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.
Article PDF
Similar content being viewed by others
Avoid common mistakes on your manuscript.
References
McInnes DA, Belcher D (1933) A durable glass electrode. Industrial and engineering chemistry: analytical edition 5:199–200
Stow RW, Randall BF (1954) Electrical measurement of the PCO2 of blood. Am J Physiol 179:678
Severinghaus JW, Bradley AF (1958) Electrodes for blood PO2 and PCO2 determination. J Appl Physiol 13: 515–520
Clark LC (1956) Monitor and control of blood and tissue oxygen measurements. Trans Am Soc Artif Intern Organs 2:41–48
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 242–255
Thornson SH, Marini JJ, Pierson DJ, Hudson LD (1983) Variability in arterial blood gas values in stable patients in the ICU. Chest 84:14–18
Ralston AC, Webb RK, Runciman WB (1991). Potential errors in pulse oximetry. I. Pulse oximetry evaluation. Anaesthesia 46:202–206
Webb RK, Ralston AC, Runciman WB (1991) Potential errors in pulse oximetry. II. Pulse oximetry evaluation. Anaesthesia 46:207–212
Ralston AC Webb RK, Runciman WB (1991) Potential errors in pulse oximetry. III. Pulse oximetry evaluation. Anaesthesia 46:291–295
Severinghaus JW, Naifeh KH, Koh SO (1989) Errors in 14 pulse oximeters during profound hypoxia. J Clin Monit 5:72–81
Fletcher R, Capnography (1994) In: Hutton P, Prys-Roberts C (eds) Monitoring in anaesthesia and intensive care, 1st edn. Saunders, London, pp 214–232
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 12:943–948
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 12:949–952
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 8:410–413
Hall, JR, Poulton J, Downs JB et al (1980) In vivo arterial blood gas analysis for evaluation. Crit Care Med 8:414
Kautsky H (1939) Quenching of luminiscence by oxygen. Trans Faraday Soc 35:216–219
Opitz N, Lubbers DW (1987) Theory and development of fluorescence-based optochemical oxygen sensors: oxygen optodes. Int Anesthesiol Clin 25: 177–197
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: 532–533
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 33:117–132
Buytendijk F (1927) The use of the antinomy electrode in the determination of pH in vivo. Arch Neerland Physiol 12:319
Kreuzer F, Nessler C (1958) Method of polarographic in vivo continuous recording of blood oxygen tension. Science 128:1005–1006
Koeff ST, Tsao MU, Vadnay A et al (1962) Continuous measurement of intravascular oxygen trension in normal adults. J Clin Invest 41:1125–1133
Charlton G, Read D, Read J (1963) Continuous intra-arterial PO2 in normal man using a flexbile microelectrode. J Appl Physiol 18:1247–1251
Band D, Semple S (1967) Continuous measurement of blood pH with an indwelling arterial glass electrode. J Appl Physiol 22:854
Gold MI, Diaz PM, Feingold A (1975) A disposable in vivo oxygen electrode for the continuous measurement of arterial oxygen tension. Surgery 78: 245–250
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 40:644
Peterson J, Goldstein S, Fitzgerald R (1980) Fibre optic pH probe for physiological use. Analytical Chem 52: 864–869
Nilsson E, Edwall G (1981) Continuous intra-arterial pH-monitoring using monocrystalline antimony as sensor. Scand J Clin Lab Invest 41:333–338
Vurek G, Feustel P, Severinghaus J (1983) A fiberoptic PCO2 sensor. Ann Biomed Eng 11:499–510
Peterson J, Fitzgerald R, Buckhold D (1984) Fibre optic probe for in vivo measurement of oxygen partial pressure. Anal Chem 56:62–67
Abraham E, Markle D, Fink S et al (1985) Continuous measurement of intravascular pH with a fiber optic sensor. Anesth Analg 64:731
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 43:677–682
Rithalia S, Edwards D, Doran B (1992) Performance characteristics of an intra-arterial oxygen electrode in critically ill adult patients. Br J Intensive Care: 29–33
Barker SJ, Tremper KK, Hyatt J et al (1987) Continuous fiberoptic arterial oxygen tension measurements in dogs. J Clin Monit 3:48–52
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 33:1538–1542
Barker SJ, Hyatt J (1991) Continuous measurement of Intraarterial pHa, PaCO2, and PaO2 in the operating room. Anesth Analg 73:43–48
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 6:147–157
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 9:45–52
Zimmerman J, Dellinger R (1993) Initial evaluation of a new intra-arterial blood gas system in humans. Crit Care Med 21:495–500
Larson CP, Vender J, Seiver A (1994) Multisite evaluation of a continuous intra-arterial blood gas monitoring system. Anesthesiology 81:543–552
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 22:580–587
Clutton-Brock TH, Fink S, Luthra AJ, Hendry SP (1994) The evaluation of a new intravascular monitoring system in the pig. J Clin Monit 10:387–391
Venkatesh B, Blutton-Brock TH, Hendry SP (1994) A multiparameter sensor for continuous intra-arterial blood gas monitoring: a prospective evaluation. Crit Care Med 22:588–594
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 18:165–168
Venkatesh B, Clutton-Brock TH, Hendry SP (1994) Intraoperative use of the Paratrend 7 intravascular blood gas sensor. Crit Care Med 22[Suppl]:A21
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 9:412–419
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: 17–29
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 7–10
Shapiro B, Mahutte C, Cane R, Gilmour I (1993) Clinical performance of a blood gas monitor: a prospective, multicenter trial. Crit Care Med 21: 487–494
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet I:307–310
Jalavisto E (1959) Oxygen consumption of blood and plasma and the percentage of reticulocytes. Acta Physiol Scand 46:244–251
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 23:47–64
Scott PV, Horton JN, Mapleson WW (1971) Leakage of oxygen from blood and water samples stored in plastic and glass syringes. BMJ 3:512–516
Hess EC, Nichols AB, Hunt WBS (1979) Pseudohypoxemia secondary to leukemia and thrombocytosis. New Engl J Med 301:361–363
Clapham MCC, Willis N, Mapleson WW (1987) Minimum volume of discard for valid blood sampling from indwelling arterial cannulae. Br J Anaesth 59:232–235
Hansen J, Casaburi R, Crapo R, Jensen R (1990) Assessing precision and accuracy in blood gas proficiency testing. Am Rev Respir Dis 141:1190
MacGregor DA, Scuderi PE, Bowton DL et al (1990) A side by side comparison of four blood gas analyzers using tonometered human blood. Chest 98:33S
Metger LF, Stauffer WB, Krupinski AV et al (1987) Detecting errors in blood gas measurements by analysis with two instruments. Clin Chem 33:512–517
Anderson JM, Miller KM (1984) Biomaterial biocompatibility and the macrophage. Biomaterials 5:5–10
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 6:53–56
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 21:437–439
Venkatesh B, Clutton-Brock TH, Hendry SP (1995) Continuous intra-arterial blood gas monitoring during cardiopulmonary resuscitation: a case report. Resuscitation 29:135–138
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)
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]:S81
Hoffman WE, Charbel FT, Edelman G (1996) Brain tissue buffering during respiratory acidosis in man. Anesth Analg 82:S183
Eberhart RC, Weigelt JA (1980) Continuous blood gas analysis: an elusive ideal. Crit Care Med 8:414
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Venkatesh, B., Hendry, S.P. Continuous intra-arterial blood gas monitoring. Intensive Care Med 22, 818–828 (1996). https://doi.org/10.1007/BF01709527
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF01709527