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Presence or absence of gas in the appendix: additional criteria to rule out or confirm acute appendicitis--evaluation with US.

PURPOSE: To investigate whether the presence or absence of gas in the appendix may be considered as additional ultrasonographic (US) criteria to rule out or confirm acute appendicitis. MATERIALS AND METHODS: The appendices in 239 control subjects, 138 patients with lower right quadrant pain without acute appendicitis, and 80 patients with acute appendicitis were prospectively evaluated for intraluminal gas with US. RESULTS: The appendices in 206 (86%) control subjects showed gas at US, and those in 33 (14%) did not. The appendices in 109 (79%) symptomatic patients without acute appendicitis showed gas, and those in 29 (21%) did not. The appendices in 12 (15%) patients with acutely inflamed appendices showed gas, and those in 68 (85%) did not. The absence of gas as a criterion for acute appendicitis had a sensitivity of 85%; specificity, 79%; positive and negative predictive values, 57% and 94%, respectively; and accuracy, 81%. Gas was useful to exclude acute appendicitis in 64 (46%) symptomatic patients because the established criteria were misleading. In 19 (24%) patients, the absence of gas was useful for diagnosis of acute appendicitis because the other criteria were not convincing. CONCLUSION: US-based detection of gas in the appendiceal lumen helps to rule out acute appendicitis, whereas the absence of gas further confirms its presence, especially in cases where established US criteria are either insufficiently present or misleading.

Acute Disease↗

Reflex control of intestinal gas dynamics and tolerance in humans.

Intestinal transit of gas is normally adapted to the luminal gas load, but in some patients impaired transit may lead to gas retention and symptoms. We hypothesized that intestinal gas transit is regulated by reflex mechanisms released by segmental distension at various gut levels. In 24 healthy subjects, we measured gas evacuation and perception of jejunal gas infusion (12 ml/min) during simultaneous infusion of duodenal lipids mimicking the postprandial caloric load (Intralipid, 1 kcal/min). We evaluated the effects of proximal (duodenal) distension (n = 8), distal (rectal) distension (n = 8), and sham distension, as control (n = 8). Duodenal lipid infusion produced gas retention (366 +/- 106 ml) with low abdominal perception (1.5 +/- 0.8 score). Distension of either the duodenum or rectum during lipid infusion expedited gas transit and prevented retention (-120 +/- 164 and -124 +/- 162 ml retention, respectively; P < 0.05 vs. control). However, the tolerance to the intestinal gas load differed markedly, depending on the site of distension; perception remained low during rectal distension (2.6 +/- 0.7 score; not significant vs. control) but increased during duodenal distension (4.4 +/- 0.7 score; P < 0.05 vs. control). We conclude that focal gut distension, either at proximal or distal sites, accelerates gas transit, but the symptomatic response depends on the site of stimulation.

Abdomen↗

Sample-hold technique for analysis of respiratory gas composition at high breathing frequencies.

A gas sampling device is described for continuous monitoring of respiratory gas composition that is applicable to experimental conditions when the breathing frequency is very high (greater than 2 Hz) and the response time of conventional gas analyzers becomes a critical limiting factor. The system utilizes the principle of discontinuous gas collection at any selected point of the respiratory cycle facilitated by ultraspeed piezoelectric valves and includes provision for sample-hold characteristics. Two distinct modes of operation are supported. In phase-locked mode gas sampling is synchronous with breathing frequency. In scanning mode gas collection is asynchronous with breathing frequency. Phase-locked mode may be used for continuous monitoring of end-tidal gas concentrations, whereas scanning mode is intended for assessing the gas concentration profile throughout the respiratory cycle. The system may be applied to steady breathing encountered in mechanical ventilation at high frequency or during quasi-steady breathing observed in panting animals. Combined with a respiratory mass spectrometer, the system has been used for measurement of gas concentrations in alveolar gas mixtures at breathing frequencies ranging from 3 to 30 Hz that were otherwise not amenable to rapid measuring techniques.

