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*Department of Anesthesiology and Intensive Care Medicine, and ||Department of Neurosurgery, Kraukenaustalten Gilead, von Bodelschwinghsche Anstalten Bethel, Bielefeld; Department of Clinical Chemistry, Universitaetskliniken des Saarlandes, Homburg/Saar; Department of Anesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany; and Department of Anesthesiology, Advocate Illinois Masonic Medical Center; and Departments of Anesthesiology and Physiology and Biophysics, University of Illinois College of Medicine, Chicago, Illinois
Address correspondence and reprint requests to Prof. Dr. Med. Fritz Mertzlufft, Klinik fuer Anaesthesiologie und Operative Intensivmedizin, Krankenanstalten Gilead gGmbH at Bethel, Akademisches Lehrkrankenhaus der Universitaet Muenster, Burgsteig 13, D-33617 Bielefeld, Germany. Address e-mail to mertzlufft{at}anaesthesie.gilead.de
We compared estimates for base excess of extracellular fluid (BEecf; mmol/L) obtained in five clinically used blood gas analyzers: AVL Compact 2 (Roche Diagnostics, Mannheim, Germany), Ciba-Corning 860 (Bayer Diagnostics, Fernwald, Germany), IL 1620 (Instrumentation Laboratories, Lexington, MA), Stat Profile Ultra (Nova Biomedical, Waltham, MA), and ABL 510 (Radiometer, Copenhagen, Denmark). A total of 134 measurements per analyzer were obtained in arterial and venous blood samples from 10 patients undergoing cardiac surgery and 65 measurements per analyzer in venous blood samples from 2 healthy volunteers. The blood samples were equilibrated in a tonometer with gases of known composition (37°C). Additional theoretical studies were performed to evaluate the relationship between pH and calculated BEecf value (with varied PCO2) using the formulas of the various analyzers. The standard deviations of repeated measurements were 0.24 mmol/L for ABL 510 and approximately 0.45 mmol/L for the other 4 analyzers. The maximal systematic difference between the average of all measurements of each analyzer was 3.7 mmol/L; this was primarily attributable to differences in measuring pH, and, to a lesser extent, to differences in calculation and determination of PCO2. Comparison of the results from samples with different oxygen saturation showed that the relative alkalinity of deoxygenated hemoglobin (Haldane effect) can also influence the determinations of BEecf.
IMPLICATIONS: A clinically useful way to quantify nonrespiratory disturbances of the acid-base balance is calculation of the base excess of extracellular fluid by using blood gas analyzers. In this study, we found significant variability in estimates of base excess of extracellular fluid obtained with five analyzers from different manufacturers. This variability is attributable to multiple factors, including lack of correction for deoxygenated hemoglobin (Haldane effect).
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