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Interpretation
..
O2
HCO3-
Handerson-Hasalbach
equation
0.03 x PaCO22
H++
= 24 x
venous HCO
pH
PaCO2
PaO2
HCO3-
7.35-7.45
35-45
.
80-100
ABG
1. arterial
blood gas
2. oxygenation
3. ventilation
4.
(acidbase disorder)
Arterial
pH
PaO2
PaCO2
O2
Venous
97-100%
38-48
70-75%
oxygenation
1. PaO2
2. A-a gradient
3. PaO2/FiO2
Oxygenation
PaO2
Mild
60-80 .
hypoxemia
Moderate
40-60 .
hypoxemia
Severe
PaO
< 40
2
hypoxemia
aO2 = 100-(/4)
FiO2
room air
A-a gradient
A-a gradient
- PaO2
PAO2
A-a gradient
=
713
1 (1 atm =
760 mmHg, = 47
mmHg) = 760 47
R (RQ) (respiratory quotient) = CO2
production/ O2 consumption (normal
RQ = A-a
0.8) gradient = 2.5 + (age/4)
Normal
Approach to Hypoxemia
crease FiO2
ntral/ Neuromuscular hypoventilat
Q mismatch
unt
ffusion defect
w ScvO2
V/Q
mismatch
shunt
Dead
space Q/
Absent
Absent V/ present Q
Do not
response with
100% oxygen
Present V
Response
with
100%
oxygen
100% oxygen
Treat specific
disease
Shunt
Intrapulmonary shunt
Extrapulmonary
shunt
Response to PEEP
ARDS
Severe pulmonary edema
COPD
Asthma
15
16
Shunt
Intrapulmonary shunt
Extrapulmonary shunt
17
Diffusion defect
PaO2/FiO2
PaO2/FiO2
500-550
PaO2/FiO2
hypoxemia
hypoxemia FiO
50
nosocomial pneumonia
97%
3 : pH 7.47,
PaO2 100 mmHg,
1. 1
PaCO2 32 mmHg,
2. 3
3.
HCO3- 24, O2 sat
50
nosocomial pneumonia
7.49,
1 : pH
PaO2 80 mmHg,
PaCO2 30 mmHg, HCO3- 22, O2 sat 97%
FiO2 0.4 PaO2/FiO2 = 200
PaO2/FiO2 =
100
FiO2
arterial blood gas
(PaO2/FiO2)1
(PaO2/FiO2)2
1. oxygen saturation
PaO2
2.
PaO2/FiO2
22
ARDS
FiO2 1.0
PaO2 100 . FiO2
oxygen saturation 90%
1.0.9
FiO2
2.0.8
3.0.7
4.0.6
5.0.5
hemoglobin oxygen
dissociation curve oxygen saturation
90% PaO2 60 .
SaO22 95% = PaO22 80
.
SaO22 90% = PaO22 60
.
SaO22 88% = PaO22 55
.
SaO22 75% = PaO22 40
.
SaO22 50% = PaO22 27
.
ventilation
PaCO2 < 35
mmHg
Hyperventilatio
n
Hypocapnia
Hypocarbia
PaCO2 > 45
mmHg
Hypoventilation
Hypercapnia
Hypercarbia
ventilation
CO2
PaCO2
production
alveolar ventilation
alveolar ventilation =
minute
ventilation dead space ventilation
=
(V t x
RR) (Vd x RR)
PaCO2
= k x CO2
production
= k x CO2 production
(Vt x
RR) (Vd x RR)
RR (Vt Vd)
PaCO2
4
1. Carbondioxide production
2. Tidal volume
3. Respiratory rate
4. Dead space volume
45
myasthenia gravis
FiO2 0.6
tidal volume 400 .
15
PaCO2 50
.
minute ventilation
PaCO2 1/MV
PaCO2 = k (1/MV)
PaCO2 x MV
= k
PaCO2 x MV = k
(PaCO2 x MV)
= 2 x MV)
(PaCO
(PaCO
1
1 =2 x
45
community acquired pneumonia
FiO2 0.6 tidal
PaCO
volume
400 .
1522
PaCO2minute
ventilation
50 .
(PaCO
11= PaCO2
22 x MV)
(PaCO
MV)
40 .
22
22 x
50 x 400 x15
=
40
x MV
MV
=
50 x 400 x15
40
PaCO2
HCO3-
acidosis
Metabolic
alkalosis
Respiratory
acidosis
Respiratory
Metabolic
Metabolic acidosis
PaCO2
=
(1.5 x HCO3-) + 8 + 2
Anion gap
Anion
Na+
gap
=
(Cl- + HCO3-)
Predicted pH
Lactic acidosis
ype A
oor tissue perfusion)
Type B
(normal tissue perfusion)
Poisoning
Alcohol
Ethanol
Methanol
Ethylene glycol
Non poisoning
Non-alcohol
Salicylate
Toluene
AKI, CKD
Rhabdomyolysis
Tumor lysis syndrome
Intravascular hemolysis
Metabolic alkalosis
PaCO2
=
(0.7x HCO3-) + 20 + 2
Chloride-responsive
Predicted pH =
7.PaCO2
Chloride-resistant
Primary aldosteronism
vomiting, NG
Short-term diuretic
Volume contraction
Bartters syndrome
Long-term diuretic
therapy
Liddles syndrome
drainage)
therapy
Acute
PaCO2
HCO3-
pH
10
0.08
10
0.08
respiratory
acidosis
Acute
respiratory
alkalosis
chronic
Acute
Acidosis
Alkalosis
10
Acute
Alkalosis
10
Respiratory
Acidosis
10
Chronic
10
Metabo
pH
alkalosi
(1.5 x HCO3-)
HCO3
+ 8 + 2
lic
acidosi
Metabo
s
lic
PaCO2
(0.7 x HCO3-)
+ 20 + 2
35
6
P.E. : mildly pale, RR 28/min, dyspnea
ABG (room air) ; pH 7.28, PaCO2 60
mmHg, PaO2 60 mmHg, HCO3- 26 mEq/L
1. Pneumonia
2. Myasthenia gravis
3. Atlectasis
nation
FiO2 x 713) (PaCO2 / R)
= (0.2 x 713) (60/0.8)
= 67.6 mmHg
PaO2 = 67.6 60 = 7.6 mmHg
A-a gradient = 2.5 + (age/4)
= 2.5 + (35/4) = 11.25
hypoxem
ia
A-a gradient
Normal A-a
gradient
Decrease FiO2
Central/
neuromuscular
hypoventilation
Wide A-a
gradient
V/Q
mismatch
Shunt
Diffusion
. Ventilation
..Hypoventilation
3. Acid- base imbalance
.. Acidosis, PaCO2 =
respiratory acidosis
HCO31
0.08
Acute
acidosis
10
0.08
Chronic
alkalosis
10
0.03
Chronic
acidosis
10
0.02
Acute
respiratory
respiratory
respiratory
10
pH
25 4
1
.hyperventilation
Metabolic
pH
acidosis
PaCO2
(1.5 x HCO3 )
-
+ 8 + 2
(0.7 x HCO3-)
Respirator
+ 20 + 2
y acidosis
Respirator
Metabolic
alkalosis
HCO3
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