Assessing gas exchange in acute lung injury/acute respiratory distress syndrome: diagnostic techniques and prognostic relevance

Abstract

Although oxygenation assessment is of primary importance during respiratory lung injury, dead space and CO2 retention are more strictly associated with outcome. The association of central venous blood analysis and pulse oximetry may provide more information than arterial blood alone.

Real-time Two-dimensional Ultrasound Guidance for Central Venous Cannulation

“…Cannulation of the central veins is an important aspect of patient care for the administration of fluid, medications, and nutrients, and for monitoring central venous pressure, central venous blood analysis, and so on. 9,46 However, CVC has an inherent risk itself. A recent report by Maecken et al 47 reminds us of the importance of understanding and correctly identifying the relevant structures, of the fact that the anatomy at these sites is not always consistent, and that ALM cannot take this variability into account.…”

Venovenous extracorporeal membrane oxygenation for acute lung failure in adults

“…1 It is characterized by a life-threatening impairment of the gas exchange, resulting in hypoxia, hypercapnia, and respiratory acidosis. 2 Underlying diseases are of pulmonary origin, including bilateral pneumonia and aspiration, or secondarily affect the lung, such as sepsis, trauma, and massive transfusion. The clinical picture is mostly an acute respiratory distress syndrome (ARDS) but may also be related to a cardiac disease.…”

Bedside Estimation of Nonaerated Lung Tissue Using Blood Gas Analysis*

“…In clinical practice, assessment of pulmonary shunt has often been replaced by measuring the ratio of PaO 2 to Fio 2 , which can less invasively be obtained with standard monitoring equipment (11)(12)(13)(14)(15)(16). The suitability of both pulmonary shunt and PaO 2 /Fio 2 for this purpose, however, is controversial because studies trying to correlate PaO 2 / Fio 2 to the pulmonary shunt or to the amount of nonaerated lung quantified by CT shunt yielded inconsistent results (5,12,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23).…”

“…In clinical practice, assessment of pulmonary shunt has often been replaced by measuring the ratio of PaO 2 to Fio 2 , which can less invasively be obtained with standard monitoring equipment (11)(12)(13)(14)(15)(16). The suitability of both pulmonary shunt and PaO 2 /Fio 2 for this purpose, however, is controversial because studies trying to correlate PaO 2 / Fio 2 to the pulmonary shunt or to the amount of nonaerated lung quantified by CT shunt yielded inconsistent results (5,12,(14)(15)(16)(17)(18)(19)(20)(21)(22)(23). Differences in regional perfusion (10,(24)(25)(26)(27), the nonlinear relationship between PaO 2 /Fio 2 and pulmonary shunt (28)(29)(30)(31), the use of different Fio 2 (12,(32)(33)(34)(35)(36)(37)(38)(39)(40), and the differences in CT methods (1,12,18,27,41,42) could help explain some of these inconsistencies.…”