Acil Servise Nefes Darlığı İle Başvuran Hastaların Arter Kan Gazı Değerlerinin Noninvaziv Yöntemle Ölçülen Kan Gazı Değerleri İle Karşılaştırılması

Öz

Amaç

Çalışmamızda nefes darlığı ile başvuran hastalarda invaziv (arter) ve non-invaziv (transkütan) kan gazı sonuçlarını karşılaştırarak, non-invaziv kan gazı ölçümünün klinik kullanıma uygunluğunun belirlenmesi amaçlandı.

Materyal-Metod

Çalışmamızda dispne sebebiyle acil servise başvuran ve arteriyal kan gazı çalışılan 234 hasta dahil edildi. Hastaların tensor Tip MTX-Matrix cihazı ile parmak ucu sO2, PO2, PCO2 ve pH değerleri ölçülerek arteriyal kan gazı ile karşılaştırıldı. Sürekli verilerin normal dağılımının test edilmesinde Kolmogorov Smirnov testi kullanıldı. Grupların karşılaştırılmasında Wilcoxon testi kullanıldı. İnvaziv

(arter) ve non-invaziv (transkütan) kan gazı sonuçlarının uyumunu test etmede Bland Altman testi kullanıldı. Sonuçlar % 95’lik güven aralığında, anlamlılık p<0.05 düzeyinde değerlendirildi.

Sonuçlar

Çalışmamızda 234 hastanın yaş ortalaması 69,0±18,1 yıl olup, hastaların%42,7’si erkekti. Hastalarda dispne dışında belirlenen en sık semptom göğüs ağrısı, en sık saptanan tanı pnömoniydi. Arter kan gazı (AKG) ölçülen pH yerine, transkütan pH kullanılabileceği saptandı (p>0,05). AKG’de

ölçülen PCO2, PO2 ve sO2’nin yerine, transkütan PCO2, PO2 ve sO2 kullanılamayacağı saptandı (p<0,05).

Tartışma

Sonuç olarak transkütan olarak kan gazı parametrelerini değerlendirilen cihazlar dispneik hastalarda pH yerine kullanılabilir. Tüm kan gazı parametrelerinin değerlendirilmesi için cihazın geliştirilmesi gerekmektedir.

Anahtar Kelimeler

• sO2,PO2,PCO2,pH,kan gazı

Comparison of Artery Blood Gas Values Measured Versus Noninvasive Blood Gas Values Measured Method in Patients With Dyspne to Admitted Emergency Department

Abstract

Purpose

We aimed to determine the suitability of non-invasive blood gas measurement for clinical use by comparing the results of invasive (arterial) and non-invasive (transcutaneous) blood gases in patients with dyspnea in our study.

Material and Methods

In our study, 234 patients were included who referred to emergency services due to dyspnea and whose arterial blood gas were measured. Tensor Type MTX-Matrix device was used to measure patients’ fingertip sO2, PO2, PCO2 and pH values and these values were compared with arterial

blood gases. Kolmogorov Smirnov test was used to test the normal distribution of continuous data. The Wilcoxon test was used to compare groups. The Bland Altman test was used to test the compatibilitiy of invasive (arterial) and non-invasive (transcutaneous) blood gas results. The

results were evaluated in a confidence interval of 95% and a significance level of p <0.05.

Results

The mean age of 234 patients in our study was 69.0 ± 18.1 years and 42.7% of the patients were male. The most frequent symptom except for dyspnea was chest pain, the most

common diagnosis was pneumonia. It was determined that transcutaneous pH could be used instead of pH measured in arterial blood gas (ABG) (p>0.05). It was found that, transcutaneous PCO2, PO2 and sO2 could not be used instead of PCO2, PO2 and sO2 level measured in ABG (p

<0.05).

Results

As a result, devices that evaluate blood gas parameters as transcutaneously can be used instead of pH in dyspneic patients. For the evaluation of all blood gas parameters, the device needs to be improved.