Animals↗

Gas exchange across avian eggshells oscillates in phase with heartbeat.

Rahn et al. (J. Appl. Physiol. 69: 1546-1548, 1990) showed that the gas pressure in a plethysmograph containing an intact egg oscillates in phase with electrocardiogram (ECG) and that this pressure variation could be used as a noninvasive way to determine the heart rate of an avian embryo. One possible mechanism to account for the pressure oscillation is the mechanical movement of the embryonic heart, which leads to volume shifts of gas within the plethysmograph. Another possibility is that the oscillation of gas pressure with heartbeat is pulsatile gas exchange resulting from pulsatile blood flow. If gas exchange were transiently stopped, a pressure signal dependent on gas exchange should disappear, while a pressure signal dependent on cardiovascular motion should persist. Using a number of late-age hen eggs (at days 15-20 of incubation), we tested these hypotheses by suddenly changing the gas composition surrounding an egg and measuring the effect of the pressure oscillation. We found that 1) after 5% CO2-95% N2 was flushed into the plethysmograph (presumably halting gas exchange), pressure oscillations went almost to zero and the ECG signal remained; after air was flushed back to the plethysmograph, the pressure signal returned to control level; 2) after 20% CO2-20% O2-60% N2 was flushed into the plethysmograph (presumably increasing net gas exchange), the pressure signal increased 2.5-fold compared with that in air; and 3) after 1% CO2-99% N2 was flushed into the plethysmograph (presumably reversing gas exchange), the oscillation pressure decreased to one-fourth of that in air and the phase of pressure relative to ECG reversed compared with the phase in air.(ABSTRACT TRUNCATED AT 250 WORDS)

Air Pressure↗

Role of nitrogen in transmucosal gas exchange rate in the rat middle ear.

This study investigates the role of nitrogen (N2) in transmucosal gas exchange of the middle ear (ME). We used an experimental rat model to measure gas volume variations in the ME cavity at constant pressure. We disturbed the steady-state gas composition with either air or N2 to measure resulting changes in volume at ambient pressure. Changes in gas volume over time could be characterized by three phases: a primary transient increase with time (phase I), followed by a linear decrease (phase II), and then a gradual decrease (phase III). The mean slope of phase II was -0.128 microl/min (SD 0.023) in the air group (n = 10) and -0.105 microl/min (SD 0.032) in the N2 group (n = 10), but the difference was not significant (P = 0.13), which suggests that the rate of gas loss can be attributed mainly to the same steady-state partial pressure gradient of N2 reached in this phase. Furthermore, a mathematical model was developed analyzing the transmucosal N2 exchange in phase II. The model takes gas diffusion into account, predicting that, in the absence of change in mucosal blood flow rate, gas volume in the ME should show a linear decrease with time after steady-state conditions and gas composition are established. In accordance with the experimental results, the mathematical model also suggested that transmucosal gas absorption of the rat ME during steady-state conditions is governed mainly by diffusive N2 exchange between the ME gas and its mucosal blood circulation.

Animals↗

Effect of acute hyperglycemia on intestinal gas transit and tolerance in nondiabetic humans.

BACKGROUND: Acute hyperglycemia usually inhibits gastrointestinal motility and hyperinsulinemia may contribute to specific inhibitory effects. However, the influences on postprandial intestinal gas dynamics have not been investigated. AIMS: To compare effects of euglycemic hyperinsulinemia and acute fasting hyperglycemia on intestinal gas dynamics in nondiabetics. METHODS: On 3 separate days, 10 healthy volunteers were evaluated in randomized order with duodenal glucose, intravenous glucose or saline infusion. Rectal gas evacuation was continuously measured; perception and abdominal girth changes were separately evaluated. After 60 min equilibration, proximal jejunal gas infusion (12 ml/min) was started for 150 min. RESULTS: Acute hyperglycemia failed to cause significant intestinal gas retention (72 +/- 64 ml and 53 +/- 29 ml final gas retention vs. saline); in contrast, gas clearance was expedited, with a maximal effect between 30 and 105 min (p < 0.001 vs. control). Euglycemic hyperinsulinemia did not significantly influence intestinal gas clearance and no relevant changes of abdominal girth or abdominal and rectal perception were seen, as compared to control (p > 0.05 for all parameters). CONCLUSION: Accelerated intestinal gas clearance under hyperglycemia is one physiologic factor to avoid postprandial intestinal gas accumulation. Specific underlying mechanisms, which need further investigation, may be disturbed in symptomatic patients.

