title: Predicting arterial blood gas and lactate from central venous blood analysis in critically ill patients: a multicentre, prospective, diagnostic accuracy study.
abstract: BACKGROUND
  The estimation of arterial blood gas and lactate from central venous blood analysis and pulse oximetry [Formula: see text] readings has not yet been extensively validated.
  
  
  METHODS
  In this multicentre, prospective study performed in 590 patients with acute circulatory failure, we measured blood gases and lactate in simultaneous central venous and arterial blood samples at 6 h intervals during the first 24 h after insertion of central venous and arterial catheters. The study population was randomly divided in a 2:1 ratio into model derivation and validation sets. We derived predictive models of arterial pH, carbon dioxide partial pressure, oxygen saturation, and lactate, using clinical characteristics, [Formula: see text], and central venous blood gas values as predictors, and then tested their performance in the validation set.
  
  
  RESULTS
  In the validation set, the agreement intervals between predicted and actual values were -0.078/+0.084 units for arterial pH, -1.32/+1.36 kPa for arterial carbon dioxide partial pressure, -5.15/+4.47% for arterial oxygen saturation, and -1.07/+1.05 mmol litre(-1) for arterial lactate (i.e. around two times our predefined clinically tolerable intervals for all variables). This led to ∼5% (or less) of extreme-to-extreme misclassifications, thus giving our predictive models only marginal agreement. Thresholds of predicted variables (as determined from the derivation set) showed high predictive values (consistently >94%), to exclude abnormal arterial values in the validation set.
  
  
  CONCLUSIONS
  Using clinical characteristics, [Formula: see text], and central venous blood analysis, we predicted arterial blood gas and lactate values with marginal accuracy in patients with circulatory failure. Further studies are required to establish whether the developed models can be used with acceptable safety.
authors.affiliation: Medical-Surgical Intensive Care Unit, Regional Hospital Centre, avenue de l'Hôpital, Orléans F-45067, France thierry.boulain@chr-orleans.fr.
authors.forename: T
authors.initials: T
authors.lastname: Boulain
authors.affiliation: Medical Intensive Care Unit, University Hospital, Tours, France.
authors.forename: D
authors.initials: D
authors.lastname: Garot
authors.affiliation: Medical-Surgical Intensive Care Unit, University Hospital, Limoges, France CIC-P 1435, Inserm U1092, Limoges, France.
authors.forename: P
authors.initials: P
authors.lastname: Vignon
authors.affiliation: Medical-Surgical Intensive Care Unit, District Hospital Centre, La Roche-sur-Yon, France.
authors.forename: J-B
authors.initials: JB
authors.lastname: Lascarrou
authors.affiliation: Medical-Surgical Intensive Care Unit, Regional Hospital Centre, Orléans, France.
authors.forename: D
authors.initials: D
authors.lastname: Benzekri-Lefevre
authors.affiliation: Medical Intensive Care Unit, University Hospital, Tours, France.
authors.forename: P-F
authors.initials: PF
authors.lastname: Dequin
mesh_terms: D002245:Carbon Dioxide / Q000097:blood*; D016638:Critical Illness; D006801:Humans; D006863:Hydrogen-Ion Concentration; D019344:Lactic Acid / Q000097:blood*; D010100:Oxygen / Q000097:blood*; D011446:Prospective Studies
chemical_list: D002245:Carbon Dioxide; D019344:Lactic Acid; D010100:Oxygen
keywords: arterial lines; blood gas analysis; catheterization, central venous; lactic acid/blood; shock