Advertisement

Intensive Care Medicine

, Volume 22, Issue 8, pp 818–828 | Cite as

Continuous intra-arterial blood gas monitoring

  • B. Venkatesh
  • S. -P. Hendry
Review Article

Abstract

Objective

To review the technology, clinical trials and current status of continuous blood gas monitoring in intensive care

Design

The review describes the history, technology, various clinical trials on continuous blood gas monitoring and discusses the various factors which might affect their performance characteristics and outlines their potential role in intensive care and during anaesthesia.

Conclusions

Over the past 10 years a number of continuous intra-arterial blood gas monitoring systems have been developed. The performance characteristics of these systems are comparable. Their levels of accuracy as measured in bench tonometry are not consistently achieved in clinical trials. The potential usefulness of these monitors in various clinical situations has been described in case studies. Controlled studies demonstrating an improvement in outcome with the use of these monitors have not been published.

Key words

Blood gases Electrodes Optodes Monitoring Bias Precision Blood flow 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    McInnes DA, Belcher D (1933) A durable glass electrode. Industrial and engineering chemistry: analytical edition 5:199–200Google Scholar
  2. 2.
    Stow RW, Randall BF (1954) Electrical measurement of the PCO2 of blood. Am J Physiol 179:678Google Scholar
  3. 3.
    Severinghaus JW, Bradley AF (1958) Electrodes for blood PO2 and PCO2 determination. J Appl Physiol 13: 515–520Google Scholar
  4. 4.
    Clark LC (1956) Monitor and control of blood and tissue oxygen measurements. Trans Am Soc Artif Intern Organs 2:41–48Google Scholar
  5. 5.
    Clutton-Brock TH, Venkatesh B (1994) Blood gas monitoring. In: Hutton P, Prys-Roberts C (eds) Monitoring in anaesthesia and intensive care, 1st edn. Sauders, London, pp 242–255Google Scholar
  6. 6.
    Thornson SH, Marini JJ, Pierson DJ, Hudson LD (1983) Variability in arterial blood gas values in stable patients in the ICU. Chest 84:14–18Google Scholar
  7. 7.
    Ralston AC, Webb RK, Runciman WB (1991). Potential errors in pulse oximetry. I. Pulse oximetry evaluation. Anaesthesia 46:202–206Google Scholar
  8. 8.
    Webb RK, Ralston AC, Runciman WB (1991) Potential errors in pulse oximetry. II. Pulse oximetry evaluation. Anaesthesia 46:207–212Google Scholar
  9. 9.
    Ralston AC Webb RK, Runciman WB (1991) Potential errors in pulse oximetry. III. Pulse oximetry evaluation. Anaesthesia 46:291–295Google Scholar
  10. 10.
    Severinghaus JW, Naifeh KH, Koh SO (1989) Errors in 14 pulse oximeters during profound hypoxia. J Clin Monit 5:72–81Google Scholar
  11. 11.
    Fletcher R, Capnography (1994) In: Hutton P, Prys-Roberts C (eds) Monitoring in anaesthesia and intensive care, 1st edn. Saunders, London, pp 214–232Google Scholar
  12. 12.
    Fink S, Wayne, W, McCartney S, Ehrlich H, Shoemaker W (1984) Oxygen transport and utilisation in hyperoxia and hypoxia: relationship of conjunctival and transcutaneous oxygen tensions in relation to haemodynamic and oxygen transport changes. Crit Care Med 12:943–948Google Scholar
  13. 13.
    Shoemaker W, Fink S, Ray W, McCartney S (1984) Effect of haemorrhagic shock on conjunctival and transcutaneous oxygen tensions in relation to haemodynamic and oxygen transport changes. Crit Care Med 12:949–952Google Scholar
  14. 14.
    Carlon GC, Kahn RC, Ray C et al (1980) Evaluation of an in vivo PaO2 monitor in the management of respiratory failure. Crit Care Med 8:410–413Google Scholar
  15. 15.
    Hall, JR, Poulton J, Downs JB et al (1980) In vivo arterial blood gas analysis for evaluation. Crit Care Med 8:414Google Scholar
  16. 16.
    Kautsky H (1939) Quenching of luminiscence by oxygen. Trans Faraday Soc 35:216–219Google Scholar
  17. 17.
    Opitz N, Lubbers DW (1987) Theory and development of fluorescence-based optochemical oxygen sensors: oxygen optodes. Int Anesthesiol Clin 25: 177–197Google Scholar
  18. 18.
    Lubbers D, Opitz N (1975) Die PCO2/PO2-optode: eine neue PCO2-bzw. PO2-Messonde zur Messung des PCO2 oder PO2 von Gasen and Flüssigkeiten. Z Naturforsch 30: 532–533Google Scholar
  19. 19.
    Gehrich JL, Lubbers DW, Opitz N et al (1986) Optical fluorescence and its application to an intravascular blood gas monitoring system. IEEE Trans Biomed Eng 33:117–132Google Scholar
