Comparison of peripheral venous and arterial blood gas in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD): a meta-analysis

Bingheng, Lou; Chen, Jianxin; Chen, Yu; Yijuan, Yu

doi:10.1007/s10049-018-0469-9

Cited by 12 publications

(13 citation statements)

References 17 publications

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“…Previous studies have found a good correlation between venous and arterial values of pH and HCO 3 - . 9 Oxygenation can be easily assessed by noninvasive pulse oximetry. Ventilation status in the COPD patients is determined by the PaCO 2 levels.…”

Section: Discussionmentioning

confidence: 99%

Correlation of PaCO2 and ETCO2 in COPD Patients with Exacerbation on Mechanical Ventilation

Tyagi¹,

Govindagoudar²,

Jakka³

et al. 2021

Indian Journal of Critical Care Medicine

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A bstract Introduction: Chronic obstructive pulmonary disease (COPD) patients in hypercapnic respiratory failure require multiple arterial blood gas (ABG) analysis for monitoring. It is a painful, invasive, and expensive investigation. This study was aimed at finding an agreement between end-tidal carbon dioxide (ETCO 2 , a noninvasive modality) and arterial carbon dioxide (PaCO 2 ) in COPD patients with acute exacerbation on mechanical ventilation. Materials and methods: A prospective observational study was conducted in COPD patients who required mechanical ventilation. ETCO 2 was recorded by mainstream capnography along with ABG analysis. An agreement between PaCO 2 and ETCO 2 was assessed. The effect of various factors on correlation was also studied. Results: A total of 100 patients with COPD in hypercapnic respiratory failure were included. Seventy-three percentage of patients were managed on invasive mechanical ventilation (IMV). The mean ETCO 2 and PaCO 2 were 48.66 ± 15.57 mm Hg and 75.52 ± 21.9 mm Hg, respectively. There was a significant correlation between PaCO 2 and ETCO 2 values ( r = 0.82, 95% confidence interval of r = 0.78–0.86, p <0.0001). The Bland-Altman analysis shows the mean bias as −19.4 (95% limits of agreement = −40.0–1.1). Pearson's correlation coefficient was 0.84 in intubated patients and 0.58 in patients on noninvasive ventilation (NIV). Pearson's correlation coefficient between PaCO 2 and ETCO 2 in subjects with consolidation, cardiomegaly, hypotension, and raised pulmonary artery pressures was 0.78, 0.86, 0.85, and 0.86, respectively. Conclusion: Mainstream ETCO 2 measurement accurately predicts the PaCO 2 in COPD patients on IMV. However, for patients on NIV, ETCO 2 is insufficient in monitoring PaCO 2 levels due to weak correlation. Clinical significance: ETCO 2 can be used as a noninvasive modality in intensive care unit for monitoring the PaCO 2 in COPD patients on IMV. This can reduce the requirement of arterial blood sampling to a minimum number, in turn, reducing the cost of the treatment and discomfort to the patients. How to cite this article: Tyagi D, Govindagoudar MB, Jakka S, Chandra S, Chaudhry D. Correlation of PaCO 2 and ETCO 2 in COPD Patients with Exacerbation on Mechanical Ventilation. Indian J Crit Care Med 2021;25(3):305–309.

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Section: Discussionmentioning

confidence: 99%

Correlation of PaCO2 and ETCO2 in COPD Patients with Exacerbation on Mechanical Ventilation

Tyagi¹,

Govindagoudar²,

Jakka³

et al. 2021

Indian Journal of Critical Care Medicine

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“…The partial pressure of oxygen in venous blood is by 13-37 mm Hg lower than in arterial blood. It is therefore not suitable for measuring oxygenation [77][78][79]. Venous BGAs are not suitable for monitoring oxygen therapy.…”

