Evaluation of time courses of agreement between minutely obtained transcutaneous blood gas data and the gold standard arterial data from spontaneously breathing Asian adults, and various subgroup analyses
Evaluation of time courses of agreement between minutely obtained transcutaneous blood gas data and the gold standard arterial data from spontaneously breathing Asian adults, and various subgroup analyses
复制标题
评估详细获得的经皮血气数据与亚洲成年人自主呼吸的金标准动脉数据之间的一致性时间过程，以及各种亚组分析
作者：
A. Umeda;M. Ishizaka;Masamichi Tasaki;T. Yamane;Taiji Watanabe;Yasushi Inoue;T. Mochizuki;Y. Okada;Sarah Kesler
背景：对意识清醒的患者进行动脉血气分析（BGA）时，通常的临床做法是在静息20-30分钟后进行一次动脉穿刺。本研究的目的是评估经皮BGA在估计动脉BGA金标准中的应用。方法选择自主呼吸的亚洲成年人（健康志愿者和呼吸系统患者）（n = 295）。使用经皮监测仪（TCM4, Radiometer Medical AsP，丹麦）监测经皮PO 2 （PtcO 2）和PCO 2 (PtcCO 2)，传感器放置在胸部、前臂、耳垂或前额。间隔1分钟经皮BGA与间隔30分钟动脉BGA比较。评估重度高碳酸血症伴PaCO 2 ~ 50 mmHg的合理诊断步骤。结果胸部和前臂的传感器同样受欢迎，因为偏差较小（n = 272）。pco2的平均偏压在4 min时接近0 mmHg，在≥8 min时几乎稳定（4 - 5 mmHg）， ptcco2高于paco2。随着时间的推移，pco2的一致性限制逐渐缩小：4分钟±13.6 mmHg， 12-13分钟±7.5 mmHg， 30分钟±6.3 mmHg。po2的协议限制也随着时间的推移而缩小（30分钟±23.1 mmHg）。亚组分析显示，paco2和pao2水平、性别和年龄对偏倚有显著影响。所有paco2≥50 mmHg的高碳酸血症患者（n = 13）在12分钟前ptcco2≥50 mmHg。结论虽然ptcco2是有用的，但由于pco2偶有较大偏倚，不能完全替代paco2。另一方面，用PtcO 2预测亚洲成年人的PaO 2是不现实的。pacco2≥50 mmHg持续12分钟可作为重度高血氧症pacco2≥50 mmHg的筛查工具。
Background Usual clinical practice for arterial blood gas analysis (BGA) in conscious patients involves a one-time arterial puncture to be performed after a resting period of 20–30 min. The aim of this study was to evaluate the use of transcutaneous BGA for estimating this gold standard arterial BGA. Methods Spontaneously breathing Asian adults (healthy volunteers and respiratory patients) were enrolled ( n = 295). Transcutaneous PO 2 (PtcO 2 ) and PCO 2 (PtcCO 2 ) were monitored using a transcutaneous monitor (TCM4, Radiometer Medical AsP, Denmark) with sensors placed on the chest, forearm, earlobe or forehead. Transcutaneous BGA at 1-min intervals was compared with arterial BGA at 30 min. Reasonable steps to find severe hypercapnia with PaCO 2 > 50 mmHg were evaluated. Results Sensors on the chest and forearm were equally preferred and used because of small biases ( n = 272). The average PCO 2 bias was close to 0 mmHg at 4 min, and was almost constant (4–5 mmHg) with PtcCO 2 being higher than PaCO 2 at ≥8 min. The limit of agreement for PCO 2 narrowed over time: ± 13.6 mmHg at 4 min, ± 7.5 mmHg at 12–13 min, and ± 6.3 mmHg at 30 min. The limit of agreement for PO 2 also narrowed over time (± 23.1 mmHg at 30 min). Subgroup analyses showed that the PaCO 2 and PaO 2 levels, gender, and younger age significantly affected the biases. All hypercapnia subjects with PaCO 2 > 50 mmHg ( n = 13) showed PtcCO 2 ≥ 50 mmHg for until 12 min. Conclusions Although PtcCO 2 is useful, it cannot completely replace PaCO 2 because PCO 2 occasionally showed large bias. On the other hand, the prediction of PaO 2 using PtcO 2 was unrealistic in Asian adults. PtcCO 2 ≥ 50 mmHg for until 12 min can be used as a screening tool for severe hypercapnia with PaCO 2 > 50 mmHg.