· -••••=•-•respira

tory failure one the commonest reaso,as for which imtierits are
achilaimd to the intensive care unit. it may be the primary reason for
admission to intensive care (for example, in a patient suffering an
exacesbation of chronic- obstructive palmonary
or acute prieummia). Alternatively, it may be a feature of a
non.respiratory pathological process. for example severe sepsis from
an intra-abdominal source. though it is often the respiratory failure
rather than the intra-abdominal sepsis which triggers intensive care
adrms.sion. Respiratory failure is conventionally classified either gas

ly or 'type 2' based on Nood gas findings.

INTERPRETATION OF BLOOD GASES

The interpretatiOn ormood gaits , fundamental to the
management of patients requiring intensive care. not just those with
respiratory failure, When draNking -an anerial blood maple into a
heparinized syringe, ensure that any liquid heparin is completely
expelled from, the syringe before use. as this will contaminate the
sample and influence the results. Arteria" l blood is obtained either
direct puncture of an artery or from an indwelling arterial line. (See
Practical procedures: Arterial cannulation. p. 371)
Most ICUs now have a blood acs analy'ser for 'point of care
testing' (POCT). These are expensive to maintain and repair_ You
will be unpopular if you damage it by, for example. blocking the
sample channels with dotted blood. If you do not know how to it,
ask for help. Normal blood gas values are as shown in Table 5.
Interpreting blood gas results will eventually become second
nature. To begin witIL it is helpful to follow a system, for vamp-
· Look at the Pa02. Is the patient hypoxaemb:'
· Note the inspired oxygen concentration (Fi0:). The higher
tb-Fi0:2 required to achieNe any given Pa O, the
moresignitic.-ant the problem (see below ).
OH 7 s-'74c.. ,
PaC, kpa
5 3
22--25 rrimol
· Rase -of 4
kr) 4 frtflli:a411,- ·
TABLE 5.1 'Normal' blood gas values
 · I 0,, is it iow, normal or high?:
o 1,00k at the pll Is the patient ..tcidotic 101
33) or alka101ie
WI 4 '31!
I( the patient has a disturbance of acid-- base balance, then it is
11 - e-sto to examine the blood gas further to (ktermine the cauw,

· Look the AtC0-, ! , is the PaCO 2 consistent with the

-sh;.inge in lilt, it the pzit lent is zicidotic, is the P'clC(-)2
tt the pzitient is zilkalotic, is the Pa( '0, k)w? If so the primary
abnormality is likely to be respiratory.
· the PaCQ 1 is normal or does not explain the abnormality
pH, look zit the base deficit/base excess.

The base deficit/base excess is a calculation of how much base (e.g.

bicarbonztte) would need to be added to or taken away (by titratiO-A).
to normalize the pH of the sample. For example, in a Metabolic -
.
acidosis, bicarbonate Would need to be added to correct the: because
there is insufficient buffering capacity present; i.e. there as base
deficit. In metabolic alkalosis, bicarbonate would need to, be taken
away to correct the pH, because there is too much base (or
insufficient hydrogen ions) present, i.e. there is a base excess
· If the base deficit/base excess is consistent with the
abnormality in pH then the primary abnormality is metabolic.
· if both the PaCO, and the base excess/ base deficit are
both altered in a way thatois consistent with the abnormality in
pH then a mixed picture is present.
· if the PaCO, and base excess/deficit are both altered in
such a way that one is consistent with the change in pH and the
other is not,. then it is likely that, a compensated
acidosiS/alkaloSis is present (see descriptions below).
This simple scheme for the interpretation of blood uses is
practical and will suffice for most situations. More complex
systems, such as that described by Stewzirt, which take account of
other plasma constituents, are beyond the scope of this book. but
for which good up-to-date reviews are readily available. ff in
doubt always seek senior help.
A number of patterns of disturbance of acid—base balance are
recognized.

Respiratory acidosis
Hypo‘entilation from any cause results in accumulation of CO, and
respiratory acidosis. Over time, the bicarbonate concentration ma
rise (base excess) in an attempt to balance this and a
. ,
 · I 0,, is it iow, normal or high?:
o 1,00k at the pll Is the patient ..tcidotic 101
33) or alka101ie
WI 4 '31!
I( the patient has a disturbance of acid-- base balance, then it is
11 - e-sto to examine the blood gas further to (ktermine the cauw,

· Look the AtC0-, ! , is the PaCO 2 consistent with the

-sh;.inge in lilt, it the pzit lent is zicidotic, is the P'clC(-)2
tt the pzitient is zilkalotic, is the Pa( '0, k)w? If so the primary
abnormality is likely to be respiratory.
· the PaCQ 1 is normal or does not explain the abnormality
pH, look zit the base deficit/base excess.

The base deficit/base excess is a calculation of how much base (e.g.

bicarbonztte) would need to be added to or taken away (by titratiO-A).
to normalize the pH of the sample. For example, in a Metabolic -
.
acidosis, bicarbonate Would need to be added to correct the: because
there is insufficient buffering capacity present; i.e. there as base
deficit. In metabolic alkalosis, bicarbonate would need to, be taken
away to correct the pH, because there is too much base (or
insufficient hydrogen ions) present, i.e. there is a base excess
· If the base deficit/base excess is consistent with the
abnormality in pH then the primary abnormality is metabolic.
· if both the PaCO, and the base excess/ base deficit are
both altered in a way thatois consistent with the abnormality in
pH then a mixed picture is present.
· if the PaCO, and base excess/deficit are both altered in
such a way that one is consistent with the change in pH and the
other is not,. then it is likely that, a compensated
acidosiS/alkaloSis is present (see descriptions below).
This simple scheme for the interpretation of blood uses is
practical and will suffice for most situations. More complex
systems, such as that described by Stewzirt, which take account of
other plasma constituents, are beyond the scope of this book. but
for which good up-to-date reviews are readily available. ff in
doubt always seek senior help.
A number of patterns of disturbance of acid—base balance are
recognized.

Respiratory acidosis
Hypo‘entilation from any cause results in accumulation of CO, and
respiratory acidosis. Over time, the bicarbonate concentration ma
rise (base excess) in an attempt to balance this and a
. ,