Capillary PO2 does not adequately reflect arterial PO2 in hypoxemic COPD patients

Magnet, Friederike Sophie; Majorski, Daniel Sebastian; Callegari, Jens; Schwarz, Sarah Bettina; Windisch, Wolfram; Schmoor, Claudia

doi:10.1183/1393003.congress-2017.pa2215

Cited by 11 publications

(17 citation statements)

References 16 publications

(52 reference statements)

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“…Novel here, is the comparison with capillary samples in a subset of patients, showing similar accuracy and precision but with capillary PO 2 being systematically lower. The consumption of oxygen by the skin capillary bed and the nature of capillary blood samples (a mix of arterial and venous) means that capillary PO 2 will typically underestimate arterial PO 2 [7, 27]. For mathematically arterialized, or measured capillary PO 2 values <10 kPa, precision may be sufficient for clinical application in the ward [17].…”

Section: Discussionmentioning

confidence: 99%

Evaluation of Mathematical Arterialization of Venous Blood in Intensive Care and Pulmonary Ward Patients

et al. 2021

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Background: Arterial blood gases are important when assessing acute or critically ill patients. Capillary blood and mathematical arterialization of venous blood have been proposed as alternative methods, eliminating pain and complications of arterial puncture. Objectives: This study compares the arterial samples, arterialized venous samples, and capillary samples in ICU and pulmonary ward patients. Method: Ninety-one adult patients with respiratory failure were included in the analysis. Arterial, peripheral venous, and mathematically arterialized venous samples were compared in all patients using Bland-Altman analysis, with capillary samples included in 36 patients. Results: Overall for pH and PCO2, arterialized venous values, and in the subset of 36 patients, capillary values, compared well to arterial values and were within the pre-defined clinically acceptable differences (pH ± 0.05 and PCO2 ± 0.88 kPa). For PO2, arterialized or capillary values describe arterial with similar precision (PO2 arterialized −0.03, LoA −1.48 to 1.42 kPa and PO2 capillary 0.82, LoA −1.36 to 3 kPa), with capillary values underestimating arterial. Conclusions: Mathematical arterialization functions well in a range of patients in an ICU and ward outside the country of development of the method. Furthermore, accuracy and precision are similar to capillary blood samples. When considering a replacement for arterial sampling in ward patients, using capillary sampling or mathematical arterialization should depend on logistic ease of implementation and use rather than improved measurements of using either technique.

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Section: Discussionmentioning

confidence: 99%

Evaluation of Mathematical Arterialization of Venous Blood in Intensive Care and Pulmonary Ward Patients

et al. 2021

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“…Luftblasen in den Kapillarproben. Darüber hinaus wurde in diesen Studien der Patientenkomfort untersucht; die arterielle Probenentnahme war für die Patienten signifikant schmerzhafter, gemessen an visuellen Analogskalen [100,101]. Kapilläre Blutgasanalysen können nach Expertenmeinung deswegen außerhalb der Intensivstation bei stabilen Patienten nach sehr guter Hyperämisierung des Ohrläppchens eingesetzt werden, jedoch nicht in Notfallsituationen bei instabilen Patienten.…”

Section: Lebensqualitätunclassified

S3-Leitlinie Sauerstoff in der Akuttherapie beim Erwachsenen

et al. 2021

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Zusammenfassung Hintergrund Sauerstoff (O2) ist ein Arzneimittel mit spezifischen biochemischen und physiologischen Eigenschaften, einem definierten Dosis-Wirkungsbereich und mit unerwünschten Wirkungen. Im Jahr 2015 wurden 14 % von über 55 000 Krankenhauspatienten in Großbritannien mit O2 behandelt. Nur 42 % der Patienten hatten dabei eine O2-Verordnung. Gesundheitspersonal ist oft unsicher über die Relevanz einer Hypoxämie, und es besteht ein eingeschränktes Bewusstsein für die Risiken einer Hyperoxämie. In den letzten Jahren wurden zahlreiche randomisierte kontrollierte Studien zu Zielen der Sauerstofftherapie veröffentlicht. Eine nationale Leitlinie ist deswegen dringend erforderlich. Methoden Im Rahmen des Leitlinienprogramms der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften e. V. (AWMF) wurde unter Beteiligung von 10 Fachgesellschaften eine S3-Leitlinie entwickelt und im Juni 2021 veröffentlicht. Bis zum 1. 2. 2021 wurde eine Literaturrecherche durchgeführt, um 10 Schlüsselfragen zu beantworten. Zur Klassifizierung von Studientypen hinsichtlich ihrer Validität wurde das Oxford Centre for Evidence-Based Medicine (CEBM) System („The Oxford 2011 Levels of Evidence“) verwendet. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) wurde verwendet und zur Bewertung der Evidenzqualität und zur Einstufung von Leitlinienempfehlungen wurde ein formaler Konsensbildungsprozess durchgeführt. Ergebnisse Die Leitlinie enthält 34 evidenzbasierte Empfehlungen zu Indikation, Verordnung, Überwachung und Abbruch der Sauerstofftherapie in der Akutversorgung. Die Hauptindikation für die O2-Therapie ist Hypoxämie. In der Akutmedizin sollten sowohl Hypoxämie als auch Hyperoxämie vermieden werden. Hyperoxämie scheint mit einer erhöhten Sterblichkeit verbunden zu sein, insbesondere bei Patienten mit Hyperkapnie. Die Leitlinie empfiehlt Zielsauerstoffsättigung für die Akuttherapie mit O2 ohne Differenzierung zwischen Diagnosen. Zielbereiche sind abhängig vom Hyperkapnierisko und Beatmungsstatus. Die Leitlinie bietet einen Überblick über verfügbare Sauerstoffzufuhrsysteme und enthält Empfehlungen für deren Auswahl basierend auf Patientensicherheit und -komfort. Fazit Dies ist die erste nationale Leitlinie zum Einsatz von Sauerstoff in der Akutmedizin. Sie richtet sich an medizinisches Fachpersonal, das Sauerstoff außerklinisch und stationär anwendet. Sie ist bis zum 30. 06. 2024 gültig.

