PDF(Pubmed)
Abstract：
Accurate arterial blood gas (ABG) analysis is essential in the management of patients with hypercapnic respiratory failure, but repeated sampling requires technical expertise and is painful. Missed sampling is common and has a negative impact on patient care. A newer venous to arterial conversion method (v-TAC, Roche) uses mathematical models of acid-base chemistry, a venous blood gas sample and peripheral blood oxygen saturation to calculate arterial acid-base status. It has the potential to replace routine ABG sampling for selected patient cohorts. The aim of this study was to compare v-TAC with ABG, capillary and venous sampling in a patient cohort referred to start non-invasive ventilation (NIV).
Recruited patients underwent near simultaneous ABG, capillary blood gas (CBG) and venous blood gas (VBG) sampling at day 0, and up to two further occasions (day 1 NIV and discharge). The primary outcome was the reliability of v-TAC sampling compared with ABG, via Bland-Altman analysis, to identify respiratory failure (via PaCO2) and to detect changes in PaCO2 in response to NIV. Secondary outcomes included agreements with pH, sampling success rates and pain.
The agreement between ABG and v-TAC/venous PaCO2 was assessed for 119 matched sampling episodes and 105 between ABG and CBG. Close agreement was shown for v-TAC (mean difference (SD) 0.01 (0.5) kPa), but not for CBG (-0.75 (0.69) kPa) or VBG (+1.00 (0.90) kPa). Longitudinal data for 32 patients started on NIV showed the closest agreement for ABG and v-TAC (R2=0.61). v-TAC sampling had the highest first-time success rate (88%) and was less painful than arterial (p<0.0001).
Mathematical arterialisation of venous samples was easier to obtain and less painful than ABG sampling. Results showed close agreement for PaCO2 and pH and tracked well longitudinally such that the v-TAC method could replace routine ABG testing to recognise and monitor patients with hypercapnic respiratory failure.
NCT04072848; www.
gov.
Recruited patients underwent near simultaneous ABG, capillary blood gas (CBG) and venous blood gas (VBG) sampling at day 0, and up to two further occasions (day 1 NIV and discharge). The primary outcome was the reliability of v-TAC sampling compared with ABG, via Bland-Altman analysis, to identify respiratory failure (via PaCO2) and to detect changes in PaCO2 in response to NIV. Secondary outcomes included agreements with pH, sampling success rates and pain.
The agreement between ABG and v-TAC/venous PaCO2 was assessed for 119 matched sampling episodes and 105 between ABG and CBG. Close agreement was shown for v-TAC (mean difference (SD) 0.01 (0.5) kPa), but not for CBG (-0.75 (0.69) kPa) or VBG (+1.00 (0.90) kPa). Longitudinal data for 32 patients started on NIV showed the closest agreement for ABG and v-TAC (R2=0.61). v-TAC sampling had the highest first-time success rate (88%) and was less painful than arterial (p<0.0001).
Mathematical arterialisation of venous samples was easier to obtain and less painful than ABG sampling. Results showed close agreement for PaCO2 and pH and tracked well longitudinally such that the v-TAC method could replace routine ABG testing to recognise and monitor patients with hypercapnic respiratory failure.
NCT04072848; www.
gov.
摘要：
背景：准确的动脉血气（ABG）分析对于高碳酸血症性呼吸衰竭患者的管理至关重要，但是重复取样需要技术专长，而且很痛苦。漏检是常见的，对患者护理有负面影响。一种较新的静脉到动脉转换方法(v-TAC，罗氏)使用酸碱化学的数学模型，静脉血气样本和外周血氧饱和度来计算动脉酸碱状态。它有可能取代选定患者队列的常规ABG采样。这项研究的目的是比较v-TAC和ABG，在开始无创通气（NIV）的患者队列中进行毛细血管和静脉采样。
方法：招募的患者接受近同时ABG，第0天的毛细血管血气（CBG）和静脉血气（VBG）采样，最多两次（第1天NIV和出院）。主要结果是与ABG相比，v-TAC采样的可靠性，通过Bland-Altman分析,识别呼吸衰竭（通过PaCO2）并检测响应于NIV的PaCO2变化。次要结果包括与pH值达成协议，采样成功率和疼痛。
结果：评估了ABG与v-TAC/静脉PaCO2之间的一致性，其中有119次匹配的采样发作，而ABG与CBG之间有105次匹配的采样发作。v-TAC（平均差（SD）0.01（0.5）kPa），但不适用于CBG(-0.75(0.69)kPa)或VBG(+1.00(0.90)kPa)。从NIV开始的32例患者的纵向数据显示ABG和v-TAC最接近（R2=0.61）。v-TAC采样的首次成功率最高（88％），并且疼痛程度低于动脉（p<0.0001）。
结论：与ABG采样相比，静脉样本的数学动脉化更容易获得，痛苦更少。结果显示PaCO2和pH值非常一致，并且纵向跟踪良好，因此v-TAC方法可以代替常规的ABG测试来识别和监测高碳酸血症性呼吸衰竭患者。
背景：NCT04072848;www.
结果：政府。
方法：招募的患者接受近同时ABG，第0天的毛细血管血气（CBG）和静脉血气（VBG）采样，最多两次（第1天NIV和出院）。主要结果是与ABG相比，v-TAC采样的可靠性，通过Bland-Altman分析,识别呼吸衰竭（通过PaCO2）并检测响应于NIV的PaCO2变化。次要结果包括与pH值达成协议，采样成功率和疼痛。
结果：评估了ABG与v-TAC/静脉PaCO2之间的一致性，其中有119次匹配的采样发作，而ABG与CBG之间有105次匹配的采样发作。v-TAC（平均差（SD）0.01（0.5）kPa），但不适用于CBG(-0.75(0.69)kPa)或VBG(+1.00(0.90)kPa)。从NIV开始的32例患者的纵向数据显示ABG和v-TAC最接近（R2=0.61）。v-TAC采样的首次成功率最高（88％），并且疼痛程度低于动脉（p<0.0001）。
结论：与ABG采样相比，静脉样本的数学动脉化更容易获得，痛苦更少。结果显示PaCO2和pH值非常一致，并且纵向跟踪良好，因此v-TAC方法可以代替常规的ABG测试来识别和监测高碳酸血症性呼吸衰竭患者。
背景：NCT04072848;www.
结果：政府。
