Interpretation of arteriovenous gases. A practical guideline. A review

Interpretación de gases arteriovenosos. Una guía práctica. Revisión de tema

Published 2022-11-30

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Vol. 34 No. 2 (2022)
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Interpretation of arteriovenous gases. A practical guideline. A review.
rev. colomb. neumol. [Internet]. 2022 Nov. 30 [cited 2024 Nov. 21];34(2):59-7. Disponible en: https://doi.org/10.30789/rcneumologia.v34.n2.2022.586
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Diego Fernando Severiche Bueno
Fundación Neumológica Colombiana image/svg+xml
    https://orcid.org/0000-0002-0976-3093
    David Felipe Severiche Bueno
    University of La Sabana image/svg+xml
      https://orcid.org/0000-0003-1262-9458
      Maria Teresa Vargas Cuervo
      Universidad del Rosario image/svg+xml
        https://orcid.org/0000-0002-4562-6184
        Diego Leon Severiche Hernandez
        Clínica del Country
          https://orcid.org/0000-0003-4887-5861
          Show authors biography

          Diego Fernando Severiche Bueno,

          Médico especialista en medicina interna, Fellow de Neumología, Universidad de La Sabana y Fundación Neumológica Colombiana, Bogotá, Colombia.

          David Felipe Severiche Bueno,

          Médico, Residente de medicina interna, Universidad de La Sabana, Bogotá, Colombia

          Maria Teresa Vargas Cuervo,

          Médica, candidata a magister en Epidemiologia, Universidad del Rosario, Bogotá, Colombia.

          Diego Leon Severiche Hernandez,

          Médico especialista en medicina interna, Neumología y cuidado intensivo. Especialista en Bioética y Educación Médica. Médico especialista adscrito de la Clínica del Country y Médico especialista de la Unidad de Cuidado Intensivo del Hospital San Rafael de Tunja.


          The evaluation of the acid-base status and the oxygenation of a patient is fundamental in any clinical setting, be it in an outpatient clinic, in an emergency service, hospitalization, in surgery or in the intensive care unit. Knowledge of the pathophysiological bases is of the utmost importance for the understanding and adequate interpretation of these conditions. The objective of this review is to provide the necessary knowledge for the adequate understanding of arteriovenous gases and to propose a model for their comprehension and interpretation. This article addresses the pathophysiological bases of acid-base disorders, the existing models in their comprehension, the model proposed for their diagnostic approach, their differential diagnoses, the diagnostic approach to hypoxemia, the interpretation of arteriovenous gases and the variables that can be obtained from them, the diagnostic approach of lactic acidosis and some examples of the proposed model.

