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Disorders of acid-base balance can lead to severe complications in many disease states, and occasionally the abnormality may be so severe as to become a life-threatening risk factor. The process of analysis and monitoring of arterial blood gas (ABG) is an essential part of diagnosing and managing the oxygenation status and acid-base balance of the...
Citations
... introduction Arterial blood gas (ABG) interpretation plays an indispensable role in emergency medicine and intensive care patients yet its interpretation is challenging. 1 Bicarbonate is highly influenced by pCO 2 values and it is rectified by standard bicarbonate (Std HCO 3 ) which is the plasma bicarbonate concentration from blood equilibrated with pCO 2 of 40 mm Hg. [2][3][4][5] The hydrogen ion concentration calculated using Std HCO 3 is known as the nonrespiratory hydrogen ion concentration (NRH + ) and it denotes the hydrogen ion concentration at non-respiratory pH (NRpH). 6,7 The net changes in blood pH reflect the sum total alterations in the hydrogen ion concentration in the blood. ...
... The Boston method (six rules) using bicarbonate also known as six bicarbonate-based bed side rules are more commonly utilized in clinical practice. 1,10,11 The calculated expected values for either pCO 2 or HCO 3 − was denoted as Exp pCO 2 or Exp HCO 3 , respectively. The actual values given in the ABG report data were simply denoted as pCO 2 or HCO 3 in the compensation rules. ...
... Bicarbonate is a highly variable quantity not only influenced by pCO 2 but also by individual metabolic components. 1,12 In the traditional approach, the pH (no unit) is compared with the pCO 2 (unit is mm Hg), HCO 3 − (unit is mmol/L) and standard base excess (unit is mmol/L) and all of their units are different. Many patients in critically ill situation presents with different pH, pCO 2 , and HCO 3 − values, so it makes an ABG interpretation an arduous task that poses a stress especially on the junior medical staffs. ...
Background
Arterial blood gas (ABG) interpretation plays an indispensable role in health care. The total changes in hydrogen ion concentration or actual pH are due to both the changes in respiratory and non-respiratory (metabolic) components affecting the hydrogen ion concentration or pH in the acid–base homeostasis. Using this concept, an innovative ABG interpretation method was developed and published by the current author. The aim of this study is to apply the compensation rules and to develop a stepwise approach in this novel method to interpret various acid–base disorders.
Methods
The total change in pH (ΔpH), non-respiratory hydrogen ion concentration (NRH⁺), changes in non-respiratory pH (ΔNRpH), and respiratory change in pH (ΔRpH) were calculated for 232 ABG samples. The expected pCO2 (Exp pCO2) or expected bicarbonate (Exp HCO3⁻) values were calculated using the compensation rules and compared with their actual given values.
Results
Few acid–base disorder cases were shown as examples comparing the physiological, standard base excess (Std BE) and parameters such as ΔpH, ΔRpH, and ΔNRpH values of novel ABG interpretation method which change in different acid–base disorders.
Conclusion
The stepwise approach in this novel method appears to be much user-friendly providing interpretation of various acid–base disorders easily and quickly.
Clinical significance
This innovative method may help to overcome the challenging task of ABG interpretation.
How to cite this article
Samuel R. Application of Boston Compensation Rules in the Development of a Stepwise Approach for Novel Diagnostic Arterial Blood Gas Interpretation Method. Indian J Crit Care Med 2023;27(10):717–723.
... The threshold values of 15 mg/L for CRP, 2 ng/ml for PCT, − 10 mEq/L for blood gas BE were accepted according to EMA sepsis scoring, previous studies, and the limit values used by our hospital 4,7 . Threshold values of 2 and 4 mMol/L for lactate measures were determined relying on previous studies [8][9][10] . ...
Early-onset sepsis (EOS) is one of the leading causes of neonatal death and morbidity worldwide and timely initiation of antibiotic therapy is, therefore, of paramount importance. This study aimed to evaluate the predictive effect of lactate and base excess (BE) values in the cord arterial blood gas and the 6th hour of life venous blood gas analysis on clinical sepsis in newborns. This is a cohort case–control study. In this study, 104 cases were divided into clinical and suspected sepsis groups according to the evaluation at the 24th hour after delivery. Lactate and BE values were evaluated in the cord arterial blood gas analysis (ABGA) and at the postnatal 6th-hour venous blood gas. The cord ABGA and postnatal 6th-hour results were compared in the clinical and suspected sepsis groups. Clinical sepsis was found to be associated with a lactate value above 2 mMol/L at postnatal 6th-hour venous blood gas (p = 0.041). This association was the highest when the clinical sepsis group's postnatal 6th-hour lactate cut-off value was determined as 3.38 mMol/L (sensitivity 57.9% and specificity 68.5%) (p = 0.032). However, no association was found between clinical sepsis diagnosis and venous BE's value in cord ABGA at the postnatal 6th hour. We found that a venous lactate value above 3.38 mMol/L at the postnatal 6th hour was the cut-off value that could indicate early-onset clinical sepsis. However, none of the biomarkers used in diagnosing EOS can accurately show all cases.