  20. 20.
    Buytendijk F (1927) The use of the antinomy electrode in the determination of pH in vivo. Arch Neerland Physiol 12:319Google Scholar
  21. 21.
    Kreuzer F, Nessler C (1958) Method of polarographic in vivo continuous recording of blood oxygen tension. Science 128:1005–1006Google Scholar
  22. 22.
    Koeff ST, Tsao MU, Vadnay A et al (1962) Continuous measurement of intravascular oxygen trension in normal adults. J Clin Invest 41:1125–1133Google Scholar
  23. 23.
    Charlton G, Read D, Read J (1963) Continuous intra-arterial PO2 in normal man using a flexbile microelectrode. J Appl Physiol 18:1247–1251Google Scholar
  24. 24.
    Band D, Semple S (1967) Continuous measurement of blood pH with an indwelling arterial glass electrode. J Appl Physiol 22:854Google Scholar
  25. 25.
    Gold MI, Diaz PM, Feingold A (1975) A disposable in vivo oxygen electrode for the continuous measurement of arterial oxygen tension. Surgery 78: 245–250Google Scholar
  26. 26.
    Le Blanc O, Brown J, Klebe J, Niedrach L et al (1976) Polymer membrane sensors for continuous intravascula monitoring of blood pH. J Appl Physiol 40:644Google Scholar
  27. 27.
    Peterson J, Goldstein S, Fitzgerald R (1980) Fibre optic pH probe for physiological use. Analytical Chem 52: 864–869Google Scholar
  28. 28.
    Nilsson E, Edwall G (1981) Continuous intra-arterial pH-monitoring using monocrystalline antimony as sensor. Scand J Clin Lab Invest 41:333–338Google Scholar
  29. 29.
    Vurek G, Feustel P, Severinghaus J (1983) A fiberoptic PCO2 sensor. Ann Biomed Eng 11:499–510Google Scholar
  30. 30.
    Peterson J, Fitzgerald R, Buckhold D (1984) Fibre optic probe for in vivo measurement of oxygen partial pressure. Anal Chem 56:62–67Google Scholar
  31. 31.
    Abraham E, Markle D, Fink S et al (1985) Continuous measurement of intravascular pH with a fiber optic sensor. Anesth Analg 64:731Google Scholar
  32. 32.
    Pfeifer PM, Pearson DT, Clayton RH (1988) Clinical trial of the Continucath intra-arterial oxygen monitor. A comparison with intermittent arterial blood gas analysis. Anaesthesia 43:677–682Google Scholar
  33. 33.
    Rithalia S, Edwards D, Doran B (1992) Performance characteristics of an intra-arterial oxygen electrode in critically ill adult patients. Br J Intensive Care: 29–33Google Scholar
  34. 34.
    Barker SJ, Tremper KK, Hyatt J et al (1987) Continuous fiberoptic arterial oxygen tension measurements in dogs. J Clin Monit 3:48–52Google Scholar
  35. 35.
    Miller WW, Yafuso M, Yan CF, Hui HK, Arick S (1987) Performance of an in-vivo, continuous blood-gas monitor with disposable probe. Clin Chem 33:1538–1542Google Scholar
  36. 36.
    Barker SJ, Hyatt J (1991) Continuous measurement of Intraarterial pHa, PaCO2, and PaO2 in the operating room. Anesth Analg 73:43–48Google Scholar
  37. 37.
    Mahutte CK, Sassoon CSH, Muro JR et al (1990) Progress in the development of a fluorescent intravascular blood gas system in man. J Clin Monit 6:147–157Google Scholar
  38. 38.
    Smith BE, King PH, Schlain L (1992) Clinical evaluation — continuous real-time intraarterial blood gas monitoring during anesthesia and surgery by fiber optic sensor. Int J Clin Monit Computing 9:45–52Google Scholar
  39. 39.
    Zimmerman J, Dellinger R (1993) Initial evaluation of a new intra-arterial blood gas system in humans. Crit Care Med 21:495–500Google Scholar
  40. 40.
    Larson CP, Vender J, Seiver A (1994) Multisite evaluation of a continuous intra-arterial blood gas monitoring system. Anesthesiology 81:543–552Google Scholar
  41. 41.
    Haller M, Kilger E, Briegel J, Forst H, Peter K (1994) Continuous intra-arterial blood gas and pH monitoring in critically ill patients with severe respiratory failure: a prospective criterion standard study. Crit Care Med 22:580–587Google Scholar
  42. 42.
    Clutton-Brock TH, Fink S, Luthra AJ, Hendry SP (1994) The evaluation of a new intravascular monitoring system in the pig. J Clin Monit 10:387–391Google Scholar
  43. 43.
    Venkatesh B, Blutton-Brock TH, Hendry SP (1994) A multiparameter sensor for continuous intra-arterial blood gas monitoring: a prospective evaluation. Crit Care Med 22:588–594Google Scholar
  44. 44.
