Thomas P. Maxwell

Progress in the development of a fluorescent intravascular blood gas system in man

In vitro and in vivo animal studies have shown accurate measurements of arterial blood pH (pHa), carbon dioxide tension (PaCO2), and oxygen tension (PaO2) with small intravascular fluorescent probes. Initial human clinical studies showed unexplained intermittent large drops in sensor oxygen tension (PiO2). Normal volunteers were studied to elucidate this problem. In the first part of this study, the probe and cannula were manipulated and the probe configuration and its position within the cannula were varied. The decreases in PiO2 were judged to be primarily due to the sensor touching the arterial wall. Retraction of the sensor tip within the cannula eliminated the problem. In the second part of this study, the accuracy of the retracted probe was evaluated in 4 subjects who breathed varying fractions of inspired oxygen and carbon dioxide. The arterial ranges achieved were 7.20 to 7.59 for pH, 22 to 70 mm Hg for PaCO2, and 46 to 633 mm Hg for PaO2. Linear regression of 48 paired sensor (i) versus arterial values showed pHi = 0.896 pHa + 0.773 (r = 0.98, SEE = 0.017); PiCO2 = 1.05 PaCO2-1.33 (r = 0.98, SEE = 2.4 mm Hg); and PiO2 = 1.09 PaO2-20.6 (r = 0.99, SEE = 21.2 mm Hg). Bias (defined as the mean differences between sensor and arterial values) and precision (SD of differences) were, respectively, -0.003 and 0.02 tor pHi, 0.77 and 2.44 mm Hg for PiCO2, and -2.9 and 25.4 mm Hg for PiO2. The mean in vivo 90% response times for step changes in inspired gas were 2.64, 3.88, and 2.60 minutes, respectively, for pHi, PiCO2, and PiO2.