Pulmonary embolism arterial blood gas analysis: Difference between revisions

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| [[Pulmonary embolism resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']]
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{{Pulmonary embolism}}
{{Pulmonary embolism}}
{{PE editors}}
'''Editor(s)-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com], {{ATI}}; {{AE}} {{Rim}}


'''''Synonyms and Keywords:''''' ABG
{{SK}} ABG


==Overview==
==Overview==
Routine laboratory tests including [[ABG|arterial blood gas]] analysis are non-specific in patients with acute pulmonary embolism; however, in cases of suspected PE they may be ordered to rule-out secondary causes. [[Hypoxemia]], [[hypocapnia]], increased [[Alveolar-arterial gradient|A-a gradient]] and [[respiratory alkalosis]] are common findings that may be observed in patients with PE.
[[Hypoxemia]], [[hypocapnia]], increased [[alveolar-arterial gradient]], and [[respiratory alkalosis]] are the typical findings that may be observed in patients with pulmonary embolism (PE).  The absence of the typical results of the arterial blood gas ([[ABG]]) analysis, however, does not exclude PE.<ref name="pmid8549223">{{cite journal| author=Stein PD, Goldhaber SZ, Henry JW, Miller AC| title=Arterial blood gas analysis in the assessment of suspected acute pulmonary embolism. | journal=Chest | year= 1996 | volume= 109 | issue= 1 | pages= 78-81 | pmid=8549223 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8549223  }} </ref>  [[ABG]] analysis results do not contribute reliably to tailoring the management of the patients among whom PE is suspected.<ref name="pmid11112122">{{cite journal |author=Rodger MA, Carrier M, Jones GN, Rasuli P, Raymond F, Djunaedi H, Wells PS |title=Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=162 |issue=6 |pages=2105–8 |year=2000 |month=December |pmid=11112122 |doi= |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=11112122 |accessdate=2012-04-30}}</ref>


==Arterial blood gas==
==Arterial Blood Gas Analysis==  
===Findings===
*In patients with pulmonary embolism, the typical findings of the [[ABG]] analysis are:<ref name="pmid2491801">{{cite journal |author=Cvitanic O, Marino PL |title=Improved use of arterial blood gas analysis in suspected pulmonary embolism |journal=[[Chest]] |volume=95 |issue=1 |pages=48–51 |year=1989 |month=January |pmid=2491801 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=2491801 |accessdate=2012-04-30}}</ref>
*In patients with pulmonary embolism, [[ABG|arterial blood gas]] analysis may reveal:<ref name="pmid2491801">{{cite journal |author=Cvitanic O, Marino PL |title=Improved use of arterial blood gas analysis in suspected pulmonary embolism |journal=[[Chest]] |volume=95 |issue=1 |pages=48–51 |year=1989 |month=January |pmid=2491801 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=2491801 |accessdate=2012-04-30}}</ref>
**[[Hypoxemia]]
:*[[Hypoxemia]],
**[[Hypocapnia]]
:*[[Hypocapnia]],
**Increased [[alveolar-arterial oxygen difference]] ([[Alveolar-arterial gradient]])  
:*Increased [[alveolar-arterial oxygen difference]] ([[Alveolar-arterial gradient|P(A-a)O2 gradient]]) and
**[[Respiratory alkalosis]]
:*[[Respiratory alkalosis]].


