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      Concordancia entre la gasometría arterial y venosa central en sujetos postoperados de cirugía de revascularización miocárdica en condición estable Translated title: Concordance between central venous and arterial blood gases in post-surgical myocardial revascularization patients in stable condition

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          Abstract

          Objetivo: La concordancia entre los parámetros de la gasometría arterial y venosa central no se ha definido aún, por lo cual estudiamos la concordancia entre ambas en sujetos postoperados de cirugía de revascularización miocárdica en condición estable. Métodos: Se estudiaron sujetos de manera consecutiva con un diseño transversal. Se les determinó la posición del catéter venoso central y al mismo tiempo se obtuvo la muestra arterial y venosa central previa a su egreso de la terapia intensiva. Los datos se expresaron según el método estadístico de Bland-Altman y al coeficiente de correlación intraclase. El resultado estadístico aceptó una p < 0.05. Resultados: Se estudiaron 206 muestras de 103 sujetos postoperados, el pH y el lactato tuvieron una diferencia media (límites de acuerdo) de 0.029 ± 0.048 (−0.018, 0.077) y −0.12 ± 0.22 (−0.57, 0.33) respectivamente; la magnitud del coeficiente de correlación intraclase respectiva fue de 0.904 y 0.943; las relativas a la presión de oxígeno 27.86 ± 6.08 (15.9, 39.8) y la saturación de oxígeno 33.02 ± 6.13 (21, 45), magnitud 0.258 y 0.418. Conclusión: Los parámetros con mejor concordancia arterial y venosa central fueron el pH y el lactato.

          Translated abstract

          Objective: The concordance between the parameters of arterial and central venous blood gases has not been defined yet. We studied the concordance between both parameters in post-surgical myocardial revascularization patients in stable condition. Methods: Consecutive subjects were studied in a cross-sectional design. The position of the central venous catheter was performed and simultaneously we obtained arterial and central venous blood samples prior to discharge from the intensive care unit. Data are expressed according to Bland-Altman statistical method and the intraclass correlation coefficient. Statistical result was accepted at P < .05. Results: Two hundred and six samples were studied of 103 post-surgical patients, pH and lactate had a mean difference (limits of agreement) 0.029 ± 0.048 (−0018, 0.077) and −0.12 ± 0.22 (−0.57, 0.33) respectively. The magnitude of the intraclass correlation coefficient was 0.904 and 0.943 respectively. The values related to oxygen pressure were 27.86 ± 6.08 (15.9, 39.8) and oxygen saturation 33.02 ± 6.13 (21, 45), with magnitude of 0.258 and 0.418 respectively. Conclusion: The best matching parameters between arterial and central venous blood samples were pH and lactate.

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          Most cited references46

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          Agreement between arterial and central venous values for pH, bicarbonate, base excess, and lactate.

          This study aimed to determine the extent of agreement between central venous and arterial values for pH, bicarbonate, base excess, and lactate in a group of intensive care unit (ICU) patients. A prospective study of a convenience sample of patients deemed by their treating doctor to require blood gas analysis as part of their clinical care in ICU. It compared pH, bicarbonate, base excess and lactate on arterial and central venous samples taken within five minutes of each other. Data were analysed using bias (Bland-Altman) methods. A total of 168 matched sample pairs from 110 patients were entered into the study. All variables showed close agreement. The mean difference between arterial and venous values of pH was 0.03 pH units, for bicarbonate 0.52 mmol/l, for lactate 0.08 mmol/l, and for base excess 0.19 mmol/l. All showed acceptably narrow 95% limits of agreement. Central venous pH, bicarbonate, base excess, and lactate values showed a high level of agreement with the respective arterial values, with narrow 95% limits of agreement. These results suggest that venous values may be an acceptable substitute for arterial measurement in this clinical setting.
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            Comparison of arterial and venous pH, bicarbonate, PCO2 and PO2 in initial emergency department assessment.

            To determine the agreement between arterial and venous samples in a pathologically diverse patient population presenting at an emergency department (ED) with a view to obviating the need for arterial blood gas (ABG) analysis in initial ED evaluation. Prospective study of 95 patients (69 males, 26 females, mean (SD) age 52 (1.6) years) with diverse medical conditions, presenting at a tertiary health centre ED and deemed by the treating physician to require an ABG analysis. Arterial and venous samples for gas analysis were taken as close in time to each other as possible. The data thus obtained were analysed for agreement between pH, Pco(2), Po(2) and bicarbonate using the Bland-Altman method. The arterial and venous values of pH, bicarbonate and Pco(2) show acceptably narrow 95% limits of agreement using the Bland-Altman method (0.13 to -0.1, 4.3 to -5.8 and 6.8 to -7.6, respectively). Agreement in Po(2) measurements was poor (95% limits of agreement 145.3 to -32.9). Venous blood gas analysis for pH, bicarbonate and Pco(2) may be a reliable substitute for ABG analysis in the initial evaluation of an adult patient population presenting to the ED.
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              Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency department.

              This study aims to determine the extent of correlation of arterial and venous pH with a view to identifying whether venous samples can be used as an alternative to arterial values in the clinical management of selected patients in the emergency department. This prospective study of patients who were deemed by their treating doctor to require an arterial blood gas analysis to determine their ventilatory or acid-base status, compared pH on an arterial and a venous sample taken as close to simultaneously as possible. Data were analysed using Pearson correlation and bias (Bland-Altman) methods. Two hundred and forty six patients were entered into the study; 196 with acute respiratory disease and 50 with suspected metabolic derangement. The values of pH on arterial and venous samples were highly correlated (r=0.92) with an average difference between the samples of -0.4 units. There was also a high level of agreement between the methods with the 95% limits of agreement being -0.11 to +0.04 units. Venous pH estimation shows a high degree of correlation and agreement with the arterial value, with acceptably narrow 95% limits of agreement. Venous pH estimation is an acceptable substitute for arterial measurement and may reduce risks of complications both for patients and health care workers.
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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Role: ND
                Journal
                acm
                Archivos de cardiología de México
                Arch. Cardiol. Méx.
                Elsevier (México )
                1405-9940
                September 2014
                : 84
                : 3
                : 147-154
                Affiliations
                [1 ] Instituto Mexicano del Seguro Social México
                [2 ] Secretaría de Salud México
                [3 ] Instituto Mexicano del Seguro Social México
                [4 ] Instituto Mexicano del Seguro Social México
                [5 ] Instituto Mexicano del Seguro Social México
                Article
                S1405-99402014000300001
                10.1016/j.acmx.2013.11.005
                583b480c-0c1e-4ec6-8c51-f5af2e24207b

                http://creativecommons.org/licenses/by/4.0/

                History
                Categories
                Cardiac & Cardiovascular Systems

                Cardiovascular Medicine
                Fiability,Repetibility,Agreement,Confiability,Cardiac surgery,Mexico,Fiabilidad,Repetibilidad,Acuerdo,Confiabilidad,Cirugía cardiaca,México

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