Abdomen↗

The effects of carrier gas composition on the performance of the Tec 6 desflurane vaporizer.

The new Tec 6 desflurane vaporizer is an electrically heated, pressurized, electromechanically coupled dual-circuit blender. We hypothesized that carrier gas viscosity should affect the electromechanical coupling of the fresh gas and vapor circuits, and that desflurane output should vary with different carrier gases. In the first portion of the study, the performance of eight vaporizers was evaluated using a constant dial setting of 10% desflurane with four different carrier gases and three different fresh gas flow rates. In the second portion of the study, the carrier gas flow rate was maintained at 1, 5, or 10 L/min, and vaporizer output was analyzed at all integer dial settings from 1% to 18%. Vaporizer output was highest when oxygen was the carrier gas and lowest when nitrous oxide was the carrier gas. This effect was accentuated at low fresh gas flow rates and correlated with carrier gas viscosity. At a flow rate of 1.0 L/min with a constant dial setting of 10%, the averaged output from vaporizers was 10.3 +/- 0.66, 9.4 +/- 0.58, 8.7 +/- 0.52, and 8.1 +/- 0.44 vol% for 100% oxygen, air, 30% oxygen plus 70% nitrous oxide, and 100% nitrous oxide, respectively. With 100% nitrous oxide as the carrier gas at a flow rate of 1.0 L/min, the vaporizer delivered 2 vol% less than the dial setting at dial settings in excess of 12%. Differences between the analyzed concentration and the dial setting were most pronounced with high concentrations of nitrous oxide at low fresh gas flow rates.

Anesthetics↗

Residential mercury spills from gas regulators.

Many older homes are equipped with mercury-containing gas regulators that reduce the pressure of natural gas in the mains to the low pressure used in home gas piping. Removal of these regulators can result in elemental mercury spills inside the home. In the summer of 2000, mercury spills were discovered in the basements of several Chicago-area homes after removal of gas regulators by gas company contractors. Subsequent inspections of approximately 361,000 homes by two northern Illinois gas companies showed that 1,363 homes had residential mercury contamination. Urine mercury screening was offered to concerned residents, and results of urine bioassays and indoor mercury air measurements were available for 171 homes. Six of these 171 homes (3.5%) had a cumulative total of nine residents with a urine mercury > or = 10 microg/L. The highest urine mercury concentration observed in a resident was 26 microg/L. Positive bioassays were most strongly associated with mercury air concentrations > 10 microg/m3 on the first floor [odds ratio (OR) = 21.4 ; 95% confidence interval (CI) , 3.6-125.9] rather than in the basement (OR = 3.0 ; 95% CI, 0.3-26) , and first-floor air samples were more predictive of positive bioassays than were basement samples. Overall, the risk of residential mercury contamination after gas regulator removal ranged from 0.9/1,000 to 4.3/1,000 homes, depending on the gas company, although the risk was considerably higher (20 of 120 homes, 16.7%) for one of the contractors performing removal work for one of the gas companies. Gas companies, their contractors, and residents should be aware of these risks and should take appropriate actions to prevent these spills from occurring and remediate them if they occur.

Adult↗

In vitro gas production measurements to evaluate interactions between untreated and chemically treated rice straws, grass hay, and mulberry leaves.