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          1. Fores-Novales B, Diez-Fores P, Aguilera-Celorrio LJ. Evaluación del equilibrio ácido base. Aportaciones del método de Stewart. Revista Española de Anestesiología y Reanimación. 2016;4(63):212-219. doi: 10.1016/j.redar.2015.04.004.
          2. Kraut JA, Madias NE. Approach to patients with acid-base disorders. Respir Care. 2001;46(4):392-403.
          3. Gomez H, Kellum JA. Understanding Acid Base Disorders. Crit Care Clin. 2015;31(4):849-860. doi: 10.1016/j.ccc.2015.06.016.
          4. Barrett KE, Barman SM, Brooks HL, Yuan JJ, editors. Gas Transport & pH. In Ganong's Review of Medical Physiology: McGraw Hill; 2019.
          5. DuBose TD. Acidosis and Alkalosis. In Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J, editors. Harrison's Principles of Internal Medicine: McGraw Hill; 2022.
          6. Kellum JA. Determinants of blood pH in health and disease. Crit Care. 2000;4(1):6-14. doi: 10.1186/cc644.
          7. Adrogué HJ, Gennari FJ, Galla JH, Madias NE. Assessing acid-base disorders. Kidney Int. 2009 Dec; 76(12):1239-47. doi: 10.1038/ki.2009.359.
          8. Kofstad J. Base excess: A historical review-has the calculation of base excess been more standardised the last 20 years? Clin Chim Acta. 2001 Mayo; 307(1-2):193-5. doi: 10.1016/s0009-8981(01)00427-2.
          9. Schlichtig R. [Base excess] vs [strong ion difference]. Which is more helpful? Adv Exp Med Biol. 1997;411:91-5. doi: 10.1007/978-1-4615-5865-1_11.
          10. MB W. Physicochemical Models of Acid-Base. Semin Nephrol. 2019;39(4):328-339. doi: 10.1016/j.semnephrol.2019.04.003.
          11. Goldfarb S, Sharma K. Acid–Base Balance Disorders. In Grippi MA, Elias JA, Fishman JA, Kotloff RM, Pack AI, Senior RM, et al., editors. Fishman's Pulmonary Diseases and Disorders. Fifth Edition ed.: McGraw Hill; 2015.
          12. Paulev PE, Zubieta-Calleja G R. Essentials in the diagnosis of acid-base disorders and their high altitude application. Journal of physiology and pharmacology. 2005;56(4):155-70.
          13. Stewart PA. Modern quantitative acid-base chemistry. Can J Physiol Pharmacol. 1983 Dec; 61(12):1444-61. doi: 10.1139/y83-207.
          14. Gilfix BM, Bique M, Magder S. A physical chemical approach to the analysis of acid-base balance in the clinical setting. J Crit Care. 1993 Dec; 8(4):187-97. doi: 10.1016/0883-9441(93)90001-2.
          15. Rastegar A. Clinical utility of Stewart's method in diagnosis and management of acid-base disorders. Clin J Am Soc Nephrol. 2009;4(7):1267-1274. doi: 10.2215/CJN.01820309.
          16. Langer T, Pelosi PCP. Respiratory Acid-Base Disorders. In Ronco C, Bellomo R, Kellum JA, Ricci Z, editors. Critical Care Nephrology: Elsevier; 2019. p. 411-416.e1.
          17. Antonini B, Piva S, Paltenghi M, Candiani A, Latronico N. The early phase of critical illness is a progressive acidic state due to unmeasured anions. Eur J Anaesthesiol. 2008 Jul;25(7):566-71. doi: 10.1017/S0265021508003669.
          18. Fencl V, Leith DE. Stewart's quantitative acid-base chemistry: applications in biology and medicine. Respir Physiol. 1993 Jan; 91(1):1-16. doi: 10.1016/0034-5687(93)90085-o.
          19. Kellum JA. Acid-base physiology in the post-Copernican era. Curr Opin Crit Care. 1999;5:458-63.
          20. Scheingraber S, Rehm M, Sehmisch C, Finsterer U. Rapid saline infusion produces hyperchloremic acidosis in patients undergoing gynecologic surgery. Anesthesiology. 1999 May;90(5):1265-70. doi: 10.1097/00000542-199905000-00007.
          21. Kurtz I, Kraut J, Ornekian V, Nguyen MK. Acid-base analysis: a critique of the Stewart and bicarbonate-centered approaches. Am J Physiol Renal Physiol. 2008 May;294(5):1009-31. doi: 10.1152/ajprenal.00475.2007.
          22. Dubin A, Menises MM, Masevicius FD, Moseinco MC, Kutscherauer DO, Ventrice E, et al. Comparison of three different methods of evaluation of metabolic acid-base disorders. Crit Care Med. 2007 May;35(5):1264-70. doi: 10.1097/01.CCM.0000259536.11943.90.
          23. Kumar V, Karon B. Comparison of Measured and Calculated Bicarbonate Values. Clinical Chemistry. 2008;54(9):1586–1587. https://doi.org/10.1373/clinchem.2008.107441.
