Indian J. Anaesth.

2004; 48 (4) :
278 INDIAN JOURNAL OF ANAESTHESIA, AUGUST 2004
278
ORIGINAL ARTICLE

POINT-OF-CARE TESTING IN ANAESTHESIOLOGY AND

INTENSIVE CARE – AN OVERVIEW
Dr. Subhash Gupta1 Dr. Abhijit Bhattacharya2

SUMMARY
The term point-of-care (POCT) testing, also called near patient testing or bedside testing, refers to the performance of diagnostic
tests at or near the patient. These tests are performed outside the confines of clinical laboratories in health care facilities. Many
descriptive titles have been used for POCT, including Point-of-care diagnostics, Alternate site testing, Bedside testing, Ancillary
laboratory testing, near and patient side testing, and Decentralized and Distributed testing.The application of point-of-care testing in
the operating room or intensive care unit is reviewed and its importance emphasized.
Keywords : Point-of-care testing, Anaesthesia, Critical care.

Introduction analysis. After the analysis, reports are communicated to

Traditionally, most of the laboratory tests ordered
from acute areas like operating room (OR) or Intensive
Care Unit (ICU) were and still are performed in the central
or stat laboratory and decisions regarding the change in
therapy or initiation of appropriate therapy were taken only
after the reports were made available. Considerable amount
of time was consumed, depending upon the type of test
ordered or the response time of the system involved in
testing.1 These tests often had to be repeated because of
error in sampling, labeling, or inadequate sampling, causing
further delay. The laboratory procedure begins with the
physician’s order for laboratory studies, using testing
profiles and prioritization levels (standard, urgent, and stat)
pre configured by the laboratory administration. The samples
are drawn and transported to the central laboratory for
the treating physician. (figure 1)
This multistep and multiperson central laboratory
program may lead to long delays between the time a
laboratory test is ordered and the time the result is received
by the clinical staff and may not keep pace with the
dynamically evolving clinical needs of the unstable, critically
ill patient.2 The intensive care unit (ICU)/operating room
(OR) diagnostic and therapeutic processes are rendered
inefficient and ineffective if the ICU/OR staff finds that
test results are classified as “pending” and are not available
at the time they are required for decision making. Even
when laboratory results arrive at the ICU/OR, they reflect
the past and not the patient’s present condition.
A few of the problems arising out of the delays
involved with traditional laboratory testing are listed in
table 1. These can definitely change the outcome of the
critically sick patients with rapidly changing internal milieu
and large volume shifts, in the operating room setting and
the ICU. Analysis of serum electrolytes is an example,
reports of which, if not available immediately, will be
useless in terms of replacement therapy.

Table - 1 : Problems with traditional laboratory tests.

Increased therapeutic turn around time

Fig. 1 : Traditional steps involving centralized laboratory testing Delayed data availability
Delayed decision making
1. M.D., Asso. Consultant, Increased blood loss
2. D.A., M.D., D.Acp., Senior Consultant,
Department of Anaesthesiology, Increased pre-analytic error
Pain and Perioperative Medicine, Sir Ganga Ram Hospital, More redundant blood tests
New Delhi – 110060. India
Correspond to :
Dr. S. Gupta With the advent of transplant surgery, especially
E-mail : s_grh99@yahoo.com liver transplant, and major cardiac surgery the need for
(Accepted for publication on 23-06-2004) immediate availability of laboratory test results became
GUPTA, BHATTACHARYA : POINT OF CARE TESTING IN ANAESTH. AND ICU
overwhelming. Tableside laboratory tests which could be
carried out in accordance with the requirement of surgery
and postoperative intensive care, prompted anaesthesiologists
to search for a viable and efficient alternative and Point-
of-care technology for the OR and the ICU.
Point-of-care testing
The term point-of-care (POCT) testing, also called
near patient testing or bedside testing, refers to the
performance of diagnostic tests at or near the patient. These
tests are performed outside the confines of clinical
laboratories in health care facilities. Many descriptive titles
have been used for POCT, including Point-of-care diagnostics,
Alternate site testing, bedside testing, ancillary laboratory
testing, near and patient side testing, and decentralized and
distributed testing. In the Point-of-care framework, testing
is performed on whole blood immediately on request with
user friendly devices located within the vicinity of the
patient either directly at the patient’s bedside or in a ‘mini’
or ‘stat’ laboratory within the ICU/OR setting.