In vitro gas production was measured to investigate associative effects of untreated and chemically treated rice straw (RS) and of RS and grass hay or mulberry leaves (ML). The RS was treated with NaOH, urea, or (NH4)HCO3. Cumulative gas production was recorded at 2, 4, 6, 8, 12, 16, 24, 36, 48, 60, 72, and 96 h of incubation, and the Gompertz function was used to describe the kinetics of gas production. Treatment with NaOH, urea, and NH4HCO3 increased (P < 0.05) gas production at 48 h by 55, 52, and 37% and the maximum rate of gas production of RS from 0.64 to 1.51, 1.27, and 1.13 mL/h, respectively. The inclusion of treated straws, hay, and ML in a mixture with RS at increasing proportions (25, 50, 75, 100%) elevated cumulative gas production and its rate. Maximum gas production was not different between the RS and its mixtures with the treated straws, but inclusion of hay into RS or NH4HCO3-treated RS increased the maximum gas production. Associative effects were defined as the difference between the observed gas production for the mixtures and the sum of the individual component feeds. The NaOH-treated RS, included at higher proportions, had positive associative effects at all times of incubation < 96 h; effects were negative or absent at 96 h. No effects were observed with mixtures of RS with urea-treated RS. The NH4HCO3-treated RS mixture tended to have negative associative effects at all three levels. Positive associative effects (P < 0.05) were observed for both RS and NH4HCO3-treated RS at almost all inclusion levels of hay or ML after 12 to 96 h of incubation. The response was more pronounced with ML than with hay. Associative effects generally declined with duration of incubation. We conclude that positive associative effects on in vitro gas production occurred more consistently when RS was incubated in mixtures with hay or ML than when incubated in mixtures with chemically treated RS.

Animals↗

Carbon dioxide-protein interaction in a gas-solid phase.

In the course of developing the packaging of protein foods under the carbon dioxide atmosphere, various proteins in a solid state were found to adsorb carbon dioxide gas gradually. The results obtained by the Warburg manometry indicated that 100-1000 mul of carbon dioxide gas was adsorbed at 25 degrees C for 24 hr by gram of purified proteins, dried protein foods and other proteinous materials such as the rabbit hair and raw silk when they were placed in the high partial pressure of carbon dioxide gas. Casein, gelatin and raw silk were revealed to be the better adsorbents comparing with egg albumin, hemoglobin, gluten and others tested in this experiment. This adsorption was found to be almost specific to carbon dioxide gas. Amount of carbon dioxide gas adsorbed by casein and gelatin depended on the moisture content of them. The lower the moisture is, the greater the adsorption amount of carbon dioxide gas increase. Peptones and partial hydrolyzates of gelatin also showed the adsorbability. Oligo-peptides, amino acids and amines were examined too. Among these, L-lysine (free base), L-arginine (free base), histamine and tyramine adsorbed a large amount of carbon dioxide gas while others failed to do so. Some differences, however, were observed between temperature dependence and reversibility of the carbon dioxide gas adsorption by proteins and those by amines and amino acids (free bases). The mode of interaction between carbon dioxide and protein in a gas-solid phase was discussed comparing with the results obtained in a gas-liquid phase. Large contribution of physical adsorption and less contribution of chemical reaction or chemisorption were assumed in the mode of the carbon dioxide-protein interaction.

Adsorption↗

[The effect of gas concentration on ethylene oxide sterilization].

Ethylene oxide (EO) gas is widely used for sterilization of medical instruments and supplies. The gas being used in our hospital consists of 20% EO and 80% carbon dioxide and is packed in a cylinder as liquefied gas. We investigated the relationship between the composition of the gas and the amount of EO gas used by measuring the EO concentration in a sterilizer. The concentration of EO was increased as the amount of gas increased, and it decreased sharply when the remaining gas in the cylinder decreased up to about 12% of its initial value. This value agreed with the calculated one by gas-liquid equilibrium when all of the liquefied gas was consumed and only saturated gas remained in the cylinder.

