Optimal handling of blood samples for routine measurement of lactate and pyruvate

Blood lactate and pyruvate are of critical importance for the diagnosis of mitochondrial diseases. To determine guidelines for adequate blood pyruvate and lactate determinations, intraindividual studies were carried out on 10 subjects, and the influences of venostasis, delay before deproteinization, and pH in the pyruvate assay were analyzed. Delays of 1 hour or more before deproteinization of samples induced major elevations of lactate-pyruvate ratios. The lactate-pyruvate ratio correlated positively with pH in the pyruvate assay, and inadequate pH appeared as a largely underestimated cause of misleading results, while venostasis was a minor source of errors.

Low VA/Q areas: arterial-alveolar N2 difference and multiple inert gas elimination technique

In 16 critically ill patients the arterial-alveolar N2 difference and data from the multiple inert gas elimination technique (MIGET) were compared in the evaluation of the contribution of low alveolar ventilation-perfusion ratio (VA/Q) lung regions (0.005 less than VA/Q less than 0.1) to venous admixture (Qva/QT). The arterial-alveolar N2 difference was determined using a manometric technique for the measurement of the arterial N2 partial pressure (PN2). We adopted a two-compartment model of the lung, one compartment having a VA/Q of approximately 1, the other being open, gas filled, unventilated (VA/Q = 0), and in equilibrium with the mixed venous blood. This theoretical single compartment represents all lung regions responsible for the arterial-alveolar N2 difference. The fractional blood flow to this compartment was calculated using an appropriate mixing equation (Q0/QT). There was a weak but significant relationship between Q0/QT and the perfusion fraction to lung regions with low VA/Q (0.005 less than VA/Q less than 0.1) (r = 0.542, P less than 0.05) and a close relationship between Q0/QT and the perfusion fraction to lung regions with VA/Q ratios less than 0.9 (r = 0.862, P less than 0.001) as obtained from MIGET. The difference Qva/QT-Q0/QT yielded a close estimation of the MIGET right-to-left shunt (Qs/QT) (r = 0.962, P less than 0.001). We conclude that the assessment of the arterial-alveolar N2 difference and Q0/QT does not yield a quantitative estimation of the contribution of pathologically low VA/Q areas to QVa/QT because these parameters reflect an unknown combination of pathological and normal (0.1 less than VA/Q less than 0.9) gas exchange units.(ABSTRACT TRUNCATED AT 250 WORDS)

[Contamination of an oxygen delivery circuit by compressed air]

Routine checking of the FIO2 of a mixture delivered by a ventilator revealed large discrepancies between the FIO2 assigned and that effectively delivered, the latter being low. Measurements of FIO2 at the wall outlets showed the O2 delivery pipeline to be contaminated by compressed air. By disconnecting all the ventilators supplied by this pipeline one after the other, one ventilator, or rather its blender, was found responsible.

[A method of continuous recording on microsamples of the Hb-O2 association curve. II. A study of Bohr effect and carbamino-formation (author's transl)]

The authors have worked out an adaptation to microsamples (200-400 mul) of the DUVELLEROY et al. method, allowing the continous registration of the O2-Hb association curve. The microsample being diluted in buffer solution, it is possible to predetermine its pH and PCO2. The prefixed conditions are maintained during the initial deoxygenation phase, and all along the curve registration. Moreover, the adjustment to the desired values of the pH and PCO2 allows the quantification of total BOHR effect, proton BOHR effect and carbamino-formation, during the course of oxygenation.