          24. Ayaz F, Furrukh M, Arif T, Ur-Rahman F, Ambreen S. Correlation of Arterial and Venous pH and Bicarbonate in Patients With Renal Failure. Cureus. 2021;13(11):e19519. doi: 10.7759/cureus.19519.
          25. Story DA, Poustie S. Agreement between two plasma bicarbonate assays in critically ill patients. Anaesth Intensive Care. 2000;28(4):399-402. doi: 10.1177/0310057X0002800407. PMID: 10969366.
          26. Goundan PN, Willard DL, Sahin-Efe A, Fan SL, Alexanian SM. Comparison of bicarbonate values from venous blood gas and chemistry panels measured at the time of diagnosis and resolution of diabetes ketoacidosis. J Clin Transl Endocrinol. 2019;18:1-4. doi: https://doi.org/10.1016/j.jcte.2019.100205.
          27. Gomella LG, Haist SA, editors. Blood gases and acid–base disorders. In Clinician's Pocket Reference: The Scut Monkey. 11th ed.: McGraw Hill; 2007.
          28. Gonzalez-Garcia M, Maldonado D, Barrero M, Casas A, Perez-Padilla RTDCA. Arterial blood gases and ventilation at rest by age and sex in an adult Andean population resident at high altitude. European Journal of Applied Physiology. 2020;120(12):2729-2736. doi: 10.1007/s00421-020-04498-z.
          29. Sanghavi S, Albert TJ, Swenson ER. Acid-Base Balance. In Broaddus VC, Ernst J, King KT, Lazarus S, editors. Murray & Nadel's Textbook of Respiratory Medicine: Elsevier; 2021. p. 154-167.
          30. Kelen GD, Nicolaou DD, Cline DM. Acid-Base Disorders. In Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM, editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide: McGraw Hill; 2016.
          31. Gomez A, Montenegro G, Gomez H, Leon A. In Perfusión tisular. Evidencia médica y estrategia clínica: Distribuna; 2010. p. 157-166.
          32. Seifter JL. Acid-Base Disorders. In Goldman L, Schafer A, editors. Goldman-Cecil Medicine.: Elsevier; 2016. p. 762-774.
          33. Holst JA, Hoppe JA. Acid-Base Disorders. In Bakes K, Buchanan J, Moreira M, Byyny R, Pons P, editors. Emergency Medicine Secrets: Elsevier; 2016. p. 762-774.
          34. Berend K. Review of the Diagnostic Evaluation of Normal Anion Gap Metabolic Acidosis. Kidney Dis (Basel). 2017;3(4):149-159. doi: 10.1159/000479279.
          35. Kraut JA, Nagami GT. The serum anion gap in the evaluation of acid-base disorders: what are its limitations and can its effectiveness be improved? Clin J Am Soc Nephrol. 2013;8(11):2018-2024. doi: 10.2215/CJN.04040413.
          36. Jung B, Martinez M, Claessens YE, Darmon M, Klouche K, Lautrette A, et al. Diagnosis and management of metabolic acidosis: guidelines from a French expert panel. Ann Intensive Care. 2019;9(1):1-17. doi: 10.1186/s13613-019-0563-2.
          37. Melamed ML, Raphael KL. Metabolic Acidosis in CKD: A Review of Recent Findings. Kidney Med. 2021;3(2):267-277. doi: 10.1016/j.xkme.2020.12.006.
          38. Emmett M. Metabolic Alkalosis: A Brief Pathophysiologic Review. Clin J Am Soc Nephrol. 2020;15(12):1848-1856. doi: 10.2215/CJN.16041219.
          39. Tinawi M. Pathophysiology, Evaluation, and Management of Metabolic Alkalosis. Cureus. 2021;13(1):e12841. doi: 10.7759/cureus.12841.
          40. O'Driscoll BR, Howard LS, Earis J, Mak V. British Thoracic Society Emergency Oxygen Guideline Group; BTS Emergency Oxygen Guideline Development Group. BTS guideline for oxygen use in adults in healthcare and emergency settings. Thorax. 2017;72(1):ii1-ii90. doi: 10.1136/thoraxjnl-2016-209729.
          41. Lee WL, Slutsky AS. Acute Hypoxemic Respiratory Failure and ARDS. In Broaddus VC, Ernst J, King KT, Lazarus S, editors. Murray and Nadel's Textbook of Respiratory Medicine: Elsevier; 2021. p. 1740-1760.
          42. Chang DW. Arterial/Alveolar Oxigen Tension (a/A) Ratio. In Chang DW. Respiratory Care Calculations. Tercera edición ed. Nueva York: Delmar; 2012. p. 11-13.
          43. Chang DW. FiO2 Needed for a Desired PaO2. In Chang DW. Respiratory Care Calculations. Tercera edición ed. Nueva York: Delmar; 2012. p. 82-83.
          44. Broccard AF. Making sense of the pressure of arterial oxygen to fractional inspired oxygen concentration ratio in patients with acute respiratory distress syndrome. OA Critical Care. 2013 Jun;1(9). doi: 10.13172/2052-9309-1-1-705.
          45. McDonald CF. Low-flow oxygen: how much is your patient really getting? Respirology. 2014 May;19(4):469-70. doi: doi.org/10.1111/resp.12290.