Historical perspective - Evolution of POC testing
Laboratory testing started at the bedside or ward
level in 19th century London hospitals when ward laboratories
were introduced to chemically analyze urine and fecal
specimens. Through the years this scenario has changed
because of advancements in laboratory medicine and testing
profiles. The site of testing kept on going farther and farther
away from the patient, in the form of a central laboratory
catering to the entire hospital. With the development of
reliable methods of measuring blood gases and pH in the
early 1960s, these measurements became an essential guide
for managing critically ill patients. At the beginning, these
tests were limited to only cardiorespiratory laboratories in
conjunction with respiratory functions and cardiac
catheterization. Later, these gained popularity with critical
care centers and operation rooms because of faster and
easy availability of results.
Now technologic advancement characterised by
microchemistry, microcomputerization, miniaturization and
non invasive testing has revolutionized the concept of present
day laboratories. Point-of-care testing first became a
necessity when rapid changes during liver transplant protocols
demanded immediate knowledge of levels of ionized calcium.3
Along with these, the economically driven need to shorten
length of hospital stay, reduce hospital costs, and manage
scarce resources has prompted health care providers to
implement POC testing, without compromising patient
outcome. Biosensors and biosensor based methods, and
whole blood analysis have enabled a shift to immediate
diagnostic testing at the point-of-care.3-6
279
Types of POC testing 7-9
Initially, the critical care profile included whole
blood ionized calcium (Ca++) and electrolytes with blood
gases and hematocrit. Now biosensor based whole blood
measurements in critical care clusters include glucose,10
ionized magnesium,11 lactate,12 urea nitrogen, creatinine,
and CO2 content.13 Manufacturers are designing and
introducing unique new in vitro, ex vivo, and in vivo
systems14-16 - future problem solvers in the Point-of-care
paradigm. POCT has focused on various combinations of
the following testing profiles: blood gas analyses, critical
care electrolytes (sodium, potassium, chloride, glucose,
lactate, ionized calcium, ionized magnesium, blood urea
nitrogen, and creatinine), hematology variables (hemoglobin
and hematocrit), coagulation parameters (activated
clotting time [ACT], prothrombin time [PT], activated
partial thromboplastin time [aPTT]), and myocardial
markers (creatine kinase MB isoenzyme [CK-MB],
myoglobin, Troponin I and T). Additional analytes and
testing profile configurations are continuously under
development.
Fig. 2 : POC technology in ICU/ OR
Types of monitors for POCT
Point-of-care testing devices can be used in vitro, ex
vivo, or in vivo and include many options. The analyzer
traditionally has been defined by laboratory medicine as an
in vitro measurement device that requires the permanent
removal of blood, fluids, or tissue from the patient. A
monitor is defined as a measurement device that does not
require permanent removal of blood, fluid, or tissue from
the patient and can be invasive or non invasive. Figure 2
illustrates the POC modalities that are used in the OR and
the ICU.
A blood monitor can be used ex vivo or in vivo. Ex
vivo technologies use specimens that are drawn from the
patient and analyzed just outside of the body, with some
of them allowing the return of the specimens to the
280
patient (i.e., intra arterial catheter attached to an
analyzer17). In vivo technologies provide the opportunity to
measure pH, blood gases, electrolytes, lactate, and glucose
levels directly, using invasive sensors. In 1994 Inomata16
demonstrated the use of fibreoptic pulmonary catheters
to measure the SVO2 continuously and correlated this with
the cardiac output (CO) and in the same year Haller18
demonstrated the use of an intra arterial fibreoptic
sensor for continuous monitoring of PO2, PCO2 and pH.
Subcutaneous monitoring of glucose concentrations is
another example of in vivo biosensors whose clinical
relevance was shown by Fischer19 in 1994. Further, the use
of gastric intramucosal pH monitoring was studied by
Doglio20 as a prognostic index in critically ill patients.
Other examples of non invasive monitors include testing
exhaled air, urine and transcutaneous sampling. Some of
this technology is already available or is under development
(Figure 3).
Fig. 3 : Types of POC Testing
Potential advantages and disadvantages of POC testing
As evaluation of the risk benefit ratio of a particular
medication needs rigorous randomized placebo controlled
trials, it is very difficult to determine advantages vs
disadvantages of POC testing in such a trial. Inspite of
this, POC testing has been used in numerous studies and
certain advantages and disadvantages of POC testing
have been suggested. Reduction of Turn-Around Time (TAT)
is one the advantages that have been well documented.21
Often POC testing is performed by persons who may
not have the type of training that ensures quality control,
proper documentation of test results and proficiency
testing.
