Evaluation of a hand-held blood gas analyzer for rapid determination of blood gases, electrolytes and metabolites in intensive care setting.

BACKGROUND: Intensive care units, operating rooms, emergency departments, and neonatology units need rapid measurements of blood gases, electrolytes, and metabolites. These analyses can be performed in a central laboratory or at the clinic with traditional or compact cassette-type blood gas analyzers such as the epoc blood gas testing system for analyzing whole blood samples at the bedside. In this study, the performance and interchangeability of a hand-held epoc blood gas analyzer was evaluated. METHODS: The analytical performance of the epoc analyzer was evaluated by determining within-and between-run precisions. The accuracy of the epoc analyzer was assessed by comparing patient results from the device with those obtained with the Siemens Rapidlab 1265 and Rapidpoint RP500 and Siemens Dimension Vista and Sysmex XE-2100 analyzers. The following parameters were measured: pH, pCO2, pO2, Hb (calc), Na+, K+, iCa2+, glucose, and lactate. RESULTS: The CV% of the epoc's between-day imprecision for the various parameters varied from 0.4 to 8.6. The within-run imprecision CV% varied from 0.6 to 5.2. The squared regression coefficient (R2) between the epoc and RL1265 varied from 0.94 to 0.99, with the exception of Na+ and Ca2+ (R2≥0.82). The correlation (R2) of Na+ and K+ between epoc and Dimension Vista was 0.73 and 0.89, respectively. The correlation (R2) of Hb between the epoc and the XE-2100 analyzer was 0.94. CONCLUSIONS: With most of the measured blood gas parameters, the epoc analyzer correlated well with reference techniques. The epoc analyzer is suitable for rapid measurement of the blood gases, the electrolytes, and the metabolites in the ICU.

Determinants and prognostic value of cardiovascular autonomic function in coronary artery disease patients with and without type 2 diabetes.

OBJECTIVE Cardiovascular autonomic dysfunction is a common finding among patients with coronary artery disease (CAD) and type 2 diabetes (T2D). The reasons and prognostic value of autonomic dysfunction in CAD patients with T2D are not well known. RESEARCH DESIGN AND METHODS We examined the association between heart rate recovery (HRR), 24-h heart rate (HR) variability (SD of normal R-R interval [SDNN]), and HR turbulence (HRT), and echocardiographic parameters, metabolic, inflammatory, and coronary risk variables, exercise capacity, and the presence of T2D among 1,060 patients with CAD (mean age 67 ± 8 years; 69% males; 50% patients with T2D). Second, we investigated how autonomic function predicts a composite end point of cardiovascular death, acute coronary event, stroke, and hospitalization for heart failure during a 2-year follow-up. RESULTS In multiple linear regression model, exercise capacity was a strong predictor of HRR (R = 0.34, P < 0.001), SDNN (R = 0.33, P < 0.001), and HRT (R = 0.13, P = 0.001). In univariate analyses, a composite end point was predicted by reduced HRR (hazard ratio 1.7 [95% CI 1.1-2.6]; P = 0.020), reduced SDNN (2.0 [95% CI 1.2-3.1]; P = 0.005), and blunted HRT (2.1 [1.3-3.4]; P = 0.003) only in patients with T2D. After multivariate adjustment, none of the autonomic markers predicted the end point, but high-sensitivity C-reactive protein (hs-CRP) remained an independent predictor. CONCLUSIONS Cardiovascular autonomic function in CAD patients is associated with several variables, including exercise capacity. Autonomic dysfunction predicts short-term cardiovascular events among CAD patients with T2D, but it is not as strong an independent predictor as hs-CRP.