... The pH is the result of acid-base balance 16 . Fetal acidemia in the umbilical cord has an umbilical artery pH cutoff value < 7.20 regardless of gestational age 17,18 . ...
Background:
Acute fetal distress (AFD) is a condition that requires timely diagnosis because it generates hypoxia, acidosis, and even intrauterine death. This study aimed to determine lactate and pH values in the umbilical cord in full-term newborns (NBs) with a history of AFD.
Methods:
We conducted a cross-sectional study in full-term NBs of mothers with at least one perinatal, neonatal, or gasometric AFD antecedent. Neonatal morbidity was considered: if 1-min Apgar ≤ 6, or advanced neonatal maneuvers, or neonatal intensive care unit (NICU) admissions were necessary. The cutoff points were lactate > 4mmol/L and pH < 7.2.
Results:
Of 66 NBs, 33.3% of mothers presented at least one antecedent for developing AFD; 22.7% presented hypertensive pregnancy disease, 13.6% oligohydramnios, and 63.6% other factors. Perinatally, 28.7% required advanced neonatal resuscitation maneuvers and 7.5% admission to the NICU. In the gasometry, the lactate and pH values for the neonatal morbidity of the NBs' group were 4.726 ± 1.401 and 7.293 ± 0.056, respectively, versus 2.240 ± 0.318 and 7.359 ± 0.022 (p < 0.05) for the group without associated neonatal morbidity.
Conclusions:
Lactate values in the umbilical cord increased by 25%, and pH decreased by one percent in NBs with a history of AFD and associated morbidity.
... Arterial blood gas analysis (ABGA) may provide useful diagnostic and prognostic information about patients [9]. Moreover, the results of point-of-care testing (POCT) can be quickly obtained. ...
Arterial blood gas analysis (ABGA) is one of the few tests performed during cardiopulmonary resuscitation (CPR). There have been some studies on the prediction of survival outcomes in adult out-of-hospital cardiac arrest (OHCA) patients during CPR using ABGA results. However, in pediatric OHCA patients, the prognosis of survival outcome based on ABGA results during CPR remains unclear. We retrospectively analyzed prospectively collected data from the Korean Cardiac Arrest Resuscitation Consortium (KoCARC) registry, a multicenter OHCA registry of Republic of Korea. We analyzed 108 pediatric (age < 19 years) OHCA patients between October 2015 and June 2022. Using multivariable logistic regression, an adjusted odds ratio (aOR) was obtained to validate the ABGA results of survival to hospital admission and survival to discharge. The variables associated with survival to hospital admission were non-comorbidities (aOR 3.03, 95% confidence interval (CI) 1.22–7.53, p = 0.017) and PaO2 > 45.750 mmHg (aOR 2.69, 95% CI 1.13–6.42, p = 0.026). There was no variable that was statistically significant association with survival to discharge. PaO2 > 47.750 mmHg and non-comorbidities may serve as an independent prognostic factor for survival to hospital admission in pediatric OHCA patients. However, the number of cases analyzed in our study was relatively small, and there have been few studies investigating the association between ABGA results during CPR and the survival outcome of pediatric OHCA patients. Therefore, further large-scale studies are needed.
... Hematological parameters are important physiological indicators for animals, and blood biochemical studies are important for assessing the health and physiological state of organs in animals. Blood gas analysis can provide valuable information about the cardiopulmonary and acid-base status of a critically ill veterinary patient [23,24]. Several studies have evaluated the hematological and serum biochemical parameters in the Sunda pangolin and Chinese pangolin from various regions of the world [14,16,17,25,26], but blood gas analysis results from these two pangolin species have not been reported. ...
Venous blood gas analytes are commonly examined in animals, and the results may be important when evaluating the overall health status of an animal. Pangolins are critically endangered mammals, and there is limited information on their physiological reference values in the literature. The aim of this study was to analyze venous blood gas and biochemical parameters before and during isoflurane anesthesia in wild healthy Sunda and Chinese pangolins. The results obtained showed that the blood gas index trends of the two pangolin species before and after isoflurane anesthesia were the same. After anesthesia, the partial pressure of carbon dioxide (pCO2), partial pressure of oxygen (pO2), total carbon dioxide (CO2), mean blood bicarbonate (HCO3−), extracellular fluid compartment (BEecf) base excess and the mean blood glucose (Glu) levels of both pangolin species showed a significant increase compared to the pre-anesthesia period. In contrast, the mean blood potassium (K+), lactate (Lac) and mean blood pH levels were significantly lower. No significant differences in the mean blood sodium (Na+) or blood ionized calcium (iCa) levels were observed during anesthesia. This study is important for future comparisons and understanding the health status of this endangered species.
... Our primary findings were (I) using both lung U/S and echocardiography early performed significantly better than standard care (examination, chest x-ray, and standard labs) to detect the aetiology of ARF in ICU; and (ii) using them early alter the primary diagnosis significantly in patients have Acute respiratory distress. Only 17% of the 50 patients with ARF included in our study had the correct initial etiological diagnosis, while LUS and TTE tests 6,15,16 When patients with chronic kidney disease (CKD), acute kidney injury (AKI), and chronic cardiomyopathy (CML) were examined separately, the early combined LUS and TTE technique showed greater diagnosis accuracy in all three patient groups (P value 0.015, 0.00, and 0.011). Comparable sensitivity and specificity to those reported in earlier research employing CPUS for identification the cause of ARF in ICU were observed. ...