Keywords

• sO2,PO2,PCO2,pH,blood gas

Kaynakça

1. 1. Börekçi Ş, Umut S. Arter kan gazı analizi, alma tekniği ve yorumlaması. Türk Toraks Dergisi. 2011;12:5-9.
2. 2. Aygencel G. Arter kan gazlarının yorumlanması. Türk Kardiyol Dern Arş - Arch Turk Soc Cardiol 2014;42:194-202.
3. 3. Karalezli A. Arter kan gazları. Turkish Medical Journal. 2007;1:44-50.
4. 4. Acican T. Arter kan gazlari. Yogun Bakim Dergisi. 2003;3:160-75.
5. 5. Bogert L, Wesseling K, Schraa O, et al. Pulse contour cardiac output derived from non-invasive arterial pressure in cardiovascular disease. Anaesthesia. 2010;65: 1119-25.
6. 6. TensorTip Non-Invasive System. http://www. medica- tradefair.com/cipp/show,lang,2/oid,30405/ xa_nr,2430879/~/Web-ProdDatasheet/prod_datasheet# prod_no_table. Son erişim tarihi:15. 10. 2016.
7. 7. Saryal S. Arter kan gazları. http://docplayerbiztr/ 11726851-Arter-kan-gazlari-dr-sevgi-saryal- ankara-universitesi-gogus-hastaliklari-adhtml. Son erişim tarihi: 10. 06. 2016.
8. 8. Adejumo I, Khan J, Sovani M. P39 Noninvasive pH with Transcutaneous PCO2 monitoring as an alternative to arterial line sampling: a new patient friendly approach to monitoring Acute NIV. Thorax. 2015;70 (Suppl 3) :A95-A.

