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Calculating acid-base and oxygenation status during COPD exacerbation using mathematically arterialised venous blood

  • Stephen E. Rees EMAIL logo , Beate A. Rychwicka-Kielek , Bjarne F. Andersen , Rana Bibi , Jan F. Pedersen , Ulla M. Weinreich , Lene B. Birket-Smith and Søren R. Kristensen
Published/Copyright: July 27, 2012
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Clinical Chemistry and Laboratory Medicine (CCLM)
From the journal Clinical Chemistry and Laboratory Medicine (CCLM) Volume 50 Issue 12

Abstract

Background: Repeated arterial puncture is painful. A mathematical method exists for transforming peripheral venous pH, PCO2 and PO2 to arterial eliminating the need for arterial sampling. This study evaluates this method to monitor acid-base and oxygenation during admission for exacerbation of chronic obstructive pulmonary disease (COPD).

Methods: Simultaneous arterial and peripheral venous blood was analysed. Venous values were used to calculate arterial pH, PCO2 and PO2, with these compared to measured values using Bland-Altman analysis and scatter plots. Calculated values of PO2 were assessed with previously defined rules. Differences between maximal changes of calculated and measured values were compared using a t-test, with trends analysed by inspection of plots.

Results: Fifty-four patients, median age 67 years (range 62–75), were studied on average 3 days. Mean values of pH, PCO2 and PO2 were 7.432±0.047, 6.8±1.7 kPa and 9.2±1.5 kPa, respectively. Calculated and measured arterial pH and PCO2 agreed well, differences having small bias and SD (0.000±0.022 pH, –0.06±0.50 kPa PCO2), significantly better than venous blood alone. Calculated PO2 obeyed the clinical rules. Calculated values could track patients, with no significant differences in maximal changes in measured and calculated values (pH p=0.96, PCO2 p=0.62, PO2 p=0.33), and time-course plots matching quantity and pattern of change in measurements.

Conclusions: This study shows that arterial pH, PCO2 and PO2 can be calculated from peripheral venous values so as to characterise changes seen during exacerbation. Application of the method has potential to reduce arterial sampling, decrease discomfort and enable venous sampling as routine practice.

Keywords: arterialisation; blood gas; peripheral venous blood
Corresponding author: Stephen E. Rees, Center for Model Based Medical Decision Support, Department of Health Science and Technology, Aalborg University, 9220 Aalborg, Denmark Phone: +45 99408793, Fax: +45 98154008

Thanks go to the bio-technicians who participated in taking the extra peripheral venous samples, in particular Serab Sabrail Sadik and Christina Poulsen.

Conflict of interest statement

Authors’ conflict of interest disclosure: Stephen E. Rees is a board member and shareholder of OBI ApS, who hold a patent on the venous to arterial conversion method. Research funding played no role in the study design; in the collection, analysis, and interpretation of data; in the writing of the report; or in the decision to submit the report for publication.

Research funding: Radiometer Medical A/S provided support to the amount of 50,000 DKR to cover the costs of bio-technicians salary during the study. Radiometer Medical A/S has had no further collaboration in this study in any way.

Employment or leadership: No other authors have a conflict of interest.

Honorarium: None declared.

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Received: 2012-04-11
Accepted: 2012-06-22
Published Online: 2012-07-27
Published in Print: 2012-12-01

©2012 by Walter de Gruyter Berlin Boston

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https://doi.org/10.1515/cclm-2012-0233
Keywords for this article
arterialisation; blood gas; peripheral venous blood

Articles in the same Issue

  1. Masthead
  2. Masthead
  3. Editorials
  4. Phlebotomy, stat testing and laboratory organization: an intriguing relationship
  5. Human epididymis protein 4: the start of a post-ROMAn era?
  6. Hyperhomocysteinemia in health and disease: where we are now, and where do we go from here?
  7. Reviews
  8. The usefulness of cystatin C and related formulae in pediatrics
  9. The emerging role of biomarkers and bio-impedance in evaluating hydration status in patients with acute heart failure
  10. Biomarkers in primary open angle glaucoma
  11. Mini Review
  12. Identification of circulating microRNAs as biomarkers in cancers: what have we got?
  13. Opinion Paper
  14. HE4 in gynecological cancers: report of a European investigators and experts meeting
  15. Guidelines and Recommendations
  16. Position paper on laboratory testing for patients taking new oral anticoagulants. Consensus document of FCSA, SIMeL, SIBioC and CISMEL1)
  17. General Clinical Chemistry and Laboratory Medicine
  18. Reducing the number of clinical stat phlebotomy orders: feasible or not?
  19. Calculating acid-base and oxygenation status during COPD exacerbation using mathematically arterialised venous blood
  20. UrineCART, a machine learning method for establishment of review rules based on UF-1000i flow cytometry and dipstick or reflectance photometer
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  33. Usefulness of an antiglycolytic granular mixture of sodium fluoride and citrate for stabilizing plasma homocysteine levels
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  35. Phosphoethanolamine normal range in pediatric urines for hypophosphatasia screening
  36. Risk of false positive hepatitis C virus RNA due to sample to sample carryover on an automated hematology analyzer
  37. Lack of commutability between a quality control material and plasma samples in a troponin I measurement system
  38. Biological variation in pregnancy-associated plasma protein-A in healthy men and non-pregnant healthy women
  39. Investigation of a slope discontinuity in a patients’ results distribution for D-dimer
  40. Acknowledgment
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