Continuous transcutaneous monitoring of fetal oxygen tension during labour.
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Biomedical subjects
Publications and source records attributed to A Huch.
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Continuous transcutaneous pO2 measurements (tcPO2 measurements) were performed in healthy volunteers who were breathing air and oxygen under hyperbaric conditions (max. 4 ata). The results show a close correlation of PO2 values measured by the noninvasive method, in blood from discret arterial punctures, chamber PO2, respectively, the PO2 of the inspiratory gas mixture which was checked up to maximal values of 2,200 mm Hg. The PO2 in the arterial blood samples was measured immediately after the puncture insight the hyperbaric chamber using a specially designed through electrode.
Serum levels of carticaine were measured in 9 parturient women after peridural anesthesia as well as in the newborns. The neonatal serum level of carticaine amounted to 32 +/- 7% of the maternal (ratio = 0,32). This proportion is compared to those given in the literature for the local anesthetics Lidocaine (0,52-0,58), Mepivacaine (0,64) and Bupivacaine (0,23-0,26).
Transcutaneous oxygen blood tension (tcpO2), heart rate, respiratory amplitude, respiratory rate, and relative local perfusion have been monitored continuously during heart catheterization in 37 children with congenital heart disease. The tcpO2 method allows an adequate measurement of the severity and duration of hypoxemia following arrhythmias or injection of contrast medium. The extent of hyperoxia following diagnostic procedures can also be controlled by this method.
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In 23 patients 18 to 73 years old transcutaneous PO2, relative local perfusion and cardiorespirogram during induction and end stage of anaesthesia were monitored. This method allows continuous sufficiently exact estimation of PaO2. The comparison between tcPO2 and corresponding blood gas analysis from arterial samples showed a good correlation of r=0.94. Thus continuous tcPO2 registration enables quick diagnosis of hypoxia and its therapy.
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Results are reported concerning the clinical application of the transcutaneous PO2 method (tc PO2 method) according to Huch et al. for monitoring arterial PO2. Thirty long-term continuous tc PO2 recordings were made in 22 ventilated children and infants with cardiorespiratory problems in four different pediatric intensive care units (Zürich, Göttingen, Kassel, and Mainz). These recordings were compared with 132 arterial PO2 determinations made during the same period of time. There was a linear relationship and a close correspondence between arterial PO2 and tc PO2 (r = .94). The continuous recordings have shown that the variability of PO2 is much greater than assumed so far by single blood gas analysis. This fact restricts greatly the value of single samples. Continuous tc PO2 monitoring has proved to be a great help in optimal respirator setting.
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The method of measuring oxygen partial pressure transcutaneously has provided an opportunity for continuous monitoring of patients on long-term resporator treatment. It has been convincingly demonstrated that serial samples obtained by arterial puncture are inadequate for controlling oxygen supply. An ideal correlation between arterial and transcutaneous pO2 was obtained when the control arterial sample was taken via an indwelling arterial catheter and artefacts, e.g. reaction to the needle puncture, had been eliminated. The necessary percentage of oxygen in the inspiratory mixture can be accurately gauged by continously measuring arterial pO2, as can changes brought about by the application of positive end-expiratory pressure in children on long-term ventilation. The transcutaneous measurement makes it possible to improve continuous monitoring of critically ill patients, and to carry out sparingly and safely long-term ventilation in them.
Heating of a skin area to a temperature of 42 degrees to 44 degrees C produces a certain physiological condition which induces maximal vasodilatation. Detailed experiments have shown that local peripheral vascular resistance of such an area remains constant for several hours. The flow in this area is proportional to the actual perfusion pressure. Relative flow was measured by means of a new type of electrode fixed to the skin like and ECG electrode, and compared with simultaneous intra-arterial blood pressure measruements. The changes in arterial blood pressure were also recorded by the skin electrode. This new parameter is defined as "peripheral perfusion pressure". It is appropiate for non-invasive continuous monitoring of the circulatory system of patients.
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We report the technical premises, the physiological aspects in connection with calibration, handling, clinical reliability and applicability of the non-invasive Po2 method (tcPo2 technique). In particular we discuss the diagnostic possibilities in monitoring the newborn, for detecting hypoxemia, in monitoring mother and fetus during delivery and the relation of tcPo2 to other parameters usually recorded for monitoring patients.
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