AARC Clinical Practice Guideline: Blood Gas Analysis and Hemoximetry: 2013

Davis, Michael D.; Walsh, Brian K; Sittig, Steven E.; Restrepo, Ruben D

doi:10.4187/respcare.02786

Cited by 121 publications

(93 citation statements)

References 64 publications

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“…Rapid processing of the samples alone is certainly not sufficient to prevent spurious hypoxemia, as elegantly shown by Fox et al 5 ; performing in vitro studies of blood samples using a tonometer, they observed a drop in P O 2 from 130 to 55 mm Hg within 2 min only for a WBC count of 276 ϫ 10 9 /L at ambient temperature. Our results reinforce the AARC recommendations 11 but suggest that they may not be sufficient to prevent spurious hypoxemia.…”

Section: Discussionsupporting

confidence: 81%

“…11 Although our ABGs were processed according to these recommendations (immediately cooled and analyzed without delay), we still observed clinically important spurious hypoxemia. Some authors have described a blunted P aO 2 decay in samples placed on ice, 5,10 but others have argued that immediate cooling is not sufficient to eliminate spurious hypoxemia, because the oxygen consumption by leukocytes continues during the time (as short as a few minutes) required by samples to gradually reach ice water temperature.…”

Section: Discussionmentioning

confidence: 99%

“…10 Published data come from small series, but no study has ever systematically investigated the reliability of P aO 2 and S aO 2 in this setting, probably because of the relative rarity of extreme hyperleukocytosis. Although the American Association for Respiratory Care (AARC) has recommended immediate cooling and analysis of ABG for hyperleukocytic patients, 11 these guidelines rely on limited data, and their effect on the magnitude of spurious hypoxemia has never been evaluated.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Hypoxemia During Extreme Hyperleukocytosis: How Spurious?

Louw

Desai²,

Schneider³

et al. 2015

Respir Care

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BACKGROUND: Spurious hypoxemia has been described in case reports during extreme hyperleukocytosis and has led to recommendations for immediate cooling and analysis of arterial blood gases (ABGs). We sought to determine, in samples processed as recommended, the magnitude of spurious hypoxemia in acute leukemia subjects with hyperleukocytosis. METHODS: A retrospective chart review was conducted of all subjects admitted between 2003 and July 2014 for acute leukemia, who presented with white blood cell (WBC) count > 50 ؋ 10 9 cells/L and had ABGs performed. For each ABG, we collected P aO 2 , S aO 2 , simultaneous WBC count, and S pO 2 when available. Bland and Altman analysis was used to assess the agreement between S pO 2 and S aO 2 . RESULTS: One-hundred forty-six samples (from 45 subjects) were included, of which 57 samples (from 18 subjects) had data available for Bland and Altman analysis. Mean (S pO 2 ؊ S aO 2 ) was 2.5%, and 95% CI for limits of agreement between S pO 2 and S aO 2 was (؊10.1,15.1)%. The mean (S pO 2 -S aO 2 ) was significantly higher for WBC count > 100 ؋ 10 9 /L as compared with WBC count < 100 ؋ 10 9 /L (3.8% vs 0.4%, P ‫؍‬ .04), and the 95% CIs for limits of agreement were (؊10.3,18)% versus (؊7.9,8.6)%. S pO 2 and S aO 2 were poorly correlated (r 2 ‫؍‬ 0.19), whereas the difference (S pO 2 -S aO 2 ) was fairly correlated with WBC count (r 2 ‫؍‬ 0.44). Overall, 11 of 19 samples with WBC count > 150 ؋ 10 9 /L had P aO 2 < 55 mm Hg whereas S pO 2 was > 94%, the proportion being 5 of 62 samples for WBC count < 150 ؋ 10 9 /L (P < .001). Three subjects with WBC count > 150 ؋ 10 9 /L exhibited large S pO 2 to S aO 2 differences (10 -20%) before leukapheresis, which decreased to below 5% afterward. CONCLUSIONS: In subjects with acute leukemia and hyperleukocytosis, despite cooling and quickly analyzing the samples, we observed poor correlation and agreement between S pO 2 and S aO 2 , unacceptably low for WBC count > 100 ؋ 10 9 /L. Our results suggest that current guidelines may not totally prevent the diagnosis of spurious hypoxemia.

