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October 16-20, 2010 San Diego, CA Home Abstract Archive Search Abstracts 2010 Session Grid 2010 Meeting Website Policy Statements ASA Website Feedback 
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A1641
October 16, 2007 1:30 PM - 3:00 PM Room Room 301 |
| Continuous Measurement of O2 Delivery and Uptake with PA Catheter and Pulse Total-Hemoglobinometer |
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Hiromasa Nagata, M.D., Takashige Yamada, M.D., Yoshifumu Kotake, M.D., Ph.D., Junzo Takeda, M.D., Ph.D., Naoki Kobayashi Anesthesiology, Keio University School of Medicine, Tokyo, Japan |
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Objective Assessment of oxygen delivery(DO2)and uptake(VO2)may provide important information for the treatment of critically ill patients. Measurement of total hemoglobin (Hb) is necessary to evaluate DO2and VO2 by Fick's method. Currently, DO2 and VO2 determination is done periodically since there is no widespread method to continuously measure Hb concentration. Pulse total-hemoglobinometer (Nihon-Koden Corp, Tokyo, Japan) is based on the technology of pulse oximeter and it can continuously measure SpO2 and Hb concentration. (Crit Care Med 2005;33:2831). This devise transcutaneously measures absorption of 660nm(reduced hemoglobin), 805nm(isosbestic point), 940nm(oxygenated hemoglobin), and 1300nm(water density) and calculates Hb concentration. We design a system that continuously measure DO2 and VO2 with data from pulmonary artery catheter(PAC)and pulse total-hemoglobinometer. The purpose of this prospective, observational study was to evaluate this system for postoperative surgical patients. Method With IRB approval, postoperative patients who admitted to multidisciplinary intensive care unit at Keio University Hospital after major cardiovascular surgery were participated in this study. All the patients were mechanically ventilated and extubated on the first postoperative day. Continuous cardiac output (CCO) and mixed venous hemoglobin oxygen saturation (SvO2) was monitored by PAC. Hb and SpO2 were monitored by pulse total-hemoglobinometer. These data were transferred to computer and DO2 and VO2 were automatically calculated by the following formula DO2=1.34XHbXCCOXSpO2 VO2=1.34XHbXCCOX(SpO2-SvO2) Additionally, the accuracy of pulse total-hemoglobinometer was statistically analyzed with Bland-Altman method against co-oximeter. The results were expressed as bias±precision (1SD of bias). Results Data from 37 patients (26 males and 11 females, age; 68±9years, operation time; 420±130 min) were analyzed. Total measurement time was 1281 hours. Bias±precision between pulse total-hemogloinometer and co-oximeter was 1.1±1.6g/dl (Figure1). Postoperative trends of DO2(circle) and VO2(square) every 3hrs were expressed as mean±SD and were summarized in the Figure 2. Conclusion We developed a system that can continuously display DO2 and VO2 by combining the CO and SvO2 from PAC and SpO2 and Hb from pulse total-hemoglobinometer. By using this system, DO2 and VO2 can be monitored regardless of the endtracheal intubation, DO2 and VO2 peaked 21 hours after ICU admission, which corresponded to liberation from ventilator.[figure1][figure2] Anesthesiology 2007; 107: A1641 |
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