tailieunhanh - Báo cáo y học: " Equipment review: Continuous assessment of arterial blood gases"

Tuyển tập các báo cáo nghiên cứu về y học được đăng trên tạp chí y học General Psychiatry cung cấp cho các bạn kiến thức về ngành y đề tài: Equipment review: Continuous assessment of arterial blood gases. | Roupie Critical Care 1997 1 11 http c CRITICAL CARE REVIEW Equipment review Continuous assessment of arterial blood gases Eric E Roupie 14cc-1-1-011 Introduction Determination of arterial oxygenation arterial CO2 partial pressure and pH is traditionally performed by intermittent arterial blood sampling. However this method presents a number of disadvantages such as the need for iterative and uncomfortable arterial punctures and can be associated with substantial blood loss 1 2 . Despite these major impediments to serial measurements arterial blood gas values are the most frequently ordered laboratory examinations in the intensive care unit ICU and the operating room 3 . In the ICU except for once-daily analysis which represents a spot check of the physiological state of the patient indications for sampling are essentially the result of a deleterious event 4 . In these situations sampling depends greatly upon the judgement of the physician nurse or other health care provider to determine whether a blood gas measurement is needed. The delay between the event itself and blood sampling plus the delay in obtaining the results means that this sort of analysis may be misleading. For example clinically important changes in a patient s blood gas status may go undetected or may occur after a sample has been drawn and while it is being analysed 5 . Moreover considerable spontaneous variation in blood gases frequently occurs even in stable ICU patients 6 . Because clinical decisions need to be made on the basis of trends in blood gases as well as with the rapid detection of an acute event 6 7 continuous non-inva-sive monitoring techniques such as pulse-oximetry and continuous capnography have been developed. Unfortunately these devices are not always accurate or reliable in acute situations such as shock hypothermia or during the use of vasopressors 8 9 . Moreover pulse-oximetry does not measure oxygen tension and major drawbacks also exist for continuous .