[Blood gas analysis in interhospital transfer--a useful extension of respiratory monitoring?]

Abstract

Objective: Investigation of blood gas analysis during hospital-to-hospital transport of ventilated ICU-patients to detect critical events, changes of gas exchange and reliability of non-invasive monitoring.

Methods: 47 ventilated patients (age 9-76 years, mean 50 years, diagnosis: ARDS = 16, intracranial bleeding = 14, severe trauma = 4, acute hemodynamic failure = 3, others = 10), transported by a special physician staffed intensive care ambulance using invasive hemodynamic monitoring. Blood gas analysis was performed before and during transport every 30 minutes and respirator mode, vital signs and events were documented.

Results: In 19 (40.4%) patients there were critical events during transport (paO2 < 70 mmHg, paCO2 < 25 mmHg, paCO2 > 55 mmHg, pH < 7.30, pH > 7.55). In 4 patients with PaO2 < 70 mmHg there was SpO2 > or = 97% (by pulsoximetry), correlation between SaO2 (invasive) and SpO2 (by pulsoximetry) was r = 0.81 (P < 0.001) with a maximum difference of 8 percent. In several patients critical changes of condition could be recognized in an early stage by blood gas analysis.

Conclusions: Blood gas analysis during hospital-to-hospital transport of ICU-patients can be performed easily and allows to optimize artificial ventilation and to recognize earlier and safer severe problems of gas exchange.