Sepsis Clinical Trial
Official title:
Utility of Mathematically Converted Venous to Arterial Blood Gas for Clinical Monitoring
Objective: Arterial blood gas (ABG) is essential in the clinical assessment of potential
acutely ill patients venous to arterial conversion (v-TAC), a mathematical method, has
recently been developed to convert peripheral venous blood gas (VBG) values to arterialized
VBG (aVBG) values. The aim of this study is to test the reliability of aVBG compared to ABG
in an intensive care unit (ICU) setting.
Method: Consecutive patients admitted to the ICU with pH values <7,35 or >7,45 are included
in this study. Paired ABG and aVBG samples are drawn from patients via arterial catheter,
central venous catheter and/or peripheral venous catheter and compared.
Arterial blood gas (ABG) analysis is essential in assessment of respiratory and metabolic
status in acutely ill patients. In comparison to peripheral venous blood (PVG) sampling, the
ABG sampling procedure is more painful for the patient and technically more challenging for
the clinician to perform. Other drawbacks of ABG sampling include adverse events such as
subcutaneous hematoma, arterial thrombosis or embolization, and pseudoaneurysms.
Peripheral venous blood gas (VBG) sampling has been suggested as an alternative to the ABG
procedure. This procedure causes less patient discomfort and the sample can be analysed in
combination with other venous blood tests. Studies have revealed that pH and bicarbonate have
good correlation, whereas venous and arterial blood gasses (pO2 and pCO2) show low agreement.
However, a new method has been developed to calculate ABG values mathematically from
peripheral venous blood by use of venous to arterial conversion (v-TAC) software (Obimedical,
Denmark), supplemented with oxygen saturation measured by pulse oximetry. The principle of
the method is a mathematical transformation of VBG values to arterialized values (aVBG) by
simulating the transport of blood back through the tissue. Initial testing of the method in
an emergency department setting showed acceptable clinical congruence between arterial and
mathematically arterialized pH and pCO2 with a small difference (+/- SD) on 0.001 +/- 0.024
and 0.00 0.46 kPa, respectively. However, inaccurate values of pO2 were seen when oxygen
saturation measured by pulse oximetry was above 96%, due to the flat shape of the oxygen
dissociation curve (ODC).
Although most patients in the ICU have arterial catheters therefrom ABG can be drawn,
applying arterial catheter is difficult or even impossible in some patients. In relation to
step-down some patients get arterial catheters removed and in the event of deterioration in
patients acid-base or respiratory disease aVBG could prove useful as a minimally invasive
tool to assess patients status.
The aim of this study is to investigate if v-TAC is reliable and safe to use in patients with
critically respiratory or metabolic disease admitted to the ICU.
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