Venous blood gases in the assessment of respiratory failure in patients undergoing sleep studies: a randomized study.

Autor:	Lindstrom SJ; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.; Victorian Respiratory Support Service, Melbourne, Victoria, Australia.; Institute for Breathing and Sleep, Melbourne, Victoria, Australia.; Barwon Health, Geelong, Victoria, Australia.; Deakin University, Geelong, Victoria, Australia.; Department of Intensive Care, Mercy Health, Melbourne, Victoria, Australia.; Alfred Health, Melbourne, Victoria, Australia., McDonald CF; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.; Victorian Respiratory Support Service, Melbourne, Victoria, Australia.; Institute for Breathing and Sleep, Melbourne, Victoria, Australia.; University of Melbourne, Melbourne, Victoria, Australia., Howard ME; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.; Victorian Respiratory Support Service, Melbourne, Victoria, Australia.; Institute for Breathing and Sleep, Melbourne, Victoria, Australia.; University of Melbourne, Melbourne, Victoria, Australia., O'Donoghue FJ; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.; Victorian Respiratory Support Service, Melbourne, Victoria, Australia.; Institute for Breathing and Sleep, Melbourne, Victoria, Australia.; University of Melbourne, Melbourne, Victoria, Australia., McMahon MA; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.; Victorian Respiratory Support Service, Melbourne, Victoria, Australia.; Institute for Breathing and Sleep, Melbourne, Victoria, Australia., Rautela L; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.; Victorian Respiratory Support Service, Melbourne, Victoria, Australia.; Institute for Breathing and Sleep, Melbourne, Victoria, Australia., Churchward T; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.; Victorian Respiratory Support Service, Melbourne, Victoria, Australia.; Institute for Breathing and Sleep, Melbourne, Victoria, Australia., Biesenbach P; Department of Emergency Medicine, Esbjerg University Hospital, Esbjerg, Denmark., Rochford PD; Department of Respiratory and Sleep Medicine, Austin Health, Melbourne, Victoria, Australia.; Victorian Respiratory Support Service, Melbourne, Victoria, Australia.; Institute for Breathing and Sleep, Melbourne, Victoria, Australia.
Jazyk:	angličtina
Zdroj:	Journal of clinical sleep medicine : JCSM : official publication of the American Academy of Sleep Medicine [J Clin Sleep Med] 2024 Aug 01; Vol. 20 (8), pp. 1259-1266.
DOI:	10.5664/jcsm.11128
Abstrakt:	Study Objectives: Venous blood gases (VBGs) are not consistently considered suitable surrogates for arterial blood gases (ABGs) in assessing acute respiratory failure due to variable measurement error. The physiological stability of patients with chronic ventilatory failure may lead to improved agreement in this setting. Methods: Adults requiring ABGs for sleep or ventilation titration studies had VBGs drawn before or after each ABG, in a randomized order. Veno-arterial correlation and agreement were examined for carbon dioxide tension (PCO 2 ), pH, oxygen tension (PO 2 ), and oxygen saturation (SO 2 ). Results: We analyzed 115 VBG-ABG pairs from 61 patients. Arterial and venous measures were correlated ( P < .05) for PCO 2 ( r = .84) and pH ( r = .72), but not for PO 2 or SO 2 . Adjusted mean veno-arterial differences (95% limits of agreement) were +5.0 mmHg (-4.4 to +14.4) for PCO 2 ; -0.02 (-0.09 to +0.04) for pH; -34.3 mmHg (-78.5 to +10.0) for PO 2 ; and -23.9% (-61.3 to +13.5) for SO 2 . VBGs obtained from the dorsal hand demonstrated a lower mean PCO 2 veno-arterial difference ( P < .01). A venous PCO 2 threshold of ≥ 45.8 mmHg was > 95% sensitive for arterial hypercapnia, so measurements below this can exclude the diagnosis without an ABG. A venous PCO 2 threshold of ≥ 53.7 mmHg was > 95% specific for arterial hypercapnia, so such readings can be assumed diagnostic. The area under the receiver operating characteristic curve of 0.91 indicated high discriminatory capacity. Conclusions: A venous PCO 2 < 45.8 mmHg or ≥ 53.7 mmHg would exclude or diagnose hypercapnia, respectively, in patients referred for sleep studies, but VBGs are poor surrogates for ABGs where precision is important. Clinical Trial Registration: Registry: Australian New Zealand Clinical Trials Register; Name: A comparison of arterial and blood gas analyses in sleep studies; URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=372717; Identifier: ACTRN12617000562370. Citation: Lindstrom SJ, McDonald CF, Howard ME, et al. Venous blood gases in the assessment of respiratory failure in patients undergoing sleep studies: a randomized study. J Clin Sleep Med . 2024;20(8):1259-1266. (© 2024 American Academy of Sleep Medicine.)
Databáze:	MEDLINE
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