RespiratoryMonitoring.pptVIP

Respiratory Monitoring Dr Arthur Chun-Wing LAU Associate Consultant Department of Intensive Care PYNEH 28 Sep 2007 Gas exchange Pulse oximetry Capnometry Continuous blood gas analysis Transcutaneous monitoring (PTCO2 and PTCCO2) Question Answer: A (Patient A, with the higher PaO2 but the lower hemoglobin content, is more hypoxemic) Patient A: Arterial oxygen content = 7 x 1.36 x .95 + 0.0031 x 85 = 9.3 ml O2/dl Patient B: Arterial oxygen content = 15 x 1.36 x .85 + 0.0031 x 55 = 17.5 ml O2/dl Arterial oxygen content CaO2 = (Hgb x 1.36 x SaO2) + (0.0031 x PaO2) Question Which of the following situation(s) would be expected to lower PaO2? anemia CO poisoning Abnormal hemoglobin that holds oxygen with half the affinity of normal hemoglobin Abnormal hemoglobin that holds oxygen with twice the affinity of normal hemoglobin lung disease with intra-pulmonary shunting. Answer: only 5 1 affects only content, not oxygen saturation or PO2. 2 through 4 affect only oxygen saturation and content, not PO2 Important How to measure oxygen saturation Calculated from pO2: as in most automated blood gas analyzers (Clark electrodes) calculated from the measured parameters pO2 and pH, on the basis of standard oxygen-dissociation curves Assumption: there is an otherwise normal hemoglobin dissociation curve, also provided that nothing else is binding to the Hb except O2 Differential spectrophotometry: as in oximeter Tonometry process of exposing a liquid to an ambient gas phase in such a way that each gas in the gaseous phase partitions to an equilibrium between the liquid and gas phases. For QC samples, checking linearity of electrodes, or for various hemoglobin studies. Transcutaneous monitors rely on the oxygen content of capillary blood measured by heating skin locally to dilate capillaries agrees well with arterial blood pO2 when tissue perfusion is adequate, but not in states of hypoperfusion Pulse Oximetry What is oxygen saturation % Numerator oxygenated Hemoglobin c