Ethylene Oxide↗

Mobile resonance enhanced multiphoton ionisation-time-of-flight mass spectrometer with a novel hybrid laser desorption/molecular beam ion source for rapid detection of aromatic trace compounds from gas phase and solid samples.

A mobile, field applicable resonance enhanced multiphoton ionisation-time-of-flight mass spectrometer (REMPI-TOFMS) for direct-inlet gas-phase analysis as well as for characterisation of solid samples, has been developed. For solid-sample analysis, laser desorption (LD) with IR-laser pulses is used for volatilisation of the neutral analytes from a target in the ion source prior to REMPI-TOFMS analysis. For direct inlet gas-phase analysis, a needle gas inlet is used and the formed molecular beam is REMPI-ionised directly in the ion source. A special ion source was developed, which can be rapidly interchanged between the REMPI-TOFMS and the LD-REMPI-TOFMS modes. The system is equipped with a tuneable optical parametrical oscillator (OPO)-laser system. The analytical properties are characterised for both modes of operations. In both cases, analytical performance is similar to that achieved with instruments specifically designed for either gas-phase or solid-phase characterisation. Results from field measurements of a wood combustion flue gas of a 174 kW bio mass furnace are given. Gas-phase analysis was applied for time-resolved on-line REMPI-TOFMS of the semi-volatile aromatic flue gas constituents. The low-volatile aromatic compounds, which were precipitated with the particulate matter in the filtering unit of the sampling train, were characterised by direct LD-REMPI-TOFMS of the glass fibre filter material. By combining the gas-phase and particulate results a rather comprehensive characterisation of the aromatic species present in the flue gas (i.e. aerosol--gas phase plus particulate matter) was achieved.

Mass Spectrometry↗

Gas nuclei, their origin, and their role in bubble formation.

Gas bubbles are the primary agent in producing the pathogenic effects of decompression sickness. Bubble formation during decompression is not simply the consequence of inert gas supersaturation. Numerous experiments indicate that bubbles originate as pre-existing gas nuclei. Radii are on the order of 1 microm or less. Heterogeneous nucleation processes are involved in generating these gas entities. Musculoskeletal activity could be the main promoter of gas nuclei from stress-assisted nucleation. The half-life and faculty for nuclei to initiate bubble formation during decompression depend on many factors. Oxygen window and surface tension are involved in resolving bubbles. Two factors have been proposed to stabilize gas nuclei against dissolution: gas nuclei trapped in hydrophobic crevices and gas nuclei coated with surface-active molecules such as surfactants. Diffusion and surface tension could play an important role in the formation of gas nuclei crevices. However, while the concept of in vivo hydrophobic crevices remains a theoretical possibility, none have yet been identified in tissues and/or in microcapillaries. Moreover, while surfactants seem present in numerous tissues and could play a role in gas nuclei stabilization, they could also be involved in bubble elimination. The understanding of such mechanisms is of primary importance to neutralize nuclei and for modeling bubble growth. Here we present in a single document a summary of the original findings and views from authors in this field.

Animals↗

Balloon embolectomy catheters in small arteries. II. Comparison of fluid-filled and gas-filled balloons.

