Abstract:A
bstract
Background
Arterial blood gas (ABG) analysis is a common test ordered in critically ill patients. Often, it is performed very frequently without influencing patient care. Hence, we decided to check the utility of the ABG test in our intensive care unit (ICU).
Materials and methods
The data of the previous day ABGs were captured by reviewing the chart in an online pro forma which was filled by the authors. Data relating to patient's d… Show more
“…In one study, up to 80% of ABGs were sent based on "routine" practice with no clinical treatment performed based on test results. 20 In a level one trauma center that performed targeted education, the number of ABGs sent was reduced by 33%, representing an annual cost savings of $700,000 and reduction in phlebotomy volume of 100 liters of blood. 21 Blood draws are frequently performed to assess anticoagulation status during ECMO and over-anticoagulation can contribute to bleeding.…”
Section: Discussionmentioning
confidence: 99%
“…Many ABGs are sent without actionable consequence in critically ill patients. In one study, up to 80% of ABGs were sent based on “routine” practice with no clinical treatment performed based on test results 20 . In a level one trauma center that performed targeted education, the number of ABGs sent was reduced by 33%, representing an annual cost savings of $700,000 and reduction in phlebotomy volume of 100 liters of blood 21 …”
BackgroundAdult extracorporeal membrane oxygenation (ECMO) patients are at high risk for allogeneic blood transfusion. Few studies have characterized iatrogenic blood loss from phlebotomy in adult ECMO patients. We hypothesized that iatrogenic phlebotomy would be a significant source of blood loss during ECMO.MethodsAdults who had their entire ECMO run at our medical center between 2020 and 2022 were included. Average daily phlebotomy volume and total phlebotomy volume during ECMO were estimated based on the total number of laboratory tests that were processed. In addition, the crude and adjusted association between total phlebotomy volume during ECMO and RBC transfusion during ECMO was evaluated using linear regression and Loess curve analysis.ResultsA total of 161 patients who underwent 162 ECMO runs were included. Of the 162 ECMO runs, 88 (54.3%) were veno‐arterial and 74 (45.7%) were veno‐venous ECMO. Median duration of ECMO was 5 days [25th, 75th percentile = 2, 11]. Median daily phlebotomy volume was 130 mLs [25th, 75th percentile = 94, 170] and median total phlebotomy volume during ECMO was 579 mLs [25th, 75th percentile = 238, 1314]. There was a significant crude and adjusted association between total phlebotomy volume and RBC transfusion during ECMO (beta coefficient = 0.0023 and 0.0024 respectively, both p < .001) based on linear regression analysis.DiscussionPhlebotomy for laboratory testing is a significant source of blood loss during ECMO in adults. Comprehensive patient blood management for adult ECMO patients should include strategies to reduce laboratory testing and/or phlebotomy volume during ECMO.
“…In one study, up to 80% of ABGs were sent based on "routine" practice with no clinical treatment performed based on test results. 20 In a level one trauma center that performed targeted education, the number of ABGs sent was reduced by 33%, representing an annual cost savings of $700,000 and reduction in phlebotomy volume of 100 liters of blood. 21 Blood draws are frequently performed to assess anticoagulation status during ECMO and over-anticoagulation can contribute to bleeding.…”
Section: Discussionmentioning
confidence: 99%
“…Many ABGs are sent without actionable consequence in critically ill patients. In one study, up to 80% of ABGs were sent based on “routine” practice with no clinical treatment performed based on test results 20 . In a level one trauma center that performed targeted education, the number of ABGs sent was reduced by 33%, representing an annual cost savings of $700,000 and reduction in phlebotomy volume of 100 liters of blood 21 …”
BackgroundAdult extracorporeal membrane oxygenation (ECMO) patients are at high risk for allogeneic blood transfusion. Few studies have characterized iatrogenic blood loss from phlebotomy in adult ECMO patients. We hypothesized that iatrogenic phlebotomy would be a significant source of blood loss during ECMO.MethodsAdults who had their entire ECMO run at our medical center between 2020 and 2022 were included. Average daily phlebotomy volume and total phlebotomy volume during ECMO were estimated based on the total number of laboratory tests that were processed. In addition, the crude and adjusted association between total phlebotomy volume during ECMO and RBC transfusion during ECMO was evaluated using linear regression and Loess curve analysis.ResultsA total of 161 patients who underwent 162 ECMO runs were included. Of the 162 ECMO runs, 88 (54.3%) were veno‐arterial and 74 (45.7%) were veno‐venous ECMO. Median duration of ECMO was 5 days [25th, 75th percentile = 2, 11]. Median daily phlebotomy volume was 130 mLs [25th, 75th percentile = 94, 170] and median total phlebotomy volume during ECMO was 579 mLs [25th, 75th percentile = 238, 1314]. There was a significant crude and adjusted association between total phlebotomy volume and RBC transfusion during ECMO (beta coefficient = 0.0023 and 0.0024 respectively, both p < .001) based on linear regression analysis.DiscussionPhlebotomy for laboratory testing is a significant source of blood loss during ECMO in adults. Comprehensive patient blood management for adult ECMO patients should include strategies to reduce laboratory testing and/or phlebotomy volume during ECMO.
