Abstract
Objectives: Recent reports on venous blood gas analysis have shown that venous bicarbonate concentration is useful in the evaluation of the body acid-base status. Most of these reports have been based on the Bland-Altman analysis comparing arterial and venous blood gas values. We intended to elucidate any factors that decrease the agreement between venous and arterial bicarbonate concentrations, which might impair the usefulness of venous blood gas analysis. Methods: Healthy volunteers and patients with various diseases (n = 141) were evaluated by simultaneous arterial and venous blood sampling and Bland-Altman analysis. The venous-arterial bicarbonate concentration difference was compared between healthy volunteers and untreated respiratory alkalosis patients. Intentional hyperventilation (30 or 60 breaths/min, for 3 min) was also performed on 6 healthy volunteers and the venous-arterial bicarbonate concentration difference was evaluated. Results: The relative average bias in bicarbonate concentration was 2.00 mEq/l with venous bicarbonate higher than arterial bicarbonate with 95% limits of agreement of ±4.15 mEq/l. Hyperventilation challenges increased the venous-arterial bicarbonate concentration difference in an intensity-dependent manner. The venous-arterial bicarbonate concentration difference was higher in untreated respiratory alkalosis patients than in healthy volunteers (P Conclusion: Although venous bicarbonate may be useful to evaluate the body acid-base status, hyperventilation increases the venous-arterial bicarbonate concentration difference. Physicians should keep this phenomenon in mind.
Highlights
Since the pulse oximeter was invented and it became possible to evaluate the systemic oxygen level by measuring percutaneus oxygen saturation (SpO2), peripheral venous blood gas analysis (VBGA) with simultaneous SpO2 measurement has been considered useful as an alternative to arterial blood gas analysis (ABGA) [1,2,3]
We reported that underestimation of respiratory alkalosis may occur with the “SpO2 plus VBGA” method in untreated
A meta-analysis and a review using Bland-Altman analysis reported that venous pH, bicarbonate and base excess
Summary
Since the pulse oximeter was invented and it became possible to evaluate the systemic oxygen level by measuring percutaneus oxygen saturation (SpO2), peripheral venous blood gas analysis (VBGA) with simultaneous SpO2 measurement has been considered useful as an alternative to arterial blood gas analysis (ABGA) [1,2,3]. Ing arterial blood, because VBGA is much easier and less invasive than ABGA especially in the youngest pediatric patients and in an emergency room. The agreement between variables on arterial and venous blood gas analysis has been well reviewed [1]. The usual method to evaluate the agreement has been with the Bland-Altman analysis [4]. We reported that intentional hyperventilation increased venous-arterial partial CO2 pressure (PCO2) differences and pH differences [2]. We reported that underestimation of respiratory alkalosis may occur with the “SpO2 plus VBGA” method in untreated
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