Pulmonary embolism arterial blood gas analysis: Difference between revisions
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| [[File:Siren.gif|30px|link=Pulmonary embolism resident survival guide]]|| <br> || <br> | |||
| [[Pulmonary embolism resident survival guide|'''Resident'''<br>'''Survival'''<br>'''Guide''']] | |||
|} | |||
{{Pulmonary embolism}} | {{Pulmonary embolism}} | ||
'''Editor(s)-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com], {{ATI}}; {{AE}} {{ | '''Editor(s)-In-Chief:''' [[C. Michael Gibson, M.S., M.D.]] [mailto:charlesmichaelgibson@gmail.com], {{ATI}}; {{AE}} {{Rim}} | ||
{{SK}} ABG | |||
==Overview== | ==Overview== | ||
[[Hypoxemia]], [[hypocapnia]], increased [[alveolar-arterial gradient]], and [[respiratory alkalosis]] are | [[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 Analysis== | ==Arterial Blood Gas Analysis== | ||
*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 | |||
**[[Hypoxemia]] | **[[Hypoxemia]] | ||
**[[Hypocapnia]] | **[[Hypocapnia]] | ||
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**[[Respiratory alkalosis]] | **[[Respiratory alkalosis]] | ||
* The above mentioned [[ABG]] findings are not exclusive for the diagnosis of 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 | |||
** Normal [[PaO2]] | |||
**Normal [[alveolar-arterial oxygen gradient]] | **Normal [[alveolar-arterial oxygen gradient]] | ||
** Combined [[respiratory acidosis|respiratory]] and [[metabolic acidosis]] in cases of massive PE | |||
* 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> | |||
* 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> | |||
==References== | ==References== | ||
{{ | {{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]] | |||
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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 above mentioned typical ABG findings are not exclusive for the diagnosis of PE. Some variations include:[1][4]
- Hypercapnia in cases of massive PE secondary to circulatory collapse
- Normal PaO2
- Normal alveolar-arterial oxygen gradient
- Combined respiratory and metabolic acidosis in cases of massive PE
- 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
- ↑ 1.0 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.
- ↑ 2.0 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) - ↑ 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) - ↑ 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) - ↑ 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)