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    Arterial Blood Gas Analysis: Dr. Rakesh Chandra Chaurasia PG3 Ims, Bhu Moderator Dr. Yashpal

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    Armaanjeet Singh
    The document discusses arterial blood gas analysis and summarizes key points about assessing alveolar ventilation, oxygenation, and acid-base balance from an ABG test. It covers normal and abnormal pO2, pCO2, and bicarbonate levels and analyzing primary versus mixed acid-base disorders. Steps for interpreting an ABG result including evaluating pH, pCO2, HCO3, and anion gap are outlined. Reasons for ABG sampling and potential sources of error are also mentioned.

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    Arterial Blood Gas Analysis: Dr. Rakesh Chandra Chaurasia PG3 Ims, Bhu Moderator Dr. Yashpal

    Uploaded by

    Armaanjeet Singh
    28 views34 pages
    The document discusses arterial blood gas analysis and summarizes key points about assessing alveolar ventilation, oxygenation, and acid-base balance from an ABG test. It covers normal and abnormal pO2, pCO2, and bicarbonate levels and analyzing primary versus mixed acid-base disorders. Steps for interpreting an ABG result including evaluating pH, pCO2, HCO3, and anion gap are outlined. Reasons for ABG sampling and potential sources of error are also mentioned.

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    The document discusses arterial blood gas analysis and summarizes key points about assessing alveolar ventilation, oxygenation, and acid-base balance from an ABG test. It covers normal and abnormal pO2, pCO2, and bicarbonate levels and analyzing primary versus mixed acid-base disorders. Steps for interpreting an ABG result including evaluating pH, pCO2, HCO3, and anion gap are outlined. Reasons for ABG sampling and potential sources of error are also mentioned.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    28 views34 pages

    Arterial Blood Gas Analysis: Dr. Rakesh Chandra Chaurasia PG3 Ims, Bhu Moderator Dr. Yashpal

    Uploaded by

    Armaanjeet Singh
    The document discusses arterial blood gas analysis and summarizes key points about assessing alveolar ventilation, oxygenation, and acid-base balance from an ABG test. It covers normal and abnormal pO2, pCO2, and bicarbonate levels and analyzing primary versus mixed acid-base disorders. Steps for interpreting an ABG result including evaluating pH, pCO2, HCO3, and anion gap are outlined. Reasons for ABG sampling and potential sources of error are also mentioned.

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    Arterial Blood Gas

    Analysis
    Dr. Rakesh Chandra Chaurasia
    PG3
    IMS, BHU
    Moderator Dr. Yashpal.
    Arterial Blood Gas Analysis
    • Basic physiological processes reflected in ABG are:

     Alveolar ventilations,

     Oxygenation and

     Acid base balance.


    Alveolar ventilations
    • VA = VCO2 / pCO2 * K

    • The alveolar ventilation is that portion of total ventilation that


    participates in gas exchange with pulmonary blood.

    • Thus PaCO2 is the best index for assessment of alveolar ventilation.

    • High PaCO2 (> 45 mm Hg) indicates alveolar hypoventilation and


    low PaCO2 (< 35 mm Hg) implies alveolar hyperventilation.
    Breathing pattern’s effect on PaCO2 :
    PaCO2 level is dependent on Va.
    Patient Vt * f = Ve Description

    A 400 ml* 20/ min = 8 L / min. Slow and deep

    B 200 ml * 40/ min = 8 L / min. Rapid and shallow

    Patient (Vt – vd ) * f = Va Description

    A 400 - 150) * 20 = 5 L / min Slow and deep

    B (200 – 150)* 40 = 2 L / min Rapid and shallow


    Oxygenation assessment
    • How much oxygen is in the arterial blood

     PaO2, SaO2, CaO2

    • Alveolar- arterial O2 tension deference,

    • PaO2/ FiO2 ratio .


    • Determinants of PaO2 are
     Age. ( as age increases the expected PaO2 decrease)
    Expected PaO2 = (104 – Age/3 )
    Patm

     FiO2 ( as FiO2 increased the expected PaO2 increase)


    Alveolar gas equestrian PAO2 = {( Patm- PH2o )FiO2-
    (PaCO2/0.8)}
    Types PaO2 range

    Hypoxemia
    Normal 80 – 100 mm of Hg

    Mild 60 – 80 mm of Hg

    Moderate 40 – 60 mm of Hg

    Severe < 40 mm of Hg
    Alveolar- Arterial O2 gradient
    P(A-a)O2 is alveolar arterial difference in partial pressure of
    oxygen.

     PAO2 = {( Patm- PH2o )FiO2-(PaCO2/0.8)}

     Normal range is 5 – 25 mm of Hg (increase with age)

     Increased P(A-a)O2 indicate parenchyma damages.