... BG's are an indication of ventilation, gas exchange and acid-base status of blood, where blood is collected either from an arterial or venous blood supply. [12][13][14][15][16] Chest radiographic X-ray provides an image, which allows physicians to perceive structure and morphology of diaphragm. It clearly demonstrates the elevation of diaphragm. ...
Objectives:
Diaphragm is dome-shaped fibro-muscular assembly, composed of central tendon surrounded by peripheral muscle fibers. It plays a significant role in respiration and maintenance of lumber spine stability. Any condition that interferes with diaphragmatic innervation, contractile muscle function or mechanical coupling to chest wall can cause diaphragm dysfunction; which is usually manifests as elevation at chest radiography. Functional imaging with M-mode ultrasonography has been used in assessment of diaphragm kinetics in a variety of normal and pathological conditions. In this study, we evaluate the departmental ultrasound accuracy in diaphragm motion assessment and compare its results with other institutional parameters.
Methods:
We retrospectively reviewed the recorded laboratory investigation and chest radiograph of 163 pediatric patients. A total of 131 patients met clinical inclusion criteria for our study, patients under age of 14 years having clinical suspicion of diaphragmatic dysfunction. Patients having neuromuscular blockers, surgical plication, and phrenic nerve pacing were excluded. The mean age was 1.6 (SD 2.6) years and there were 44.3% of male and 55.7% of female patients.
Results:
The data demonstrated that ultrasonography is a highly sensitive and specific diagnostic tool compared to X-ray and laboratory investigation and clinical suspicion. The second-best results were obtained by X-ray and less accurate results were obtained by laboratory investigation.
Conclusion:
In proper sonographic technique; diaphragmatic ultrasound appears to be a valid and reliable diagnostic too; for diaphragmatic dysfunction. Diaphragm ultrasound may act as an imaging tool guiding rehabilitation success in diaphragmatic dysfunction cases.
... Arterial blood gas analysis (ABG) is essential to diagnose a patient's oxygenation level and acid-base balance in metabolic or respiratory syndrome. It utilizes three approaches for acid-base physiology vis-à-vis HCO3levels, standard base excess, and the strong ion difference [5]. The metabolic and oxygenation parameters define clinical paradigms such as respiratory acidosis or alkalosis. ...
... The consistency of the ABG report is important and can be determined by using the Henderson equation, which is given by [5]: ...
... 8 pH is the result of the balance between lactate, which tends to lower the pH, and BE, which stabilizes it. 9 Cord ABGA is necessary for evaluating neonatal acidemia but is not generally recommended for every delivery. However, routine cord ABGA is recommended for all high-risk deliveries. ...
... It has been shown that pH is the most important parameter to show the acidemia status in cord blood gas and it is a result of the balance between lactate and BE from other parameters. 9,16 Similarly, our results showed that pH, one of the cord ABGA parameters, is important to demonstrate mild acidemia. While the 1-minute Apgar score does not provide much information about the newborn's long and shortterm outcomes, the 5-minute Apgar score is more valuable. ...
Objective:
This study aimed to evaluate the necessity of cord arterial blood gas analysis in cases without fetal distress and normal Apgar score.
Materials and methods:
The cord arterial blood gas analysis and the 1- and 5-minute Apgar scores data of 1438 cases were evaluated. Newborns with fetal distress, neonates requiring cardiopulmonary resuscitation in the delivery room, congenital anomalies, severe and moderate acidemia (pH ≤7.1 at cord arterial blood gas analysis), and pre- and post-term newborns are excluded. Following cord arterial blood gas analysis, threshold values were accepted as abnormal pH <7.2, base excess ≥ -6 mmol/L, lactate ≥ 5 mmol/L, bicarbonate < 18 mmol/L, and partial pressure of carbon dioxide ≥ 50 mmHg. We evaluated the correlation between cord arterial blood gas analysis and 1- and 5-minute Apgar scores.
Results:
There was a significant correlation between both 1- and 5-minute Apgar scores and cord arterial blood gas analysis values such as pH, lactate, and partial pressure of carbon dioxide (P < .001). In addition, a significant correlation was found between the 5-minute Apgar score of <7 and some cord arterial blood gas analysis abnormal threshold values (pH, bicarbonate, base excess) (P < .001). We found that some patients with mild acidemia had 1- and 5-minute Apgar scores of ≥7 in 1.9% and 2% of cases, respectively.
Conclusion:
The 5-minute Apgar score of 7 or higher may not be sufficient to verify the wellbeing of a newborn. Relying only on the Apgar scores may create the risk of missing some newborns with mild metabolic acidosis. The necessity of routine cord arterial blood gas analysis should be considered in prospective studies even if there are no signs of fetal distress and Apgar score ≥7.
... It is advisable to undertake intermittent ABG analysis in ICU patients to determine the exact oxygenation status, especially in resource-constrained countries. 24,28 ...