          46. Byrne AL, Bennett M, Chatterji R, Symons R, Pace NL, Thomas PS. eripheral venous and arterial blood gas analysis in adults: are they comparable? A systematic review and meta-analysis. Respirology. 2014;19(2):168-175 doi: 10.1111/resp.12225.
          47. Chong WH, Saha BK, Medarov BI. omparing Central Venous Blood Gas to Arterial Blood Gas and Determining Its Utility in Critically Ill Patients: Narrative Review. Anesth Analg. 2021;133(2):374-378. doi: 10.1213/ANE.0000000000005501.
          48. Bloom BM, Grundlingh J, Bestwick JP, Harris T. The role of venous blood gas in the emergency department: a systematic review and meta-analysis. Eur J Emerg Med. 2014;21(2):81-88. doi: 10.1097/MEJ.0b013e32836437cf.
          49. Kelly AM. The case for venous rather than arterial blood gases in diabetic ketoacidosi. Emerg Med Australas. 2006;18(1):64-7. doi: 10.1111/j.1742-6723.2006.00803.x.
          50. Awasthi S, Rani R, Malviya D. Peripheral venous blood gas analysis: An alternative to arterial blood gas analysis for initial assessment and resuscitation in emergency and intensive care unit patients. Anesth Essays Res. 2013;7(3):355-8. doi: 10.4103/0259-1162.123234.
          51. Ma OJ, Rush MD, Godfrey MM, Gaddis G. Arterial blood gas results rarely influence emergency physician management of patients with suspected diabetic ketoacidosis. Acad Emerg Med. 2003;10(8):836-41. doi: 10.1111/j.1553-2712.2003.tb00625.x.
          52. Kelly AMMR, Kyle E. Venous pH can safely replace arterial pH in the initial evaluation of patients in the emergency department. Emerg Med J. 2001;18(5):340-2. doi: 10.1136/emj.18.5.340.
          53. Boon Y, Kuan WS, Chan YH, Ibrahim I, Chua MT. Agreement between arterial and venous blood gases in trauma resuscitation in emergency department (AGREE). Eur J Trauma Emerg Surg. 2021;47(2):365-372. doi: 10.1007/s00068-019-01190-6.
          54. White HD, Vazquez-Sandoval A, Quiroga PF, Song J, Jones SF, Arroliga AC. Utility of venous blood gases in severe sepsis and septic shock. Proc (Bayl Univ Med Cent). 2018;31(3):269-275. doi: 10.1080/08998280.2018.1460133.
          55. Martin CM, Priestap F. Agreement between venous and arterial blood gas analysis of acid-base status in critical care and ward patients: a retrospective cohort study. Can J Anaesth. 2017;64(11):1138-1143. doi: 10.1007/s12630-017-0951-8.
          56. Van-Beest P, Wietasch G, Scheeren T, Spronk P, Kuiper M. Clinical review: use of venous oxygen saturations as a goal - a yet unfinished puzzle. Crit Care. 2011;15(5):1-9. doi: 10.1186/cc10351.
          57. Lim BL, Kelly AM. A meta-analysis on the utility of peripheral venous blood gas analyses in exacerbations of chronic obstructive pulmonary disease in the emergency department. Eur J Emerg Med. 2010;17(5):246-248. doi: 10.1097/MEJ.0b013e328335622a.
          58. Duscio E, Vasques F, Romitti F, Cipulli F, Gattinoni L. Oxygen Delivery. In Pinsky MR, Teboul JL, Vincent JL, editors. Hemodynamic Monitoring. Lessons from the ICU. Cham: Springer; 2019.
          59. Singer M. Mitochondrial Function.. In Pinsky MR, Teboul JL, Vincent JL, editors. Hemodynamic Monitoring. Lessons from the ICU. Cham: Springer; 2019.
          60. Kraut JA, Madias N E. Lactic acidosis. New England Journal of Medicine. 2014;371(24):2309-19. doi: 10.1056/NEJMra1309483.
          61. Seheult J, Fitzpatrick G, Boran G. Lactic acidosis: an update. Clinical chemistry and laboratory medicine. 2017;55(3):322-333. doi: 10.1515/cclm-2016-0438.
          62. Reddy AJ, Lam SW, Bauer SR, Guzman JA. Lactic acidosis: Clinical implications and management strategies. Cleveland Clinc Journal of medicine. 2015;82(9):615-24. doi: 10.3949/ccjm.82a.14098.
          63. Adeva-Andany M, López-Ojén M, Funcasta-Calderón R, Ameneiros-Rodríguez E, Donapetry-García C, Vila-Altesor M, et al. Comprehensive review on lactate metabolism in human health. Mitochondrion. 2014;17(76):76-100. doi: 10.1016/j.mito.2014.05.007.
          64. Mehta AN, Emmett M. Approach to Acid-Base Disorders. In Gilbert SJ, Weiner DE, editors. National Kidney Foundation Primer on Kidney Diseases: W.B. Saunders; 2014. p. 113-122.

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