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TECHNOLOGY, COMPUTING, AND SIMULATION

The Implications of Arterial Po₂ Oscillations for Conventional Arterial Blood Gas Analysis

Department of Anesthesia, Section of Critical Care, Department of Clinical Studies-Philadelphia, School of Veterinary Medicine, Center for Sleep and Respiratory Neurobiology, University of Pennsylvania, Philadelphia, Pennsylvania; Department of Anesthesiology, Johannes Gutenberg University, Mainz, Germany; SpectruMedix LLC, State College, Pennsylvania; Department of Anesthesiology and Intensive Care Medicine, Otto-von-Guericke-University, Magdeburg, Germany

In a surfactant-depletion model of lung injury, tidal recruitment of atelectasis and changes in shunt fraction lead to large Pao₂ oscillations. We investigated the effect of these oscillations on conventional arterial blood gas (ABG) results using different sampling techniques in ventilated rabbits. In each rabbit, 5 different ventilator settings were studied, 2 before saline lavage injury and 3 after lavage injury. Ventilator settings were altered according to 5 different goals for the amplitude and mean value of brachiocephalic Pao₂ oscillations, as guided by a fast responding intraarterial probe. ABG collection was timed to obtain the sample at the peak or trough of the Pao₂ oscillations, or over several respiratory cycles. Before lung injury, oscillations were small and sample timing did not influence Pao₂. After saline lavage, when Po₂ fluctuations measured by the indwelling arterial Po₂ probe confirmed tidal recruitment, Pao₂ by ABG was significantly higher at peak (295 ± 130 mm Hg) compared with trough (74 ± 15 mm Hg) or mean (125 ± 75 mm Hg). In early, mild lung injury after saline lavage, Pao₂ can vary markedly during the respiratory cycle. When atelectasis is recruited with each breath, interpretation of changes in shunt fraction, based on conventional ABG analysis, should account for potentially large respiratory variations in arterial Po₂.

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Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999