    PaO2/ FiO2 ratio
    • Inspired room air FiO2 = 21% , PiO2 = 150 mm of Hg

    • PAO2 = 100 mm of Hg

    • PaO2= 90 mm of Hg.
    Berlin criteria for ARDS severity
    PaO2/ FiO2 ratio Inference • Acute onset ( within 1 week)
    • Bilateral radiographic
    200 - 300 Mild
    pulmonary infiltration,
    • Respiratory failure not fully
    200 - 100 Moderate
    explained by heart failure or
    volume overload
    < 100 Severe
    • PiO2/FiO2 < 300.
    Acid Base status
    • Sorensen formula pH = - log[H+ ]
    • [H+] = 40 nEq/L at pH 7.4
    Different methods of analyzing acid base
    disorders
     Classic or traditional approach.

    o Bicarbonate based approach essentially revolves around the Henderson Hesselbach formula

    o pH = pK + [log (HCO)/PaCO]

    o Based on this approach acid base disorders are classifed into 6 primary disorders

    o Metabolic acidosis ( High anion gap/ Normal anion gap)


    o Metabolic alkalosis
    o Acute and chronic respiratory acidosis
    o Acute and chronic respiratory alkalosis.
    Bicarbonate Buffer system
    CO2 + H2O Carbonic anhydrase H2 CO3 H+ + HCO3 -

    • Acids during acidosis use HCO3 -

    H+ + HCO3 - H2 CO3. CO2 + H2O

    • Alkali during alkalosis use H2 CO3 .

    Alkali + H2 CO3 H+ + HCO3 -


    Renal regulation of acid base balance
    •1
     Stewart approach

    Parameters Acidosis Alkalosis

    Respiratory PCO2 PCO2

    Non respiratory (
    metabolic)
    SID Abnormal SID SID SID

    Anion excess SID Lactate

    Atot ( non volatile Albumin


    weak acids)
    Inorganic phosphate
    • SID apparent SIDa= (Na+k+Ca+Mg)–(Cl) –Lactate-other strong ions

    • (Na + k + Ca + Mg) – (Cl) Normal strong ion difference is about 40 mEq/L

    • SID effective SIDe = (HCO3) + (A–) where A– is the total concentration of dissociated weak
    noncarbonic acids, mainly albumin and PO4-

    • Strong ion gap (SIG) or Atot = SIDa- SIDe.

    • Normal Strong ion gap is zero.

    • Atot represents all non bicarbonate buffer pairs primarily albumin, inorganic phosphate,
    hemoglobin.

    • Atot= [HA] + [A–]


    Abnormal values
    • pH < 7.35 • paCO2 < 35 mm of Hg
    Acidosis ( Respiratory/ Respiratory alkalosis
    Metabolic)
    • pH > 7.45 • HCO3- < 22 mEq/L
    Alkalosis (Respiratory/
    Metabolic) Metabolic acidosis
    • HCO3- > 26 mEq/L
    • paCO2 >45 mm of Hg Metabolic alkalosis
    Respiratory acidosis
    Simple Acid Base Disorders
    • A single primary process of acidosis or alkalosis with or without
    compensation.
    •
    Characteristics of 10 acid base disorders
    Mixed acid base disorders
    • Presence of more than one acid base disorders simultaneously
    • Clue for mixed disorders are:
     PCO2 and HCO3 are in opposite directions.

     Normal pH for abnormal pCO2 and HCO3.

     pH change in opposite direction for known primary disorders.


    Anion gap
     AG = Na+ - Cl- - HCO3-

     Normal value is 14+/- 2 mEq/ L

     This is due to unmeasured anions.


    These are
    albumins, phosphate, sulphate , organic acids.
    .
    • Cause of increase AG • Cause of normal AG
     Lactic acidosis Diarrhoea
     Ketoacidosis Renal tubular acidosis
     Chronic renal failure Additions disease
     Methanol poisonings Carbonic anhdrase inhibitors
     Ethelene glycol poisonings
     Starvation
    Step by step analysis of ABG
    Look PaO2 < 80 mm of Hg and O2 saturation < 90% for
    hypoxemia.

    Look at pH
     < 7.35 acidosis
     > 7.45 alkalosis
     7.35 – 7.45. Normal/ mixed acid base disorder.
    Continue
    Look at pCO2
     > 45 mm of Hg ( acidosis)
     < 35 mm of Hg ( alkalosis)

     Look at HCO3-
     < 22 mEq/L ( acidosis )
     > 26 mEq/L (alkalosis)
    Continue
    Determine primary acid base disorder
    Match either pCO2 or HCO3- with pH.
     Look for Compensation
    Are the PCO2 and HCO3- in opposite side.
    Is the compensation adequate??
    Metabolic disorder. Calculate PCO2 expected
    If PCO2 measured # PCO2 expected than there is mixed
    disorder.
    Continue
    • Respiratory disorder. Calculate expected HCO3-
    If measured HCO3- # expected HCO3- than mixed disorder
    present.
     Calculate anion gap….. If it is more , there is metabolic acidosis

     Does the AG explain the change in HCO3- ?


    Calculate Delta gap
    (Rule out coexistence of two or more acid base disorders)
    ABG Sampling
    • Application of ABG
    • To document respiratory failure and assess its severity
    • To monitor patient on ventilator and assist in weaning
    • To assess acid base disorders in critical illness
    • To assess response to therapeutic intervention and mechanical
    ventilation
    • To assess pre op patients.
    Continue
    • Arterial puncture site
    • Allen’s test
    • Sampling error
    Due to Heparin
    Due to air mixing
    Due to size of syringes
    Due to body temperature
    Due to leukocytosis and thrombocytosis

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