Is venous blood gas performed in the <scp>E</scp>mergency <scp>D</scp>epartment predictive of outcome during acute on chronic hypercarbic respiratory failure?

Domaradzki, Lisa; Gosala, Sahithi; Iskandarani, Khaled; Louw, Andry Van de

doi:10.1111/crj.12746

Cited by 7 publications

(4 citation statements)

References 32 publications

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“…Blood gas analysis performed using a venous blood sample is sufficient to assess tissue pH and electrolyte and lactate levels but cannot accurately detect partial carbon dioxide pressure (PaCO 2 ). [ 5 6 7 8 9 10 11 12 ] PaCO 2 in venous blood measures tissue carbon dioxide and does not reflect the arterial PaCO 2 value. Since the bicarbonate level is calculated by an indirect method using pH and pCO 2 and the Henderson–Hasselbach equation in blood gas analyses, the blood gas analysis of venous samples does not show the bicarbonate level accurately.…”

Section: 2 Arterial Blood Gas Evaluationmentioning

confidence: 99%

2021 Guideline for the Management of COPD Exacerbations

Doğan¹,

Varol²,

Köktürk³

et al. 2021

Turkish Journal of Emergency Medicine

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Chronic obstructive pulmonary disease (COPD) is an important public health problem that manifests with exacerbations and causes serious mortality and morbidity in both developed and developing countries. COPD exacerbations usually present to emergency departments, where these patients are diagnosed and treated. Therefore, the Emergency Medicine Association of Turkey and the Turkish Thoracic Society jointly wanted to implement a guideline that evaluates the management of COPD exacerbations according to the current literature and provides evidence-based recommendations. In the management of COPD exacerbations, we aim to support the decision-making process of clinicians dealing with these patients in the emergency setting.

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Section: 2 Arterial Blood Gas Evaluationmentioning

confidence: 99%

2021 Guideline for the Management of COPD Exacerbations

Doğan¹,

Varol²,

Köktürk³

et al. 2021

Turkish Journal of Emergency Medicine

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“…Additional assessment techniques include identifying signs of respiratory failure for ventilatory support, such as respiratory acidosis, increased work of breathing, and persistent hypoxemia (1). Assessing partial CO 2 (PCO 2 ) with a venous blood gas (VBG) could provide additional information regarding the patient's respiratory status and may be helpful in assessing response to treatment; however, neither PCO 2 nor ETCO 2 alone is sufficient to determine the need for noninvasive ventilation (NIV) or intubation (1,65,66). 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.…”

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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“…Arterial blood gas analysis (ABGA) is routinely performed in emergency, critical care, and pulmonary departments principally to assess acid–base disturbances or to diagnose and quantify respiratory insufficiency. Although the number of inappropriate ABGAs is sometimes large [1], venous blood gas analysis cannot fully replace it for clinical decision-making [2]. Pain is the most frequent side effect [3].…”

Section: Introductionmentioning

confidence: 99%

Ultrasound guidance in difficult radial artery puncture for blood gas analysis: A prospective, randomized controlled trial

Grandpierre¹,

Bobbia²,

Muller³

et al. 2019

PLoS ONE

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BackgroundUltrasound (US) guidance has yet to prove its applicability in radial arterial blood gas analysis (ABGA) punctures. The main objective of our study was to compare the number of first-attempt successes (NFAS) for radial arterial puncture in difficult patients with or without US guidance. The Secondary aims were to compare the number of punctures (NOP), puncture time, and patient pain.MethodsIn this single-center, randomized controlled trial, patients who required a radial ABGA and in whom the arterial puncture was assessed as difficult (because of non-palpable radial arteries or two previous puncture failures by a nurse) were assigned to the US group or no-US (NUS) group (procedure performed by a trained physician).ResultsThirty-six patients were included in the US group and 37 in the NUS groups. The NFAS was 7 (19%) in the NUS group and 19 (53%) in the US group. The relative risk of success in the US group was 2.79 (95% CI,1.34 to 5.82), p = 0.01. In the NUS and US groups, respectively, the median NOP was 3 [2; 6] vs. 1 [1; 2], estimated difference −2.0 (95%CI, −3.4 to −0.6), p < 0.01; the respective puncture time was 3.1 [1.6; 5.4] vs. 1.4 [0.6; 3.1] min, estimated difference −1.45 (95%CI, −2.57 to −0.39), p = 0.01; the respective median patient pain was 6 [4; 8] vs. 2 [1; 4], estimated difference −4.0 (95%CI, −5.8 to −2.3); p < 0.01.ConclusionUS guidance by a trained physician significantly improves the rate of success in difficult radial ABGA patients.

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Is venous blood gas performed in the Emergency Department predictive of outcome during acute on chronic hypercarbic respiratory failure?

Abstract: Our results do not support the use of VBG on admission as a predictor for NIV failure, intubation and mortality during AHRF.

Cited by 7 publications

References 32 publications

2021 Guideline for the Management of COPD Exacerbations

2021 Guideline for the Management of COPD Exacerbations

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

Ultrasound guidance in difficult radial artery puncture for blood gas analysis: A prospective, randomized controlled trial

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