9. 9. Bhat R, Kim WD, Shukla A, Vidyasagar D. Simultaneous tissue pH and transcutaneous carbon dioxide monitoring in critically ill neonates. Critical care medicine. 1981;9 (10):744-9.
10. 10. Antoine C, Young BK, Silverman F. Simultaneous measurement of fetal tissue pH and transcutaneous pO2 during labor. Europ J Ohsrer Gynec reprod Biol. 1984;17: 69-76.
11. 11. Van Oppen JD, Daniel PS, Sovani MP. What is the potential role of transcutaneous carbon dioxide in guiding acute noninvasive ventilation? Respir Care. 2015;60: 484-91.
12. 12. Eberhard P, Gisiger P, Gardaz J, Spahn D. Combining transcutaneous blood gas measurement and pulse oximetry. Anesthesia and analgesia. 2002;94 (1 Suppl): S76-80.
13. 13. Hayoz J, Schmid E, Schmidlin D, Tschupp A. Combined pulse oximetry and carbon dioxide tension ear sensor in adult patients early after cardiac surgery. European Journal of Anaesthesiology (EJA). 2002;19:23-4.
14. 14. Senn O, Clarenbach CF, Kaplan V, Maggiorini M, Bloch KE. Monitoring carbon dioxide tension and arterial oxygen saturation by a single earlobe sensor in patients with critical illness or sleep apnea. CHEST Journal. 2005;128: 1291-6.
15. 15. Bendjelid K, Schütz N, Stotz M, Gerard I, Suter PM, Romand JA. Transcutaneous PCO2 monitoring in critically ill adults: clinical evaluation of a new sensor. Critical care medicine. 2005;33 :2203-6.
16. 16. Rodriguez P, Lellouche F, Aboab J, Buisson CB, Brochard L. Transcutaneous arterial carbon dioxide pressure monitoring in critically ill adult patients. Intensive care medicine. 2006;32 :309-12.
17. 17. Bolliger D, Steiner L, Kasper J, Aziz O, Filipovic M, Seeberger M. The accuracy of non-invasive carbon dioxide monitoring: A clinical evaluation of two transcutaneous systems. Anaesthesia. 2007;62 :394-9.
18. 18. Gorska K, Korczynski P, Maskey-Warzechowska M, Chazan R, Krenke R. Variability of Transcutaneous Oxygen and Carbon Dioxide Pressure Measurements Associated with Sensor Location. Adv Exp Med Biol. 2015;858:39-46.
19. 19. McVicar J, Eager R. Validation study of a transcutaneous carbon dioxide monitor in patients in the emergency department. Emergency Medicine Journal. 2009;26:344-6.
20. 20. Feiner JR, Severinghaus JW, Bickler PE. Dark skin decreases the accuracy of pulse oximeters at low oxygen saturation: the effects of oximeter probe type and gender. Anesthesia & Analgesia. 2007;105:S18-S23.
21. 21. Chan MM, Chan MM, Chan ED. What is the effect of fingernail polish on pulse oximetry? CHEST Journal. 2003;123:2163-4.
22. 22. Hinkelbein J, Genzwuerker HV, Sogl R, Fiedler F. Effect of nail polish on oxygen saturation determined by pulse oximetry in critically ill patients. Resuscitation. 2007;72:82-91.
23. 23. Rodden AM, Spicer L, Diaz VA, Steyer TE. Does fingernail polish affect pulse oximeter readings? Intensive and Critical Care Nursing. 2007;23:51-5.
24. 24. Welch J, DeCesare R, Hess D. Pulse oximetry: instrumentation and clinical applications. Respir Care. 1990;35:584-97.
25. 25. Wahr JA, Tremper KK. Noninvasive oxygen monitoring techniques. Critical care clinics. 1995;11:199-217.
26. 26. Razi E, Akbari H. A comparison of arterial oxygen saturation measured both by pulse oximeter and arterial blood gas analyzer in hypoxemic and non-hypoxemic pulmonary diseases. Turk Thorac J. 2006;7:043-7.
27. 27. Chiappini F, Fuso L, Pistelli R. Accuracy of a pulse oximeter in the measurement of the oxyhaemoglobin saturation. European Respiratory Journal. 1998;11:716-9.
28. 28. Nickerson BG, Sarkisian C, Tremper K. Bias and precision of pulse oximeters and arterial oximeters. Chest. 1988;93:515-7.
29. 29. Morris R, Nairn M, Torda T. A comparison of fifteen pulse oximeters. Part I: a clinical comparison; Part II: a test of performance under conditions of poor perfusion. Anaesth intensive care. 1989;17:62-73.
30. 30. Kelly AM, Holdgate A, Keijzers G, et al. Epidemiology, prehospital care and outcomes of patients arriving by ambulance with dyspnoea: an observational study. Scand J Trauma Resusc Emerg Med. 2016;24:113.
31. 31. Miner B, Tinetti ME, Van Ness PH, et al. Dyspnea in Community- Dwelling Older Persons: A Multifactorial Geriatric Health Condition. J Geriatr Soc. 2016;64:2042-50.
32. 32. Burri E, Hochholzer K, Arenja N, et al. B-type natriuretic peptide in the evaluation and management of dyspnoea in primary care. Journal of internal medicine. 2012;272:504-13.
33. 33. Frese T, Sobeck C, Herrmann K, Sandholzer H. Dyspnea as the reason for encounter in general practice. J clin med res. 2011;3:239-46.
34. 34. Okkes IM, Oskam SK, Lamberts H. The probability of specific diagnoses for patients presenting with common symptoms to Dutch family physicians. J fam prac. 2002;51:31-6.
35. 35. Lund N, Rohlen A, Simonsson P, et al. High total carbon dioxide predicts 1-year readmission and death in patients with acute dyspnea. Am j emerg med. 2015; 33:1335-9.
36. 36. Kelly AM, Keijzers G, Klim S, et al. An Observational Study of Dyspnoea in Emergency Departments: The Asia, Australia, and New Zealand Dyspnoea in Emergency Departments Study (AANZDEM). Acad Emerg Med. 2016; 24: 328-336.