Various potential advantages and disadvantages are
listed in Table 2.
INDIAN JOURNAL OF ANAESTHESIA, AUGUST 2004
Table - 2 : Potential advantages and disadvantages.
Potential advantages Potential disadvantages
Decreased therapeutic turn around time Lack of adequate documentation
Rapid data availability Problems of training and competency
Increased real time patient management Poor analytic performance
Augmented clinical decision making Sample handling error
Decreased preanalytic error Postanalytic error (e.g., transcription
error or communication failure)
Decreased iatrogenic blood loss Increased costs
Fewer redundant blood tests Unauthorized testing
Test clustering Limited test menu
Integration with performance maps, No critical values notification system
algorithms, and care paths. and/or documentation
Decreased therapeutic Turn Around Time (TTAT)
Therapeutic Turn-Around Time (TTAT) is the time
between ordering the tests to the implementation of the
actions generated by the results. Salem21 and Fletcher,22
stated that there is considerable saving of time by the use
of bedside microchemistry instruments. POC testing can
facilitate patient care management by allowing for the
implementation of treatment decisions right away rather
than having to wait, sometimes for hours, for the results.
By the time the results are available, the condition of the
patient may be completely different from the situation that
prompted the ordering of the particular test.
With application of POC testing, order writing is
abbreviated or not even required, specimen transport is
minimized, and processing steps, TTAT is diminished.
Manual delivery of specimens and reporting intermediaries
are not required (Figure 4).
Fig. 4 : Flow chart showing decreased steps of POC testing in
comparison to traditional laboratory.
GUPTA, BHATTACHARYA : POINT OF CARE TESTING IN ANAESTH. AND ICU
Kost13 also observed that POC testing reduces the
TAT drastically and makes the reports available instantly.
In one of the studies, Fleisher23 showed that TAT was
comparable between Point-of-care testing and urgent care
centralized laboratory (UCL) equipped with fully automated
sample delivery system and reporting interface. But in other
laboratories that are not fully automated, there was no
difference in analytic TAT. But, the time delay was mainly
in transport of the sample. The decrease in the turn-around-
time (TAT) allows the treating anaesthesiologist to act
promptly by augmenting clinical decisions and altering the
treatment according to real time test results.
Blood conservation and fewer redundant tests
In the OR and the ICU, where frequent blood draws
are required for laboratory analysis, blood conservation is
an important priority.24,25 Physicians are familiar with the
dreaded call from the laboratory requesting more blood
because the amount sent was insufficient. Moreover, some
of the equipment (analyzers) used in central laboratory has
fixed menus for which minimum fixed sample size is
required. Present day microsample POC devices require
smaller blood samples for the same test menu. Usually the
plasma (after centrifugal separation) is analyzed in the
central laboratory in contrast to POC devices that use whole
blood. With ever decreasing blood sample requirements for
analysis, microsample POC devices can have a great impact
on blood conservation.21
In a central clinical laboratory, usually the test menu
is fixed for that apparatus and it will analyze a blood
sample for all the tests available under that menu whether
those were ordered or not. For example, for the haematocrit
the entire range of the CBC is processed by the machine.
Unfortunately, this advantage of using small sample
sizes does not always equal blood conservation. In practice
with the use of POC testing for blood gas and electrolyte
analysis, some individuals persist in the practice of collecting
sufficient blood for two or three samples “just in case the
cartridge fails or error on part of operator.”
Portability
Portability of the POC analyzers is another advantage.
This technology is especially useful in several situations,
including ambulance patient transfers, air transport (even
outer space), in remote areas, and rural areas, where the
cost even with the low volume of tests would prohibit a
traditional laboratory setting.
Reduction in preanalytic error
An advantage of POC testing is that it reduces the
risk of errors associated with handling, transport, labeling,
281
and delays in analyzing samples (i.e., preanalytic error)
that are associated with traditional laboratory testing.26
Personnel
The concept of POCT generally does away with
requirement of specially trained staff to run the equipment.
Although the anaesthesiologists acknowledge the advantages
of POC testing, they believe that having to perform these
tests themselves detracts from their ability to render direct
patient care and that this is an added responsibility that
they sometimes are reluctant to accept and would prefer be
left to laboratory personnel. On the other hand, laboratory
personnel and respiratory therapists (in the case of arterial
blood gases) may perceive POC testing as an invasion of
their duties and as a threat to their job security.27 Untrained
personnel as opposed to trained technicians operating in
central laboratories, operate POC devices present at bedside.