Balloon embolectomy catheters were studied in 3 mm dog carotid arteries to compare liquid-filled balloons with gas-filled balloons. Balloons were filled with syringes containing 1 cc fluid (1F), 1 cc gas (1G), and 50 cc gas (50G). Results showed that lateral wall pressures (LWPs) were precisely controlled with fluid-filled balloons but were poorly controlled with gas-filled balloons because gas-filled balloons exhibited spontaneous changes in diameter and LWP. Also, when Edwards 4F balloons were filled in clinically satisfactory criteria, out of direct vision, the following LWPs (in millimeters of mercury) were obtained: 54.4 +/- 8 with 1F, 95.2 +/- 13.8 with 1G, and 216 +/- 19.8 with 50G following balloon inflation; 28.1 +/- 5.7 with 1F and 34.2 +/- 7.1 with 1G following balloon deflation. Balloons filled with 50G collapsed completely during balloon deflation. Statistically lower (P less than 0.05) LWPs were obtained with fluid-filled balloons versus gas-filled balloons and with deflation versus inflation. Gas-filled balloons produced slightly lower shear forces than did fluid-filled balloons (P less than 0.05), but only through regions of stenosis and only at low LWPs-namely 25 and 75 mm Hg LWP. Gas-filled balloons produced no reduction in shear force at higher LWPs. It was concluded that fluid-filled balloons are preferable to gas-filled balloons for use in the operating room because fluid-filled balloons provide lower LWPs greater surgeon control, and only slightly increased shear forces. With both fluid-filled and gas-filled balloons, lower LWPs can be achieved by distending balloons to apparently satisfactory levels and then deflating them to slightly lower levels.

Animals↗

Excretion-retention data of steady state gas exchange in tidal breathing. II. Dependency on the diffusion coefficient.

The steady state gas transfer properties of the lung can be derived from excretion-retention (E-R) data of inert tracer gases that are infused intravenously. E = PE/Pv and R = Pa/Pv, where PE, Pa and Pv represent the partial pressures of the tracer gases in mixed expired gas, arterial blood and mixed venous blood, respectively. In this paper, we investigate the influence of diffusive gas mixing in the lung on E and R. To that end, E-R data sets were simulated with a lung model that takes into account tidal breathing, the morphometric geometry of the airways, diffusion limited gas mixing in the alveolar space and gas dissolved in superficial lung tissue. The results show a linear relationship between R/E and D-0.5, where D represents the diffusion coefficient of the tracer gases in the alveolar gas mixture. This is in contrast to the results of simulations with a lung model that describes the different gas transport mechanisms, including diffusion, as a constant rate process, where a linear relationship between R/E and D-1 is predicted. It is further shown that E-R data of helium and sulphur hexafluoride cannot be used to demonstrate diffusion limited gas mixing in the lung, in particular, in the presence of a real shunt fraction. For that purpose, excretion data of pairs of tracer gases with different D but equal, medium blood-gas partition coefficients (1 less than lambda less than 30) should be used. For such pairs of tracer gases, the E values may differ by more than 10% when the D values for the two gases are 0.22 and 0.1 cm2s-1, respectively.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Gas Analysis↗

Effects of SO2 and pH on blood-gas partition coefficients of inert gases.

Potential effects of SO2 and of pH on blood-gas partition coefficients, lambda, for inert gases, including SF6, ethane, cyclopropane, halothane, diethyl ether, acetone and N2, were systematically investigated using human blood. Measurements on lambda were performed at 37 degrees C in conditions of varied SO2 and pH using gas chromatography. Incorporating the experimental data on lambda, multiple inert gas elimination was applied to 18 patients with varied chronic lung diseases, in order to estimate the effects of SO2 and of pH on both inert gas exchange and resultant recovery of VA/Q distribution in the lung. For this purpose, the data obtained by the procedure of multiple inert gas elimination were analyzed with the classical approach but allowance was made for lambda of the indicator gas to vary according to exchange of O2 and of CO2 in the pulmonary capillary. Among the gases studied, ethane, cyclopropane, halothane and diethyl ether showed significantly smaller lambda values in the oxygenated blood than in deoxygenated blood, whereas SF6, acetone and N2 were little dependent on SO2. An increase in lambda was found for ethane and a decrease for halothane with increasing pH in the blood. The other gases were not significantly influenced by pH. In spite of these experimental findings, regional difference of either SO2 or pH in the lung did not exert important influence on the inert gas exchange or on the predicted VA/Q distribution. In conclusion, blood-gas partition coefficients of some inert gases are consistently altered by SO2 and pH, but their possible effects on inert gas exchange seem to be negligible.