“…An arterial blood gas (ABG) test is one of the most frequently performed tests in intensive care units (ICU). It is the most accurate method of assessing the oxygenation level by determining the level of oxygen pressure in arterial blood (PaO 2 ) [6,7]. The ABG test is used to detect hypoxia (0-80 mm Hg), normoxia (80-100 mm Hg), and hyperoxia (> 100 mm Hg), but it can also be used to measure parameters such as the level of carbon dioxide pressure in arterial blood (PaCO 2 ), pH, concentration of bicarbonate in arterial blood (HCO 3 -), and excess or deficit of base in arterial blood (BE), thus allowing the assessment of ventilation and the body's acid-base balance [8].…”
Oxygen is the most common and widely used drug. Oxygen therapy is used not only among mechanically ventilated patients in intensive care units, but also in the perioperative period and in patients requiring oxygen supplementation in other hospital wards. The main methods of monitoring the blood oxygenation level include arterial blood gases and pulse oximetry. A new parameter that allows the monitoring of patients' oxygenation status is the oxygen reserve index (ORi). The ORi provides easy, non-invasive, bedside monitoring of oxygen reserve capacity. The oxygen reserve index reflects the partial pressure of oxygen in arterial blood (PaO 2 ) in the range 100-200 mm Hg. It therefore allows the detection of mild hyperoxia, enabling the safe use of lower concentrations of oxygen in the breathing mixture. It is also a useful tool in predicting impending hypoxia. This paper summarizes the usefulness of oxygen reserve index monitoring in various clinical situations in everyday anaesthesiology practice.
StreszczenieTlen jest najczęściej i najpowszechniej używanym lekiem. Tlenoterapia stosowana jest wśród wentylowanych mechanicznie pacjentów oddziałów intensywnej terapii, w okresie okołooperacyjnym, a także u pacjentów wymagających suplementacji tlenem, przebywających na innych oddziałach szpitalnych. Do głównych metod monitorowania poziomu utlenowania krwi w organizmie należą oznaczanie gazometrii krwi tętniczej oraz pulsoksymetria. Nowym parametrem pozwalającym na monitorowanie gospodarki tlenowej jest indeks rezerwy tlenowej (ORi). ORi umożliwia łatwe, nieinwazyjne, przyłóżkowe monitorowanie poziomu rezerwy tlenowej organizmu. Indeks rezerwy tlenowej odzwierciedla wartości ciśnienia parcjalnego tlenu we krwi tętniczej (PaO 2 ) w zakresie 100-200 mm Hg. Pozwala on na wykrywanie łagodnej hiperoksji, co umożliwia bezpieczne stosowanie niższych stężeń tlenu w mieszaninie oddechowej. Jest również przydatnym narzędziem w przewidywaniu zagrażającej hipoksji. W artykule omówiono przydatność monitorowania indeksu rezerwy tlenowej w różnych sytuacjach klinicznych z codziennej praktyki anestezjologicznej.
“…A recent study has shown that PaO 2 ∗ 10/FiO 2 ∗ PEEP (P/FP ∗ 10 ratio) has a significantly better predictive ability for mortality in ARDS patients when compared to P/F ratio alone [ 2 ]. However, as these values change dynamically during the course of mechanical ventilation (MV) in a patient, repeated arterial sampling is required which is associated with increased chances of infection, blood loss, patient discomfort, and costs [ 4 , 5 ].…”
Background. Conventionally, PaO2/FiO2 (P/F ratio) has been used to categorize severity of acute respiratory distress syndrome (ARDS) and prognostication of outcome. Recent literature has shown that incorporation of positive end-expiratory pressure (PEEP) into the P/F ratio (PaO2
∗
10/FiO2
∗
PEEP or P/FP
∗
10) has a much better prognostic ability in ARDS as compared to P/F ratio. The aim of this study was to correlate SpO2
∗
10/FiO2
∗
PEEP (S/FP
∗
10) to PaO2
∗
10/FiO2
∗
PEEP (P/FP
∗
10) and evaluate the utility of S/FP
∗
10 as a reliable noninvasive indicator of oxygenation in ARDS to avoid repeated arterial blood sampling. Aim. To evaluate if pulse oximetry is a reliable indicator of oxygenation in ARDS patients by calculating SpO2
∗
10/FiO2
∗
PEEP (S/FP
∗
10). The primary objective was to determine the correlation of S/FP
∗
10 to P/FP
∗
10 ratio in ARDS patients. The secondary objective was to determine the cut-off value of S/FP
∗
10 ratio to predict severe ARDS and survival. Methods. Patients aged 18–80 years on invasive mechanical ventilation (MV) diagnosed with ARDS as defined by the Berlin definition were included. The values of PaO2, FiO2, and SpO2 were collected at three different time points. They were at baseline, i.e., after intubation and initiation of MV (within one hour of intubation), day one (1–24 hours of MV), and day three (48–72 hours of MV). The primary outcome was survival at the end of intensive care unit (ICU) stay. Results. A total of 85 patients with ARDS on invasive MV were included. The data points were obtained at baseline, day one, and day three of MV. S/FP
∗
10 ratio has an excellent correlation to P/FP
∗
10 ratio at baseline and day three of invasive MV (r = 0.831 and 0.853, respectively;
p
<
0.001
) and has a strong correlation on day one of invasive MV (r = 0.733,
p
<
0.001
). S/FP
∗
10 ratio ≤116 at baseline has excellent discriminant function to be categorized as severe ARDS as per Berlin definition (AUC: 0.925,
p
<
0.001
, 90% sensitivity, 93% specificity, CI: [0.862–0.988]). The increase in S/FP
∗
10 ratio by ≥64.40 from baseline to day three of MV is a good predictor of survival (AUC: 0.877,
p
<
0.001
, 73.5% sensitivity, 97% specificity, CI: [0.803–0.952]). Conclusion. S/FP
∗
10 has a strong correlation to P/FP
∗
10 in ARDS patients. S/FP
∗
10 ≤116 has an excellent discriminant function to be categorized as severe ARDS. The S/FP
∗
10 ratio on day three of MV and the change in S/FP
∗
10 ratio from baseline and day one to day three of MV are good predictors of survival in ARDS patients. This trial is registered with CTRI/2020/04/024940.
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