    Venkatesh B, Clutton-Brock TH, Hendry SP (1995) The continuous measurement of arterial blood gas chemistry using a combined electrochemical and a spectrophotometric sensor. J Med Eng Technol 18:165–168Google Scholar
  45. 45.
    Venkatesh B, Clutton-Brock TH, Hendry SP (1994) Intraoperative use of the Paratrend 7 intravascular blood gas sensor. Crit Care Med 22[Suppl]:A21Google Scholar
  46. 46.
    Venkatesh B, Clutton-Brock TH, Hendry SP (1995) Evaluation of the Paratrend 7 intravascular blood gas monitor during cardiac surgery. Comparison with an in-line blood gas monitor during cardiopulmonary bypass. J Cardiothor Vasc Anesth 9:412–419Google Scholar
  47. 47.
    Gothgen IH, Siggaard AO, Rasmussen JP, Wimberley PD, Fogh AN (1987) Fiber-optic chemical sensors (Gas-Stat) for blood gas monitoring during hypothermic extracorporeal circulation. Scand J Clin Lab Invest Suppl 188: 17–29Google Scholar
  48. 48.
    Clark JI, Pearson DT, Stone T, Clayton R, Waterhouse PS (1990) An in vitro evaluation of the IL 1312, Gas-Stat and Cardiomet 4000 Systems for blood gas analysis. Perfusionist 7–10Google Scholar
  49. 49.
    Shapiro B, Mahutte C, Cane R, Gilmour I (1993) Clinical performance of a blood gas monitor: a prospective, multicenter trial. Crit Care Med 21: 487–494Google Scholar
  50. 50.
    Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet I:307–310Google Scholar
  51. 51.
    Jalavisto E (1959) Oxygen consumption of blood and plasma and the percentage of reticulocytes. Acta Physiol Scand 46:244–251Google Scholar
  52. 52.
    Adams AP, Morgan-Hughes JO, Sykes MK (1967) pH and blood gas analysis: methods of measurement and sources of error using electrode systems. I. Anaesthesia 23:47–64Google Scholar
  53. 54.
    Scott PV, Horton JN, Mapleson WW (1971) Leakage of oxygen from blood and water samples stored in plastic and glass syringes. BMJ 3:512–516Google Scholar
  54. 55.
    Hess EC, Nichols AB, Hunt WBS (1979) Pseudohypoxemia secondary to leukemia and thrombocytosis. New Engl J Med 301:361–363Google Scholar
  55. 56.
    Clapham MCC, Willis N, Mapleson WW (1987) Minimum volume of discard for valid blood sampling from indwelling arterial cannulae. Br J Anaesth 59:232–235Google Scholar
  56. 57.
    Hansen J, Casaburi R, Crapo R, Jensen R (1990) Assessing precision and accuracy in blood gas proficiency testing. Am Rev Respir Dis 141:1190Google Scholar
  57. 58.
    MacGregor DA, Scuderi PE, Bowton DL et al (1990) A side by side comparison of four blood gas analyzers using tonometered human blood. Chest 98:33SGoogle Scholar
  58. 59.
    Metger LF, Stauffer WB, Krupinski AV et al (1987) Detecting errors in blood gas measurements by analysis with two instruments. Clin Chem 33:512–517Google Scholar
  59. 60.
    Anderson JM, Miller KM (1984) Biomaterial biocompatibility and the macrophage. Biomaterials 5:5–10Google Scholar
  60. 61.
    Greenblot G, Barker SJ, Tremper KK, Gerschultz S, Gehrich JL (1990) Detection of venous air embolism by continuous intra-arterial oxygen monitoring. J Clin Monit 6:53–56Google Scholar
  61. 62.
    Benson JB, Venkatesh B, Patla V (1995) Misleading information from a pulse oximeter and the usefulness of a continuous intra-arterial blood gas monitor in a post cardiac surgery patient. Intensive Care Med 21:437–439Google Scholar
  62. 63.
    Venkatesh B, Clutton-Brock TH, Hendry SP (1995) Continuous intra-arterial blood gas monitoring during cardiopulmonary resuscitation: a case report. Resuscitation 29:135–138Google Scholar
  63. 64.
    Venkatesh B, Piggot D, Fenandez A, Hendry SP (1996) The continuous measurement of arterial blood gas status during total hip replacement. A prospective study. Anaesth Intensive Care (in press)Google Scholar
  64. 65.
    Graystone SJ, Clutton-Brock TH (1995) Preliminary evaluation of a fibre-optic sensor for measuring intragastric carbon dioxide tension. Intensive Care Med 21[Suppl 1]:S81Google Scholar
  65. 66.
    Hoffman WE, Charbel FT, Edelman G (1996) Brain tissue buffering during respiratory acidosis in man. Anesth Analg 82:S183Google Scholar
  66. 67.
    Eberhart RC, Weigelt JA (1980) Continuous blood gas analysis: an elusive ideal. Crit Care Med 8:414Google Scholar

Copyright information

© Springer-Verlag 1996

Authors and Affiliations

  • B. Venkatesh
    • 1
  • S. -P. Hendry
    • 2
  1. 1.Department of AnaesthesiologyRoyal Brisbane HospitalBrisbaneAustralia
  2. 2.Biomedical SensorsHigh WycombeUK

Personalised recommendations