This can give rise to performance failure mainly due to
sample handling error.
Documentation
The results from POC devices usually are displayed
on a screen, with temporary printouts facility. The actions
generated from such results follow in an efficient way, but
how the results make their way into the permanent chart
is a concern. The results may get lost and never reach the
chart. This possibility not only poses a medicolegal issue
but also can affect reimbursement.
Data recording and transcription (Post analytic error)
Most of the time when reports are in printed format,
the results are not documented in the data management
system. And there can be post analytic errors during
transcription of data. The reports are usually not filed
properly and get displaced, making the data unavailable at
a later time for reference.
Unauthorized testing
This happens quite often with POC testing. Many of
the unauthorized tests are performed by physicians, for
personal use or for learning purposes. The best example of
this type testing is with the hand held glucometer.
Critical Care profiling (CCP)
A haemodynamically unstable patient loses
consciousness within ten seconds of O2 deprivation and
within six minutes permanent brain damage can result due
to drained creatine phosphate and adenosine triphosphate
(ATP) energy reserves. With the availability of bedside
multianalyzers, critical care profile (CCP) should suggest
whether tissues are receiving adequate oxygen or not, and
why the availability has been compromised. Figure 5
282
identifies a proposed CCP to assess sufficient fuel and
oxygen supply to support vital organs.
Fig. 5 : Figure identifies a proposed CCP to
assess sufficient fuel and oxygen to support vital organs
POC tests can be protocolized for specific clinical
need. These points can be better understood in the following
clinical situations.
Diabetes mellitus
We take the example of diabetes mellitus which is
the most common entity requiring multiple blood glucose
level estimations in a single day. Stress hyperglycaemia
and diabetes mellitus are commonly found among critically
ill adults.28,29,30
Ellison31 reported a rise in blood glucose levels from
144 to 774 mgdl-1 in 95 minutes during surgery. Much
milder elevations of blood glucose levels threatens vital
tissues if oxygenation is inadequate.32 Maintaining adequate
but not excessive glucose levels in the critically ill patients
makes blood glucose levels an important candidate for critical
care profile (CCP).
Malmberg30 reported that glycaemic control among
such individuals may reduce long term morbidity and
mortality. Frequent venous sampling or arterial blood glucose
monitoring may add to the growing problem of iatrogenic
blood loss and anaemia among ICU patients, as well as
delay in clinical decision making because of a long turnaround
time.24 One solution to this problem is adoption of bed side
glucometry, an accepted method for estimating blood glucose
levels in ambulatory and hospital ward patients.33,34
Electrolyte imbalance
Critically ill patients and those undergoing major
surgical procedures have a tendency towards abnormality
in the concentration of potassium and calcium, pre-existing
or iatrogenic e.g. decrease in potassium level in a
hyperventilating patient, where a normal value for potassium
may be low for that pH.
In kidney transplantation and liver transplantation,
there can be major shifts of potassium and calcium levels
during the course of surgery. Electrolyte imbalance may
also be present preoperatively,35-37 e.g. hyperkalaemia in
INDIAN JOURNAL OF ANAESTHESIA, AUGUST 2004
end stage renal disease patients. Infusion of large volumes
of fluid can change plasma matrices. Transfusion of large
amounts of citrated blood and blood components leads to
calcium binding and a decrease in ionic calcium in liver
transplantation.
In the ICU setting, hypocalcaemia can occur in
patients of sepsis, renal or cardiac disease, pancreatitis or
after major surgery.38 Since such patients are often transfused
citrated blood components, monitoring of ionized calcium
becomes mandatory. Measurements done at the bedside will
ensure early intervention.
Hypoxia
Lactate is the only blood marker whose presence
generally means that the tissues are receiving inadequate
oxygen. Lactate is the end product of the anaerobic
metabolism of glucose and is clinically sensitive to global
and to some extent regional hypoxia. In addition to hypoxia,
the degree of lactate elevation may reflect any of the
following: inadequate lactate metabolism as a result of a
severely compromised liver, the concentration of glucose
during hypoxia,39 the cause of hypoxia (sepsis, exercise,
seizure, acute myocardial infarction, and so forth),40
treatment with lactated Ringer’s solution, or sudden release
of pent up lactate as perfusion is restored. Most of the
blood gas measuring equipments currently available
incorporate serum lactate estimation facility.
