Zoekvraag Linde Morsink 13-9-2011. Kleine wijziging… Van bloedtransfusie… naar bloedgas…

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1 Zoekvraag Linde Morsink 13-9-2011

2 Kleine wijziging… Van bloedtransfusie… naar bloedgas…

3 PICO P: Patiënten waarvan men de pH, pCO2, het bic en de BE wil weten I: Veneus bloedgas C: Arterieel bloedgas O: pH, pCO2, bicarbonaat en BE

4 Zoekstrategie MEDLINE, EMBASE en COCHRANE Arterial, venous and blood gas

5 pH, pCO2, bicarbonate and base excess MEDLINE search from 1966 untill Jan 2010 in adults in emergency setting mean difference weighted for study sample size with 95% limits of agreement

6 Emergency Medicine Australasia (2010) 22, 493–498

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9 Base excess Toftegaard M, Rees SE, Andreassen S. Correlation between acid– base parameters measured in arterial blood and venous blood sampled peripherally, from vena cavae superior, and from the pulmonary artery. Eur. J. Emerg. Med. 2008; 15: 86–91: N=103 mean difference of 0.089 mmol/L with limits of agreement -0.974 to +0.552 mmol/L

10 Conclusie Bij patiënten niet in shock voldoende overeenkomst tussen veneus en arteriële pH, bicarbonaat en BE Veneuze pCO2 geschikt om te screenen voor hypercapnie en wellicht om pCO2 te vervolgen Emergency Medicine Australasia (2010) 22, 493–498

11 Key unanswered questions Emergency Medicine Australasia (2010) 22, 493–498

12 Base Deficit From the First Peripheral Venous Sample: A Surrogate for Arterial Base Deficit in the Trauma Bay. Arnold TD, Miller M, van Wessem KP, Evans JA, Balogh ZJ From the Department of Traumatology, Division of Surgery, John Hunter Hospital and University of Newcastle, Newcastle, NSW. Australia. J Trauma. 2011 Aug 11. [Epub ahead of print]

13 Methods trauma patients >18 yr, from January 2007 until July 2007 arterial blood gas sampling and peripheral venous blood gas were performed simultaneously survey of JHH trauma clinicians and members of the American Association for the Surgery of Trauma was performed to determine a clinically relevant difference between two serial base deficit measurements Bland-Altman tests were performed J Trauma. 2011 Aug 11. [Epub ahead of print]

14 Results 127 patients (79% men) mean peripheral ABD (pABD) -2.2 mmol/L ± 3.8 mmol/l mean pVBD -1.3 mmol/L ± 3.8 mmol/L average difference between measurements was 0.9 (range, -1.7 to +3.5; 95% confidence interval, 0.7-1.0) The survey of 11 JHH and 56 American Association for the Surgery of Trauma clinicians determined 2 mmol/L as clinically relevant difference between two base deficit measurements All individual paired sample's difference sat within the clinically relevant limits >95% (121 of 127) of samples sat within the 1.96 standard deviation acceptable by the Bland-Altman plot. J Trauma. 2011 Aug 11. [Epub ahead of print]

15 Conclusion There is near perfect correlation and clinically acceptable agreement between pABD and pVBD values on simultaneous testing… J Trauma. 2011 Aug 11. [Epub ahead of print]

16 Conclusie Veneus bloedgas goede maat voor pH, bicarbonaat en BE bij volwassenen op SEH, op poli en op zaal Veneus pCO2 screening voor hypercapnie of vervolgen bekende hypercapnie Onvoldoende gegevens over patiënten in shock Arterieel gas alleen nog voor pO2 (indien sat-meter onbetrouwbaar) en beoordeling pCO2 (m.n. dus beoordeling ‘respiratoire’ patiënten)

17 Leuk idee om dat op onze eigen SEH ook eens uit te zoeken? Bijv. stageproject voor student geneeskunde?