Blood Gas Interpretation

Transcription

1 Blood Gas Interpretation

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3 Pa O2 Saturation (SaO 2 ) Oxygen Therapy Monitoring Oxygen content (O( 2 Ct)

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9 Venous Oximetry Mixed venous oxygen saturation SvO 2 Surrogate for Systemic oxygen delivery and consumption Central venous oxygen saturation ScvO 2 Oxygen extraction Brain and the upper part of the body Low SvO 2 or ScvO 2 Mismatch between O Mismatch between O 2 delivery/tissue O 2 need

10 Venous Oximetry O 2 consumption independent of delivery More can be extracted as needed Fails when delivery drops low enough With decreased delivery Compensation fails More extraction Low ScvO 2 means tissue hypoxia Increased metabolic stress

11 Venous Oximetry Low SvO 2 Delivery not increase as tissue needs increase Delivery decreases for some reason Decrease arterial O2 content Decrease CO Response to tissue hypoxia Increase CO Increase extraction Decrease SvO2 Normal response as in exercise Drop SvO2 Not mean tissue hypoxia Response to prevent hypoxia Compensation

12 Venous Oximetry Scvo2 < Svo2 = 2-3% 2 Normal individuals Lower body blood supply not just O2 delivery Kidneys GIt Liver Scvo2 > Svo2 = 8% Shock Less blood delivered lower body Higher extraction O2 ScvO2 is equivalent to SvO2 In clinical decisions

13 Venous Oximetry Low ScvO 2 in shock Global increase oxygen extraction Compensation failing In face of adequate loading (Pao 2 > 80) Causes Decreased CO Inadequate PCV

14 Venous Oximetry Goal Cure ScvO2 > 70% Pao2 > 80 Fluid therapy Inotrope - dobutamine Blood transfusion Only guide it can lie Low insufficient O2 delivery, poor lung loading High good delivery but many not be everywhere

15 Don t t trust the numbers without feeling the patient!

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17 ph Pco 2 Po 2 SAT Cont HCO 3 BE FIO 2 Lac 10 min ???? Ambu RA 6.8 Warm Thoughts 09

18 ph Pco 2 Po 2 SAT Cont HCO 3 BE FIO 2 Lac 10 min ???? Ambu RA 6.8 Warm Thoughts min Ambu O 2 7.7

19 ph Pco 2 Po 2 SAT Cont HCO 3 BE FIO 2 Lac 10 min ???? Ambu RA 6.8 Warm Thoughts min Ambu O min ?? lpm 7.4

20 ph Pco 2 Po 2 SAT Cont HCO 3 BE FIO 2 Lac 10 min ???? Ambu RA 6.8 Warm Thoughts min Ambu O min ?? lpm hr lpm 9.3

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22 Banana Cake 09 Adm ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac RA

23 Banana Cake 09 ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac Adm 1 hr RA lpm 5.7

24 Banana Cake 09 ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac Adm 1 hr 4 hr RA lpm lpm 6.2

25 Banana Cake 09 ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac Adm 1 hr 4 hr 24 hr RA lpm lpm lpm 6.5

26 Banana Cake 09 ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac Adm 1 hr 4 hr 24 hr 60 hr RA lpm lpm lpm RA 3.7

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29 Parisian Deputy MIN ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac ?? RA 24.4

30 Parisian Deputy 09 ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac 30 MIN 2 HR ?? RA ?? lpm 13.2

31 Parisian Deputy 09 ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac 30 MIN 2 HR 12 HR ?? RA ?? lpm ?? lpm 6.8

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33 She's Jane 09 ph Pco2 Po2 SAT Cont HCO3 BE ?? FIO2 RA ambu Lac 9.3

34 She's Jane 09 ph ?? ?? FIO2 RA ambu >15 lpm Lac Pco2 Po2 SAT Cont HCO3 BE

35 Kool Kat Katie 09 ph BE FIO2 10 lpm Lac % Pco2 Po2 SAT Cont HCO3 PCV

36 Lady Is A Pro 09 ph BE FIO2 RA Temp 29.4 (32) Pco2 Po2 SAT Cont HCO3

37 Lady Is A Pro 09 ph BE FIO2 RA lpm Temp 29.4 (32) 29.4 Pco2 Po2 SAT Cont HCO3

38 Daydream 07

39 Daydream 07

40 Daydream 07 adm ph BE < FIO2 RA Lac Pco2 Po2 SAT Cont HCO3 PCV

41 Daydream 07 adm ph BE < FIO2 RA > 15 lpm Lac Pco2 Po2 SAT Cont HCO3 PCV

42 Daydream 07 adm ph CV BE < FIO2 RA > 15 lpm > 15 lpm Lac Pco2 Po2 SAT Cont HCO3 PCV

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49 Pulmonary Hypertension Sequela to many cases of ALI Increased pulmonary vascular resistance Inflammatory mediators Severe hypoxemia

50 Persistent Pulmonary Hypertension of the Neonate PPH-N Right to left shunting Foramen ovale Ductus arteriosus Reversion to fetal circulation Adaptive advantage Achieve adequate systemic cardiac output Neonate s unique ability Exist in a hypoxemic state Regain CO by shunting Survive pulmonary hypertension without systemic ischemia

51 Pulmonary Hypertension 1.0 FIO2 trial Pao2 < 100 torr after min Shunt fraction > 30% Cause of the hypoxemia extrapulmonary Large cardiac shunt PPHN

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53 Pulmonary Hypertension Pulmonary hypertension Failure to make the birth transition PPHN Imbalance of vasodilators and vasoconstrictors Nitric oxide and endothelin Regression to fetal circulation PPHN Perinatal hypoxemia Cytokine showers Secondary Pulmonary disease Septic shock ALI

54 Pulmonary Hypertension Therapy Traditional therapy Maximize exposure to O2 Ventilation with 100% oxygen Alkalinize arterial ph Mild hyperventilation Treatment with bases Maintain systemic blood pressure Counterbalance the pulmonary pressure ALI will counteract these approaches Inhaled NO therapy 5 to 20 ppm Immediate effect Significant pulmonary toxicity possible Free radicals

55 Pulmonary Hypertension Therapy NO - Mechanism of action Vasodilation Increasing cgmp levels Relaxation of the pulmonary vasculature Type V phosphodiesterase inhibitors Selectively prevent cgmp destruction Endogenous nitric oxide Pulses of exogenous nitric oxide Currently available Sildenafil Vardenafil Tadalafil