Blood gas analysis and haematocrit
Arterial blood gas analysis and haematocrit are the
most common tests ordered in ICU and operating room
settings. Immediate results are of prime importance in such
situations because correction of pH, PO2, and electrolyte
derangements in an early phase of disease can alter the
outcome of the patient.41
Monitoring gas exchange at the lung level can
help predict adequacy of ventilation and perfusion. PaO2
appears to be the most sensitive parameter of the adequacy
of diffusion of oxygen across the lung.41 Haematocrit or
haemoglobin concentration provides a measure of oxygen
transport capability.
So a bedside monitor providing the above tests will
be able to produce stat results with a small blood sample
and corrective steps can be taken immediately.
Coagulation disorder
The number of surgical patients receiving
anticoagulant therapy is on the rise. Patients undergoing
major surgery receive large volumes of fluid and blood
leading to problems of coagulation. The use of nonspecific
GUPTA, BHATTACHARYA : POINT OF CARE TESTING IN ANAESTH. AND ICU
haemostasis monitoring may not clarify whether or not
patients should receive blood versus blood products. Cardiac
anaesthesiologists were quick to recognize the problem and
instituted point-of-care testing facilities in the OR for
haemostasis monitoring.42 Success of broad intra-operative
coagulation assessment requires techniques combining
accuracy and consistency of measurement comparable to
laboratory systems with device characteristics that maintain
feasibility for bedside use.
Traditional methods of monitoring coagulation
like the bleeding time, activated clotting time (ACT),
prothrombin time (PT), activated partial thromboplastin
time (aPTT), platelet count, fibrinogen, and fibrinogen
degradation products, have no or minimal predictive power
for perioperative bleeding. And, moreover, these tests are
time consuming and require expertise in obtaining samples
to get accurate results.
Thromboelastography (TEG), a POC device, does
appear to accurately predict peroperative/postoperative
bleeding and, therefore, may have value in targeting
coagulation treatment.42 Currently there are two viscoelastic
coagulation monitoring devices, TEG and Sonoclot (SCT).43
These monitoring devices provide information regarding
the entire clotting system including platelet dysfunction
and fibrinolysis.
The promptness of viscoelastic results are because
of use of whole blood instead of separation of cellular and
acellular components as is the case with traditional
coagulation tests. The rapid growth in TEG and SCT
investigations provides evidence that these devices are filling
a unique need for POC testing.
Figure 6 illustrates a proposed critical care profile
in a case of end stage renal disease (ESRD) for kidney
transplantation.
Fig. 6 : Typical critical care profile (CCP) for patient undergoing kidney
transplantation (End-stage renal disease ESRD, kidney transplantation KTP,
Random blood sugar RBS, haematocrit Hct.)
283
Future developments in poct analyzers and monitors
Point-of-care testing (POCT) is a major force in the
future evolution of hospital care, with prospects for even
greater expansion of accessibility, speed, and also, hopefully,
accuracy of results. POCT test menus will continue to expand,
with more coagulation testing, chemistries, and infectious
screening, but also on site drug screening, intra-operative
hormone levels, and microchip DNA diagnostics. Non
invasive POCT will expand beyond the GlucoWatch glucose
monitor and the Bilichek noninvasive bilirubin monitor to
noninvasive CBCs and Pap smears.44
Technology improvements
POCT analyzers already have been miniaturized from
large, bulky, bench top units to very small lightweight,
disposable, hand held devices. Microchip, biochip, and
nanochip technology45,46 may allow bedside testing for
analytes, microorganisms, or genetic analysis. Techniques
are being developed for the insertion and monitoring of
microchips within human tissues and organs.
Advances in compact disc (CD-ROM) technology
also are progressing to “labs on a CD”. The CDs could be
read at the ICU bedside using standard or customized optical
readers.46
Modular design
During the last decade, there has been increasing
stress on modular design of monitors so as to incorporate
stand alone bed side devices into single platform. Devices
like pulse oximeters, non invasive blood pressure,
capnograph, and cardiac output machines have been converted
into modules that are inserted into the modular racks of the
bedside physiologic monitor. This modular conversion
conserves space at the bedside and consolidates all devices
into one networked platform that provides data display and
management, and facilitates biomedical maintenance and
general product support.48
A generic POCT modular rack with a universal
interface that connects to all physiologic monitoring systems/
networks could be constructed. Such a rack would house a
variety of POCT modules and the user could select the
modules most needed to address specific clinical situations.