Section: Practice Pointsmentioning

confidence: 99%

German S3 Guideline: Oxygen Therapy in the Acute Care of Adult Patients

et al. 2021

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Background: Oxygen (O2) is a drug with specific biochemical and physiological properties, a range of effective doses and may have side effects. In 2015, 14% of over 55,000 hospital patients in the UK were using oxygen. 42% of patients received this supplemental oxygen without a valid prescription. Health care professionals are frequently uncertain about the relevance of hypoxemia and have low awareness about the risks of hyperoxemia. Numerous randomized controlled trials about targets of oxygen therapy have been published in recent years. A national guideline is urgently needed. Methods: A national S3 guideline was developed and published within the Program for National Disease Management Guidelines (AWMF) with participation of 10 medical associations. A literature search was performed until February 1, 2021, to answer 10 key questions. The Oxford Centre for Evidence-Based Medicine (CEBM) System (“The Oxford 2011 Levels of Evidence”) was used to classify types of studies in terms of validity. Grading of Recommendations, Assessment, Development and Evaluation (GRADE) was used for assessing the quality of evidence and for grading guideline recommendation, and a formal consensus-building process was performed. Results: The guideline includes 34 evidence-based recommendations about indications, prescription, monitoring and discontinuation of oxygen therapy in acute care. The main indication for O2 therapy is hypoxemia. In acute care both hypoxemia and hyperoxemia should be avoided. Hyperoxemia also seems to be associated with increased mortality, especially in patients with hypercapnia. The guideline provides recommended target oxygen saturation for acute medicine without differentiating between diagnoses. Target ranges for oxygen saturation are based depending on ventilation status risk for hypercapnia. The guideline provides an overview of available oxygen delivery systems and includes recommendations for their selection based on patient safety and comfort. Conclusion: This is the first national guideline on the use of oxygen in acute care. It addresses health care professionals using oxygen in acute out-of-hospital and in-hospital settings.

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“…The decision to escalate to NIV or intubation is ultimately a clinical judgment, based on the patient's clinical picture and the physician's own experience. Regarding the utility of ABG, evidence indicates that there is a good correlation between ABGs and VBGs for pH, PCO 2 , and bicarbonate values; in fact, a PCO 2 of 45 mm Hg on a VBG correlates with arterial hypercarbia with 100% sensitivity (49,65,67). Of note, arterial sampling is more difficult to obtain and painful for the patient, and given the agreement between the parameters analyzed by ABG and VBG, VBG is often sufficient for most patients.…”

Section: Case Study Imentioning

confidence: 99%

“…Of note, arterial sampling is more difficult to obtain and painful for the patient, and given the agreement between the parameters analyzed by ABG and VBG, VBG is often sufficient for most patients. However, an ABG may be preferred in cases of hypoxic respiratory failure requiring mechanical ventilation or in patients with acute respiratory distress syndrome (67). Additionally, pulse oximetry should be performed in all patients with potential hypoxemia during an exacerbation (65).…”

Section: Case Study Imentioning

confidence: 99%

Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Primer for Emergency Physicians

Sorge

DeBlieux

2020

The Journal of Emergency Medicine

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Background: Acute exacerbations of chronic obstructive pulmonary disease (AECOPD) impose a significant burden on patients and the emergency health care system. Patients with COPD who present to the emergency department (ED) often have comorbidities that can complicate their management. Objective: To discuss strategies for the management of acute exacerbations in the ED, from initial assessment through disposition, to enable effective patient care and minimize the risk of treatment failure and prevent hospital readmissions. Discussion: Establishing a correct diagnosis early on is critical; therefore, initial evaluations should be aimed at differentiating COPD exacerbations from other life-threatening conditions. Disposition decisions are based on the intensity of symptoms, presence of comorbidities, severity of the disease, and response to therapy. Patients who are appropriate for discharge from the ED should be prescribed evidence-based treatments and smoking cessation to prevent disease progression. A patient-centric discharge care plan should include medication reconciliation; bedside ''teach-back,'' wherein patients demonstrate proper inhaler usage; and prompt follow-up. Conclusions: An effective assessment, accurate diagnosis, and appropriate discharge plan for patients with AECOPD could improve treatment outcomes, reduce hospitalization, and decrease unplanned repeat visits to the ED.

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Comparison of peripheral venous and arterial blood gas in patients with acute exacerbation of chronic obstructive pulmonary disease (AECOPD): a meta-analysis

Cited by 12 publications

References 17 publications

Correlation of PaCO2 and ETCO2 in COPD Patients with Exacerbation on Mechanical Ventilation

Correlation of PaCO2 and ETCO2 in COPD Patients with Exacerbation on Mechanical Ventilation

German S3 Guideline: Oxygen Therapy in the Acute Care of Adult Patients

Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Primer for Emergency Physicians

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