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hypoxemia During Extreme Hyperleukocytosis: How Spurious?

Louw

Desai²,

Schneider³

et al. 2015

Respir Care

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“…The American Association for Respiratory Care guidelines detail these current best practices for sampling, handling, and analyzing ABGs. 9 As Van de Louw et al 1 describe in their recent article, leukocyte larceny is another possible etiology of spurious results, specifically spurious hypoxemia. This effect can be seen not only with extreme leukocytosis (white blood cells Ͼ100 ϫ 10 9 /L) but with extreme thrombocytosis (platelets Ͼ100 ϫ 10 10 /L) as well, due to ex vivo oxygen consumption by these metabolically active cells.…”

mentioning

confidence: 99%

Circumstances When Arterial Blood Gas Analysis Can Lead Us Astray

Albert

Swenson

2015

Respir Care

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“…Various methods for directly or indirectly determination of the tissue oxygenation have been developed and are currently used in both clinical practice and experimental studies such as: blood gas analysis [1], polarographic electrode technique [2], transcutaneous oxygen measurement [3], pulse oximetry [4], near-infrared spectroscopy [5], magnetic resonance imaging [6], electron paramagnetic resonance [7], and positron emission tomography [8]. Each of these methods has however its own limitations, in terms of accuracy, invasiveness, time-consuming, expensiveness, etc.…”

Section: Introductionmentioning

confidence: 99%

Algorithm for mapping cutaneous tissue oxygen concentration using hyperspectral imaging

Micloş¹,

Parasca²,

Săvăstru³

et al. 2015

Biomed. Opt. Express

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Abstract:The measurement of tissue oxygenation plays an important role in the diagnosis and therapeutic assessment of a large variety of diseases. Many different methods have been developed and are currently applied in clinical practice for the measurement of tissue oxygenation. Unfortunately, each of these methods has its own limitations. In this paper we proposed the use of hyperspectral imaging as new method for the assessment of the tissue oxygenation level. To extract this information from hyperspectral images a new algorithm for mapping cutaneous tissue oxygen concentration was developed. This algorithm takes into account and solves some problems related to setting and calculation of some parameters derived from hyperspectral images. The algorithm was tested with good results on synthetic images and then validated on the fingers of a hand with different blood irrigation states. The results obtained have proved the ability of hyperspectral imaging together with the developed algorithm to map the oxy-and deoxyhemoglobin distribution on the analyzed fingers. These are only preliminary results and other studies should be done before this approach to be used in the clinical setting for the diagnosis and monitoring of various diseases. characterization of a noninvasive, in vivo system for determining tissue perfusion," Anal. Chem. 74(9), 2021-2028 (2002). 14. D. Jakovels, J. Spigulis, and I. Saknite, "Multi-spectral mapping of in-vivo skin hemoglobin and melanin," Proc.SPIE 7715, 77152Z (2010). 15. C. E. Cooper, C. E. Elwell, J. H. Meek, S. J. Matcher, J. S. Wyatt, M. Cope, and D. T. Delpy, "The noninvasive measurement of absolute cerebral deoxyhemoglobin concentration and mean optical path length in the neonatal brain by second derivative near infrared spectroscopy," Pediatr.

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AARC Clinical Practice Guideline: Blood Gas Analysis and Hemoximetry: 2013

Cited by 121 publications

References 64 publications

Hypoxemia During Extreme Hyperleukocytosis: How Spurious?

Hypoxemia During Extreme Hyperleukocytosis: How Spurious?

Circumstances When Arterial Blood Gas Analysis Can Lead Us Astray

Algorithm for mapping cutaneous tissue oxygen concentration using hyperspectral imaging

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