Using Blood Gases Dr. Jonathan R. Goodall M62 Coloproctology Meeting 2 nd April 2004.

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Presentation transcript:

Using Blood Gases Dr. Jonathan R. Goodall M62 Coloproctology Meeting 2 nd April 2004

JRG Hope Hospital April 2004

Teaching Grandma to suck eggs…

JRG Hope Hospital April 2004 Introduction  The necessary basics  Clinical examples of ABG use in ICU  Newer considerations in interpretation of acid-base disturbances

JRG Hope Hospital April 2004 The Basics - Normal Values  pH H nmol.l -1  pCO kPa  pO kPa  Actual HCO mmol.l -1  Standard HCO mmol.l -1  Base Excess +/- 2.0  SaO 2 ≥ 95 %

JRG Hope Hospital April 2004 The Basics - Interpretation Oxygenation  PaO 2  ? SaO 2 + Hb more important  Interpret only with knowledge of FiO 2

JRG Hope Hospital April 2004 The Basics - Interpretation Acid-Base Status  pH  pCO 2  HCO 3 (actual or standard)  Base Excess Oxygenation  PaO 2  SaO 2 + Hb more important?  Interpret only with knowledge of FiO 2

JRG Hope Hospital April 2004 H 2 O + CO 2 H 2 CO 3 H + + HCO 3 -

JRG Hope Hospital April 2004 H 2 O + CO 2 H 2 CO 3 H + + HCO 3 -

JRG Hope Hospital April 2004 The Basics - Standard Bicarbonate  The amount of bicarbonate that would be present if: PCO2 was 5.3 kPa Temp 37°C Blood fully oxygenated At sea level

JRG Hope Hospital April 2004 The Basics - Base Excess (Deficit)  The amount of base that needs to be added to or subtracted from each litre of blood (ecf) to return the pH to a value of 7.4 at: pCO2 5.3 kPa Temp 37°C

JRG Hope Hospital April 2004

Ivor Lewis Oesophagectomy  54 year old lady  No significant PMH  7 hour procedure  Initial post op period stable

JRG Hope Hospital April 2004

Date17/318/3 19/3 Time22:3008:0019:3010:45 FiO pH pCO pO BE

JRG Hope Hospital April 2004 Date17/318/3 19/3 Time22:3008:0019:3010:45 FiO pH pCO pO BE

JRG Hope Hospital April 2004 Date17/318/3 19/3 Time22:3008:0019:3010:45 FiO pH pCO pO BE

JRG Hope Hospital April 2004 Date17/318/3 19/3 Time22:3008:0019:3010:45 FiO pH pCO pO BE

JRG Hope Hospital April 2004

Date21/322/323/3 Time11:0019:4008:00 FiO pH pCO pO BE

JRG Hope Hospital April 2004

Cellulitis (?)  75 year old lady  Established atrial flutter  Admitted with spreading cellulitis right calf  Hypotension unresponsive to fluids (and dobutamine!)

JRG Hope Hospital April 2004

Initial ABGs Date31/3 Time02:1504:4008:50 FiO pH pCO pO BE

JRG Hope Hospital April 2004

Date31/3 Time02:1504:4008:50 FiO pH pCO pO BE

JRG Hope Hospital April 2004 Date31/3 Time02:1504:4008:50 FiO pH pCO pO BE

JRG Hope Hospital April 2004

Hyperchloraemic acidosis  Base deficit traditionally used as marker for metabolic acidosis  Appropriate fluid resuscitation should decrease base deficit  Chloride rich solutions (0.9% NaCl) can potentiate metabolic acidosis  If base deficit persists despite ‘adequate’ fluids in an otherwise well patient, check [Cl - ]!

JRG Hope Hospital April 2004 Summary  Arterial blood gases can be used to guide therapy  Must be interpreted in the light of the clinical setting  Look at acid–base disturbances, then oygenation with FiO 2  Remember the possibility that treatment may cause problems!

JRG Hope Hospital April 2004