*However, the above mentioned [[ABG]] findings are not exclusive for the diagnosis PE. Some variations include:
* The above mentioned typical [[ABG]] findings are not exclusive for the diagnosis of PE. Some variations include:<ref name="pmid8549223">{{cite journal| author=Stein PD, Goldhaber SZ, Henry JW, Miller AC| title=Arterial blood gas analysis in the assessment of suspected acute pulmonary embolism. | journal=Chest | year= 1996 | volume= 109 | issue= 1 | pages= 78-81 | pmid=8549223 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8549223  }} </ref><ref name="pmid1909617">{{cite journal |author=Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT, Weg JG |title=Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease |journal=[[Chest]] |volume=100 |issue=3 |pages=598–603 |year=1991 |month=September |pmid=1909617 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=1909617 |accessdate=2012-04-30}}</ref>  
:*[[Hypercapnia]] in cases of massive PE secondary to circulatory collapse.
**[[Hypercapnia]] in cases of massive PE secondary to [[circulatory]] collapse
:*Normal [[PaO2]] ''(partial pressure of oxygen in arterial blood)'' levels as demonstrated by majority of patients.<ref name="pmid1909617">{{cite journal |author=Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT, Weg JG |title=Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease |journal=[[Chest]] |volume=100 |issue=3 |pages=598–603 |year=1991 |month=September |pmid=1909617 |doi= |url=http://www.chestjournal.org/cgi/pmidlookup?view=long&pmid=1909617 |accessdate=2012-04-30}}</ref>  
** Normal [[PaO2]]
:*Normal [[alveolar-arterial oxygen gradient]] may be observed in ~6% of patients.
**Normal [[alveolar-arterial oxygen gradient]]
** Combined [[respiratory acidosis|respiratory]] and [[metabolic acidosis]] in cases of massive PE


===Sensitivity and Specificity===
* The absence of the typical results of the arterial blood gas ([[ABG]]) analysis, however, do not exclude PE.<ref name="pmid8549223">{{cite journal| author=Stein PD, Goldhaber SZ, Henry JW, Miller AC| title=Arterial blood gas analysis in the assessment of suspected acute pulmonary embolism. | journal=Chest | year= 1996 | volume= 109 | issue= 1 | pages= 78-81 | pmid=8549223 | doi= | pmc= | url=http://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8549223  }} </ref> [[ABG]] analysis results does not contribute reliably to tailoring the management of the patients among whom PE is suspected.<ref name="pmid11112122">{{cite journal |author=Rodger MA, Carrier M, Jones GN, Rasuli P, Raymond F, Djunaedi H, Wells PS |title=Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=162 |issue=6 |pages=2105–8 |year=2000 |month=December |pmid=11112122 |doi= |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=11112122 |accessdate=2012-04-30}}</ref>  
:In patients with suspected PE, Rodger et al, demonstrated that [[ABG]] analysis did not have sufficient [[negative predictive value]], [[specificity]], or likelihood ratios to be considered useful in the management these patients.<ref name="pmid11112122">{{cite journal |author=Rodger MA, Carrier M, Jones GN, Rasuli P, Raymond F, Djunaedi H, Wells PS |title=Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism |journal=[[American Journal of Respiratory and Critical Care Medicine]] |volume=162 |issue=6 |pages=2105–8 |year=2000 |month=December |pmid=11112122 |doi= |url=http://ajrccm.atsjournals.org/cgi/pmidlookup?view=long&pmid=11112122 |accessdate=2012-04-30}}</ref> Similar findings were observed by the PIOPED II investigators.<ref name="pmid17145249">{{cite journal |author=Stein PD, Woodard PK, Weg JG, Wakefield TW, Tapson VF, Sostman HD, Sos TA, Quinn DA, Leeper KV, Hull RD, Hales CA, Gottschalk A, Goodman LR, Fowler SE, Buckley JD |title=Diagnostic pathways in acute pulmonary embolism: recommendations of the PIOPED II investigators |journal=[[The American Journal of Medicine]] |volume=119 |issue=12 |pages=1048–55 |year=2006 |month=December |pmid=17145249 |doi=10.1016/j.amjmed.2006.05.060 |url=http://linkinghub.elsevier.com/retrieve/pii/S0002-9343(06)00779-0 |accessdate=2012-04-30}}</ref>


