCO2a and ΔpCO2v, −8.94 to 8.58 mm Hg for ΔpCO2ca and ΔpCO2v, and −4.54 to 4.91 mm Hg for ΔpCO2a and ΔpCO2ca. Conclusion This study suggests that trending pCO2v is not an accurate way to trend pCO2a in patients with respiratory failure. ΔpCO2ca via vTAC trended differently to ΔpCO2v. Our data suggest pCO2ca more accurately trends pCO2a. Data are available upon reasonable request.

更新日期：2021-05-28

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