Critical Care Center, Sabadell Hospital, CIBER Enfermedades Respiratorias, Parc Tauli University Institute, Parc Taulí 1, 08208 Sabadell, Spain.
Wyle GbmH, Albin Koebis Strasse 4, Cologne, Germany.
Ann Intensive Care. 2014 Apr 14;4:11. doi: 10.1186/2110-5820-4-11. eCollection 2014.
Earlobe arterialized capillary blood gas analysis can be used to estimate arterial gas content and may be suitable for diagnosis and management of critically ill patients. However, its utility and applicability in the ICU setting remains unexplored.
A prospective observational validation study was designed to evaluate this technique in a cohort of mechanically ventilated adult critically ill patients admitted to a polyvalent ICU. Precision and agreement between capillary gas measures and arterial references was examined. Acute Respiratory Distress Syndrome (ARDS) diagnosis capabilities with the proposed technique were also evaluated. Finally, factors associated with sampling failure were explored.
Fifty-five patients were included into this study. Precision of capillary samples was high (Coefficient of Variation PO2 = 9.8%, PCO2 = 7.7%, pH = 0.3%). PO2 measures showed insufficient agreement levels (Concordance Correlation Coefficient = 0.45; bias = 12 mmHg; percentage of error = 19.3%), whereas better agreement was observed for PCO2 and pH (Concordance Correlation Coefficient = 0.94 and 0.93 respectively; depreciable bias; percentage of error 11.4% and 0.5% respectively). The sensitivity and specificity for diagnosing ARDS were 100% and 92.3% using capillary gasometric measures. Sampling was unsuccessful in 43.6% of cases due to insufficient blood flow. Age > 65 years was independently associated with failure (odds ratio = 1.6), however hemodynamic failure and norepinephrine treatment were also influencing factors.
Earlobe capillary blood gas analysis is precise and can be useful for detecting extreme gasometrical values. Diagnosis of ARDS can be done accurately using capillary measurements. Although this technique may be insufficient for precise management of patients in the ICU, it has the potential for important benefits in the acute phase of various critical conditions and in other critical care arenas, such as in emergency medicine, advanced medical transport and pre-hospital critical care.
耳郭动脉化毛细血管血气分析可用于估计动脉血气含量，可能适用于危重症患者的诊断和治疗。然而，其在 ICU 环境中的实用性和适用性尚未得到探索。
设计了一项前瞻性观察验证研究，以评估该技术在入住多学科 ICU 的机械通气成人危重症患者队列中的应用。检查了毛细血管气体测量值与动脉参考值之间的精密度和一致性。还评估了该技术对急性呼吸窘迫综合征（ARDS）的诊断能力。最后，探讨了与采样失败相关的因素。
这项研究纳入了 55 名患者。毛细血管样本的精密度较高（PO2 变异系数为 9.8%，PCO2 变异系数为 7.7%，pH 变异系数为 0.3%）。PO2 测量值的一致性水平较低（一致性相关系数为 0.45；偏差为 12 mmHg；误差百分比为 19.3%），而 PCO2 和 pH 的一致性较好（一致性相关系数分别为 0.94 和 0.93；可忽略的偏差；误差百分比分别为 11.4%和 0.5%）。使用毛细血管气体测量值诊断 ARDS 的敏感性和特异性分别为 100%和 92.3%。由于血流量不足，43.6%的病例采样失败。年龄>65 岁与失败独立相关（比值比为 1.6），但血流动力学衰竭和去甲肾上腺素治疗也是影响因素。
耳郭毛细血管血气分析精确，可用于检测极端气体值。使用毛细血管测量值可以准确诊断 ARDS。虽然该技术可能不足以对 ICU 患者进行精确管理，但它在各种危急情况下的急性期和其他重症监护领域（如急诊医学、高级医疗转运和院前重症监护）具有重要的潜在益处。
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