==Pulse Oximetry==
* Similarly to [[ABG]], the value of the [[pulse oximetry]] in the diagnosis of PE is limited. A room-air [[pulse oximetry]] reading of ≥ 95% at diagnosis was associated with a significantly lower probability of in-hospital complications from PE and hence may be used as a prognostic marker.<ref name="pmid12935827">{{cite journal |author=Kline JA, Hernandez-Nino J, Newgard CD, Cowles DN, Jackson RE, Courtney DM |title=Use of pulse oximetry to predict in-hospital complications in normotensive patients with pulmonary embolism |journal=[[The American Journal of Medicine]] |volume=115 |issue=3 |pages=203–8 |year=2003 |month=August |pmid=12935827 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002934303003280 |accessdate=2012-05-01}}</ref>
The use of pulse oximetry in the diagnosis pulmonary embolism is restricted. However, in 2003, Kline et al, demonstrated that a room-air pulse oximetry reading of '''''≥ 95% at diagnosis''''' was associated with a significantly lower probability of in-hospital complications from pulmonary embolism and hence may be used as a prognostic marker.<ref name="pmid12935827">{{cite journal |author=Kline JA, Hernandez-Nino J, Newgard CD, Cowles DN, Jackson RE, Courtney DM |title=Use of pulse oximetry to predict in-hospital complications in normotensive patients with pulmonary embolism |journal=[[The American Journal of Medicine]] |volume=115 |issue=3 |pages=203–8 |year=2003 |month=August |pmid=12935827 |doi= |url=http://linkinghub.elsevier.com/retrieve/pii/S0002934303003280 |accessdate=2012-05-01}}</ref>


==References==
==References==
{{reflist|2}}
{{Reflist|2}}
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[[Category:Hematology]]
[[Category:Hematology]]
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[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
 
[[Category:Intensive care medicine]]
[[Category:Laboratory Tests]]
 
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Latest revision as of 23:53, 29 July 2020
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Editor(s)-In-Chief: C. Michael Gibson, M.S., M.D. [1], The APEX Trial Investigators; Associate Editor(s)-in-Chief: Rim Halaby, M.D. [2]

Synonyms and keywords: ABG

Overview

Hypoxemia, hypocapnia, increased alveolar-arterial gradient, and respiratory alkalosis are the typical findings that may be observed in patients with pulmonary embolism (PE). The absence of the typical results of the arterial blood gas (ABG) analysis, however, does not exclude PE.[1] ABG analysis results do not contribute reliably to tailoring the management of the patients among whom PE is suspected.[2]

Arterial Blood Gas Analysis

  • The absence of the typical results of the arterial blood gas (ABG) analysis, however, do not exclude PE.[1] ABG analysis results does not contribute reliably to tailoring the management of the patients among whom PE is suspected.[2]
  • Similarly to ABG, the value of the pulse oximetry in the diagnosis of PE is limited. A room-air pulse oximetry reading of ≥ 95% at diagnosis was associated with a significantly lower probability of in-hospital complications from PE and hence may be used as a prognostic marker.[5]

References

  1. ↑ 1.0 1.1 1.2 Stein PD, Goldhaber SZ, Henry JW, Miller AC (1996). "Arterial blood gas analysis in the assessment of suspected acute pulmonary embolism". Chest. 109 (1): 78–81. PMID 8549223.
  2. ↑ 2.0 2.1 Rodger MA, Carrier M, Jones GN, Rasuli P, Raymond F, Djunaedi H, Wells PS (2000). "Diagnostic value of arterial blood gas measurement in suspected pulmonary embolism". American Journal of Respiratory and Critical Care Medicine. 162 (6): 2105–8. PMID 11112122. Retrieved 2012-04-30. Unknown parameter |month= ignored (help)
  3. ↑ Cvitanic O, Marino PL (1989). "Improved use of arterial blood gas analysis in suspected pulmonary embolism". Chest. 95 (1): 48–51. PMID 2491801. Retrieved 2012-04-30. Unknown parameter |month= ignored (help)
  4. ↑ Stein PD, Terrin ML, Hales CA, Palevsky HI, Saltzman HA, Thompson BT, Weg JG (1991). "Clinical, laboratory, roentgenographic, and electrocardiographic findings in patients with acute pulmonary embolism and no pre-existing cardiac or pulmonary disease". Chest. 100 (3): 598–603. PMID 1909617. Retrieved 2012-04-30. Unknown parameter |month= ignored (help)
  5. ↑ Kline JA, Hernandez-Nino J, Newgard CD, Cowles DN, Jackson RE, Courtney DM (2003). "Use of pulse oximetry to predict in-hospital complications in normotensive patients with pulmonary embolism". The American Journal of Medicine. 115 (3): 203–8. PMID 12935827. Retrieved 2012-05-01. Unknown parameter |month= ignored (help)

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