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The effects of continuous blood gas monitoring during cardiopulmonary bypass: a prospective, randomized study--Part I
C C Trowbridge1, M Vasquez, A H Stammers
1Division of Clinical Perfusion Education, School of Allied Health Professions, University of Nebraska Medical Center, Nebraska, USA. cody_trowbridge@yahoo.com
Insights
Continuous in-line blood gas management (CILBGM) offers more accurate blood gas control during cardiopulmonary bypass (CPB). This prospective study found CILBGM significantly reduced deviations from target blood gas values compared to intermittent sampling.
Area of Science:
- Critical Care Medicine
- Cardiovascular Surgery
- Biomedical Engineering
Background:
- Continuous in-line blood gas management (CILBGM) is debated for its clinical utility and patient outcome impact.
- Accurate blood gas monitoring is crucial during cardiopulmonary bypass (CPB) to ensure patient safety and optimize physiological conditions.
Purpose of the Study:
- To evaluate if continuous in-line blood gas management (CILBGM) improves the quality of patient care.
- To compare the accuracy and effectiveness of CILBGM versus intermittent blood gas sampling during CPB.
Main Methods:
- A prospective, randomized study involving 59 patients undergoing CPB.
- Patients were assigned to either continuous monitoring (treatment group) or intermittent sampling (control group) using an in-line blood gas monitor (CDI 500).
- Comparison of blood gas parameter deviations from target values between the two monitoring methods.
Main Results:
- The in-line monitor demonstrated accuracy comparable to laboratory analysis for arterial blood gas parameters.
- Continuous in-line blood gas management showed significantly less deviation from target pH, PaCO2, and PaO2 values compared to intermittent sampling.
- No significant differences were observed in preoperative, surgical, anesthetic, or perfusion variables between the groups.
Conclusions:
- Continuous in-line blood gas management (CILBGM) provides more accurate blood gas management during cardiopulmonary bypass.
- The findings suggest CILBGM may enhance the quality of patient care by maintaining tighter control over blood gas homeostasis.
Abstract:
The use of continuous in-line blood gas management (CILBGM) is steeped in controversy concerning its potential utility and impact on patient outcomes. The purpose of this study was to determine whether the use of CILBGM results in improved quality of patient care. Fifty-nine patients were enrolled in a Institutional Review Board-approved, prospective, randomized study. An in-line blood gas monitor (CDI 500) was placed into the arterial and venous lines for all patients. Blood gas monitoring in the control group was managed by intermittent sampling (every 20-30 min), while the treatment group was managed with continuous monitoring. There were no differences between groups in preoperative, surgical, anesthetic, or perfusion variables. The accuracy of the in-line monitor was comparable to laboratory analysis for arterial blood gas parameters (N = 160; pH bias = 0.00; PaCO2 bias = -1.1 mmHg; and PaO2 bias = 0.7 mmHg). There was less deviation from target values (pH = 7.40, PaCO2 = 40 mmHg, PaO2 = 150-200 mmHg) when in-line monitoring was used versus intermittent sampling (N = 784; pH deviation = 0.05 +/- 0.03 vs. 0.03 +/- 0.01, p < 0.0001; PaCO2 deviation = 4.0 +/- 2.9 mmHg vs. 2.0 +/- 0.9 mmHg, p < 0.0001; and PaO2 deviation = 22.7 +/- 16.9 mmHg vs. 11.7 +/- 8.3 mmHg, p < 0.0001). In conclusion, the results of part I of this study demonstrate that the use of CILBGM results in more accurate blood gas management during CPB.
