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Blood volume determination by the carbon monoxide method using a new delivery system: Accuracy in critically ill humans and precision in an animal model

Dingley, John FRCA; Foëx, Bernard A. FRCS(Ed); Swart, Michael FRCA; Findlay, George FRCA; DeSouza, Pamela R. BSc, FIMLS; Wardrop, Charles FRCPE, FRCPath; Willis, Neil MSc, FIMLS; Smithies, Mark MRCP; Little, Roderick A. PhD, FRCPath

Clinical Investigations

Objective: To evaluate accuracy and repeatability of blood volume determinations made by the carbon monoxide method, using a ventilator-driven administration system.

Design: Prospective within-patient comparison, using simultaneous measurements by two methods to determine accuracy. Prospective laboratory investigation in animals to estimate repeatability.

Subjects: For accuracy: Nineteen ventilated critically ill patients in a university hospital intensive care unit. For repeatability: Six anesthetized, mechanically ventilated normovolemic pigs because this is impossible to perform in humans.

Interventions: In the accuracy study, a small mass of carbon monoxide was administered via a closed breathing system and arterial blood samples were taken from existing cannulas. In the repeatability study, an intramuscular sedative was given, followed by an inhalational anesthetic induction and mechanical ventilation via a tracheal tube. Left axillary artery and external jugular vein cannulas were sited. Anesthesia was maintained using an intravenous infusion. Five sequential circulating hemoglobin and blood volume estimations were made using the carbon monoxide method.

Measurements and Main Results: The small carboxyhemoglobin increase produced by uptake of a small, known mass of carbon monoxide was used to estimate the circulating blood volume. Simultaneous measurement, using 51Cr-labeled red blood cells, was performed.

Twenty measurements were made in 19 patients. The bias (mean difference between blood volume measurements by the two methods) was 397 mL (5.53 mL·kg−1) ±415 mL (±5.95 mL·kg−1); the limits of agreement (mean difference ±2 SD) were −433 mL and 1227 mL (−6.36 mL·kg−1 and 17.42 mL·kg−1). Therefore, 95% of expected differences will lie between these limits. The mean blood volume was 75.8 mL·kg−1 in the animals. The coefficient of variation of repeated estimates was 9.49%. Mean circulating hemoglobin mass was 7.31 mmol with a coefficient of variation of 10.18%. The mean hemoglobin concentration, by co-oximetry, was 5.014 mmol·L−1, coefficient of variation, 2.99%.

Conclusion: This arrangement is a potential bedside method of estimating blood volume and circulating hemoglobin mass. We have rendered the technique more acceptable clinically by creating a ventilator-driven administration system.

From the Departments of Anesthetics and Intensive Care Medicine (J. Dingley, M. Swart, G. Findlay, M. Smithies), Hematology (C. Wardrop, P.R. DeSouza), and Biochemistry (N. Willis), University Hospital of Wales, South Glamorgan, Wales, UK; and the North Western Injury Research Centre (R.A. Little, B.A. Foëx), University of Manchester, Manchester, England, UK.

All the intensive therapy unit work was performed at the University Hospital of Wales, South Glamorgan, Wales, UK.

All the animal work was performed at the North Western Injury Research Centre, University of Manchester, Manchester, England, UK.

The authors are indebted to Mr. Keith Stoddart of Bedfont Scientific Ltd. (Sittingbourne, Kent) for supply of the carbon monoxide and calibration gas.

Supported, in part, by a grant from the Intensive Care Society (UK). Patents for the closed breathing system were funded by the University of Wales College of Medicine.

© 1999 Lippincott Williams & Wilkins, Inc.