POCT modular analyzers could function with single or
multiuse cartridges which would be disposable. Finally,
stand alone POCT devices may interface with the monitoring
system through a generic POCT data recipient module or
directly through a port to the bedside monitor or to the
monitoring system network.
284
Sample procurement invasive
Research programs in diabetes management are
developing innovative methods of procuring and measuring
samples for glucose analysis that may become applicable
to critical care POCT. The first technique approaches the
intermittent or continuous acquisition of capillary bed or
interstitial samples with laser microporation. Reverse
iontophoresis, a second sampling technology, relies on the
application of a minielectric current to the intact skin to
cause glucose from the interstitial fluid to raise though the
epidermis. A third approach being studied is the insertion
of an indwelling subcutaneous glucose sensor.
Analyte and vasculature assessment - non invasive
Pulse oximetry is the standard at every bedside ICU
for continuous determination of oxygen saturation. Other
analytes possibly could be assessed through “imetry.”
Bilirubin is currently evaluated by neonatal spectroscopy.
In addition to non invasive spectroscopic assessment of
analytes, the microcirculation may be non invasively
evaluated using orthogonal polarization spectral imaging.48
POCT informatics : Data management and
connectivity
Connectivity for POCT devices has evolved from
point-of-service workstations to standardized POCT data
transmission protocols to remote roaming wireless connectivity
with automatic data capture. Patient results must be available
to health care providers using the laboratory/hospital
information system (L/HIS) and transmitted to the electronic
medical record. In the central laboratory the interface and
management of data have been nearly perfected. Ideally,
laboratory devices wherever they are based or used,
including POCT devices, should be managed and interfaced
in a manner similar to those of the central laboratory.49,50,51
Data management
The dispersion of POCT devices throughout the
hospital and critical care environment creates unique
challenges for data management. These problems stem
from the use of POCT devices of various designs and
technologies in multiple sites by a host of personnel with
minimal training and perspective in standard laboratory
practice.49 To address these issues Data Management
System (DMS) would require “smart” software programmed
with artificial intelligence and algorithms that are designed
to identify and expediently communicate device and
data deviations to the local device user, the local DMS
manager, or preferentially to centrally based laboratory.
Such communications would require that the next
generation of POCT data management systems include
real time bidirectional connectivity and broad based, robust
communication support.
INDIAN JOURNAL OF ANAESTHESIA, AUGUST 2004
Connectivity
POCT connectivity developments have focused on
three levels of interface and information transfer, starting
with interfacing POCT devices with the users, connectivity
expands into consolidating all devices on to one platform
and finally networking it to a DMS, L/HIS.
Summary
Interest in the paradigm of Point-of-care testing has
increased in recent years. By providing faster turnaround
time, the clinician can rapidly respond to changes in the patient’s
status, theoretically resulting in optimized treatment and shorter,
less expensive hospitalizations.52 Analysis in point-of-care
testing is no longer performed exclusively by skilled medical
technologists but also by multiskilled personnel including
anaesthesiologists, nursing staff, respiratory therapist,
emergency medical staff, physicians, and other medical staff.27,53
With rapid advances in technology, POC testing is
a dynamic work in progress; the analyzers are becoming
smaller, faster, and more user friendly and have been
demonstrated to achieve accuracy with increasingly smaller
blood samples, aiding in blood conservation.
POCT has focused on various combinations of the
following testing profiles: from blood gas analyses, critical
care electrolytes to hematology variables, coagulation
parameters, and myocardial markers. The anaesthesiologist
and every critical care therapist must decide which bedside
test or cluster of tests are indicated for their given patient
population. To determine this, other factors must be
considered, including advantages and disadvantages, analysis
of test accuracy, clinical impact, and cost benefit ratio. A
recent editorial by Jahn,54 put forward recommendations for
the implementation of near patient testing. He suggested a
strong multidisciplinary and interdepartmental team approach
is necessary to ensure cost effectiveness, better analytic
performance, reliability, comparability, and quality control.
The transfer of blood gas and other blood
measurements germane to the critically ill from the
laboratory to the ICU/OR should have profound effect on
critical care as did the introduction of laboratory based
blood gas analyzers more than 40 years ago.
Acknowledgements
We gratefully acknowledge Dr. Chand Sahai,
associate consultant of our department, for providing help
in preparation of this manuscript.
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