Use of blood gas values to estimate the source of blood withdrawn from a wedged flow-directed catheter in critically ill patients

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Abstract
A technique for sampling blood from the damaged pulmonary microvasculature in patients with acute respiratory failure is described. Blood was aspirated through the distal lumen of wedged pulmonary arterial catheters in 28 critically ill patients. Successful aspiration was achieved in 88% of the attempts and 20 ml of blood drawn before sampling was optimal for clearing mixed venous precapillary blood. The blood gas values obtained were classified as "capillary" when the wedge (w) PO2 greater than PaO2 and PwCO2 less than PaCO2 (17 patients, 61%); "mixed venous" when PwO2 and PwCO2 were equal to values obtained from the main pulmonary artery (5 patients, 18%); and "mixed source" when intermediate PwO2 and PwCO2 were noted, i.e., PaO2 greater than PwO2 greater than PVO2 and PwCO2 variably greater than or less than PaCO2 (6 patients, 21%). When mixed venous samples are eliminated, microvascular sampling can be assumed in 82% of the successful aspirations.

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