Is venous blood gas performed in the Emergency Department predictive of outcome during acute on chronic hypercarbic respiratory failure?
| Autor: | Lisa Domaradzki, Andry Van de Louw, Sahithi Gosala, Khaled Iskandarani |
|---|---|
| Rok vydání: | 2017 |
| Předmět: |
Pulmonary and Respiratory Medicine
Male medicine.medical_specialty medicine.medical_treatment pCO2 Hypercapnia 03 medical and health sciences Pulmonary Disease Chronic Obstructive 0302 clinical medicine Predictive Value of Tests Internal medicine medicine Intubation Intratracheal Immunology and Allergy Intubation Arterial pH Humans Hospital Mortality Genetics (clinical) Aged Retrospective Studies Aged 80 and over Noninvasive Ventilation business.industry 030208 emergency & critical care medicine Emergency department Venous blood Middle Aged 030228 respiratory system Respiratory failure Breathing Cardiology Arterial blood Female Blood Gas Analysis business Emergency Service Hospital Respiratory Insufficiency |
| Zdroj: | The clinical respiratory journal. 12(5) |
| ISSN: | 1752-699X |
| Popis: | Background During acute on chronic hypercarbic respiratory failure (AHRF), arterial pH is associated with non-invasive ventilation (NIV) failure and mortality. Venous blood gas (VBG) has been proposed as a substitute for arterial blood gas, based on a good agreement between venous and arterial values. We assessed the predictive value of admission VBG on intubation rate, NIV failure and mortality during AHRF. Methods Retrospective chart review of inpatients admitted between 2009 and 2015 with AHRF who had VBG performed on admission. Demographic, clinical and biological data were collected throughout the hospital course. Results 196 patients were included and hospital survival was not significantly associated with initial venous pH, PCO2 or HCO3-. Patients requiring intubation had significantly lower venous pH [7.29 (7.24-7.33) vs 7.31 (7.28-7.36), P = .04] while venous PCO2 and HCO3- did not differ as compared to non-intubated patients. Intubation within 48 h of admission was associated with significantly lower venous pH [7.28 (7.24-7.30) vs 7.32 (7.28-7.37), P = .002] and higher PCO2 [72 (63-92) mm Hg vs 62 (52-75) mm Hg, P = .04]. Among 69 patients receiving NIV, there were no differences in venous pH [7.29 (7.25-7.31) vs 7.30 (7.27-7.35), P = .3] or PCO2 [68 (44-74) mm Hg vs 70 (55-97) mm Hg, P = .23] associated with subsequent intubation. Using c statistics, we observed poor performances of venous pH, PCO2 or HCO3- for prediction of NIV failure, intubation or hospital mortality. Conclusions Our results do not support the use of VBG on admission as a predictor for NIV failure, intubation and mortality during AHRF. |
| Databáze: | OpenAIRE |
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