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“…The German guideline considers CBG and ABG analyses to be equivalent (5), although recent data suggest that CBG analysis underestimates the actual oxygenation level in the blood (22). Depending on whether one sets a limit value for LTOT at 55 mm Hg or 60 mm Hg, about 21% or 30% of patients, respectively, would have been prescribed non-indicated LTOT, thus representing overprescription (22). After confirmation of hypoxemia at rest, during exercise, and/or at night, the necessary oxygen flow rates should be titrated to achieve PaO 2 ≥60 mm Hg.…”

Section: The Diagnosis Of Hypoxemic Respiratory Failurementioning

confidence: 99%

Long-Term Oxygen Therapy

Koczulla¹,

Schneeberger²,

Jarosch³

et al. 2018

Deutsches Ärzteblatt International

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n a first pilot study in 1967, Levine and colleagues (1) found that oxygen delivery to patients with chronic obstructive pulmonary disease (COPD) and hypoxemia improved pulmonary hypertension and increased exercise performance (1). As a result, oxygen supplementation developed as a therapeutic measure in chronic hypoxemia. However, there is still insufficient evidence for oxygen therapy, as it is essentially based on two studies from the early 1980s (2, 3). This review provides an overview of the current evidence, with the aim of examining the practical, day-today aspects of long-term oxygen therapy (LTOT). Methods This article is based on a selective literature search in PubMed. Publications from January 1980 to April 2018 were searched using the terms "long-term oxygen therapy," "ambulatory oxygen therapy," "nocturnal oxygen therapy," and "supplemental oxygen." Current German and international guidelines (in German or English) were also included. Results Long-Term Oxygen Therapy For chronic hypoxemic patients with an arterial partial pressure of oxygen (PaO 2) ≤ 55 mm Hg, national guidelines for LTOT recommend giving oxygen for at least 15 hours per day (4) or for 16 hours per day (5); this should be extended to 24 hours for increased efficacy (see section "Indication criteria for LTOT") (4, 5). This includes targeted oxygen replacement during exercise and at night. As studies do not consider these different situations of oxygen deficiency separately, the effects of these three therapeutic approaches cannot be delimited. The goals of LTOT are to improve quality of life and exercise performance, as well as to reduce morbidity and mortality (5). Effects of LTOT LTOT for chronic hypoxemia The currently validated evidence for prescribing LTOT is based on two randomized controlled trials published in the early 1980s (2, 3). In the so-called MRC (Medical Research Council) trial, 87 COPD patients (FEV 1 , 0.6 L) were included who had pronounced chronic hypoxemia (PaO 2 = 51 mm Hg) and hypercapnia (PaCO 2 = 54 mm Hg) in a resting state; they were then Summary Background: Long-term oxygen therapy (LTOT) is an established treatment for patients with chronic hypoxemia. Its scientific basis is derived mainly from two trials from the early 1980s that showed a survival advantage for patients with chronic obstructive pulmonary disease (COPD) treated with LTOT. Robust data are not available for other diseases associated with hypoxemia. Methods: This review is based on pertinent publications retrieved by a selective search in PubMed. Results: The use of LTOT for 15 to 16 hours per day (or, better, 24 hours per day) is recommended in current guidelines for patients with chronic hypoxemia (PaO 2 ≤ 55 mm Hg) because this treatment was found to be associated with a lower mortality rate compared to no LTOT (33% vs. 55%, p <0.05) based on data from the early 1980s. In the short term, oxygen administration to a hypoxemic patient can improve oxygen saturation by nine percentage points and improve physical performance to a clinically re...

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Capillary PO2 does not adequately reflect arterial PO2 in hypoxemic COPD patients

Cited by 11 publications

References 16 publications

Evaluation of Mathematical Arterialization of Venous Blood in Intensive Care and Pulmonary Ward Patients

Evaluation of Mathematical Arterialization of Venous Blood in Intensive Care and Pulmonary Ward Patients

S3-Leitlinie Sauerstoff in der Akuttherapie beim Erwachsenen

Long-Term Oxygen Therapy

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