Adult↗

Continuous distributions of ventilation and gas conductance to perfusion in the lungs.

Theoretical analysis and experimental observations were conducted to establish a method allowing to demonstrate the characteristics of distribution of ventilation (VA) as well as of diffusive conductance (G) to perfusion (Q) in the lungs. O2, CO2 and CO binding to hemoglobin molecules within the erythrocyte together with six inert gases including SF6, ethane, cyclopropane, halothane, diethyl ether and acetone, of varied solubility in blood and different diffusivity in lung tissue, were used as indicator gases. 15 patients with interstitial pneumonia of unknown etiology, placed in the supine position, were given a mixture of 21% O2 and 0.1% CO in N2 as the inspired gas and saline containing appropriate amount of the six inert gases was infused via an antecubital vein. After a steady state was established, the expired gas was collected and the samples of both arterial and mixed venous blood were simultaneously taken through catheters inserted into the femoral and pulmonary artery. The concentrations of the indicator gases in the samples were measured by gas chromatography, with electrodes or with the Scholander gas analyzer. Assuming that the mass transfer efficiency of a given indicator gas at each gas exchange unit would be limited by VA/Q and G/Q ratios, the data obtained from the human subjects were analyzed in terms of a lung model having 20 units along the VA/Q and G/Q axes, respectively. The numerical analysis including the procedure of simultaneous Bohr integration for O2, CO2 and CO in a pulmonary capillary and the method of weighted least-squares combined with constrained optimization permitted the data to be transformed into a virtually continuous distribution of Q against VA/Q and G/Q axes. The numerical procedure was strictly tested using various artificial distributions of VA/Q and G/Q ratios, showing that it could characterize the distributions containing up to at least two modes on VA/Q-G/Q field with a substantial accuracy. Analytical results estimated from the patients with interstitial lung disease revealed the following features. (1) There appears to be bimodal distribution of Q along G/Q axis extending to relatively low G/Q less than 10(-3) ml(STPD)/(ml.Torr), which may limit O2 exchange between alveolar gas and capillary blood. This area of low G/Q receives 10% of total Q. (2) Severe diffusion limitation causing disequilibrium of the inert gas across the blood-gas barrier is solely observed in 2 out of 15 patients and an amount of Q associated with this phenomenon is very small (below 1%).(ABSTRACT TRUNCATED AT 400 WORDS)

Carbon Dioxide↗

In vitro assessment of a flow-through fluorometric blood gas monitor.

The Gas-STAT blood gas monitor uses fluorometric techniques to continuously monitor blood gas tensions and acid-base status in the extracorporeal perfusion circuit during cardiac surgery. We evaluated the in vitro performance of this instrument by using a tonometry loop to simulate the clinical environment and to provide controlled gas tensions and pH in the circulating fluid. In this article we report the in vitro study in which 35 Gas-STAT blood gas sensors were used to assess the precision, stability, response time, and specificity of the instrument and to confirm the sterile integrity of its flow-through cells. The blood gas monitor exhibited precision values for pH, carbon dioxide tension (PCO2), and oxygen tension (PO2) of 0.1%, 1.3%, and 1.0%, respectively; stabilities were 0.002 units/h for pH, 0.5 mm Hg/h for PCO2, and 1.4 mm Hg/h for PO2; time constants (tau, a response to within 1/e of a new gas tension, approximately 63%) were 81 seconds for PCO2 and 72 seconds for PO2. No significant interference was detected in in vitro tests of 30 drugs and metabolites typically encountered during cardiac surgery. Bacterial challenge of the flow-through cell membranes showed that they provide an effective barrier isolating the sensors from contaminants in the fluid path. Our quality control consisted of measurement of a midrange gas standard as an unknown immediately following sensor calibration; this simple program is proposed as a complement to the manufacturer's operating procedures.(ABSTRACT TRUNCATED AT 250 WORDS)

Blood Gas Analysis↗