Blood Gas Interpretation

Blood Gas Interpretation

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

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

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

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

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

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

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

Don t t trust the numbers without feeling the patient!

ph Pco 2 Po 2 SAT Cont HCO 3 BE FIO 2 Lac 10 min 7.149 104.2 11.2???? 36.5 4.3 Ambu RA 6.8 Warm Thoughts 09

ph Pco 2 Po 2 SAT Cont HCO 3 BE FIO 2 Lac 10 min 7.149 104.2 11.2???? 36.5 4.3 Ambu RA 6.8 Warm Thoughts 09 23 min 7.199 64.3 382 99.9 18.6 25.3-3.3 Ambu O 2 7.7

ph Pco 2 Po 2 SAT Cont HCO 3 BE FIO 2 Lac 10 min 7.149 104.2 11.2???? 36.5 4.3 Ambu RA 6.8 Warm Thoughts 09 23 min 7.199 64.3 382 99.9 18.6 25.3-3.3 Ambu O 2 7.7 30 min 7.217 71 77.2 91.6?? 29.1 0.5 10 lpm 7.4

ph Pco 2 Po 2 SAT Cont HCO 3 BE FIO 2 Lac 10 min 7.149 104.2 11.2???? 36.5 4.3 Ambu RA 6.8 Warm Thoughts 09 23 min 7.199 64.3 382 99.9 18.6 25.3-3.3 Ambu O 2 7.7 30 min 7.217 71 77.2 91.6?? 29.1 0.5 10 lpm 7.4 1 hr 7.267 53.3 121.2 98.4 16.9 24.5-2.4 10 lpm 9.3

Banana Cake 09 Adm ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac 7.449 26.1 58.4 91.7 10.8 18.3-4.2 RA

Banana Cake 09 ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac Adm 1 hr 7.449 26.1 58.4 91.7 10.8 18.3-4.2 RA 7.433 28.8 135.6 99.4 9.4 19.4-3.7 5 lpm 5.7

Banana Cake 09 ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac Adm 1 hr 4 hr 7.449 26.1 58.4 91.7 10.8 18.3-4.2 RA 7.433 28.8 135.6 99.4 9.4 19.4-3.7 5 lpm 5.7 7.471 32.5 136.3 99.6 10.1 23.9 1 5 lpm 6.2

Banana Cake 09 ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac Adm 1 hr 4 hr 24 hr 7.449 26.1 58.4 91.7 10.8 18.3-4.2 RA 7.433 28.8 135.6 99.4 9.4 19.4-3.7 5 lpm 5.7 7.471 32.5 136.3 99.6 10.1 23.9 1 5 lpm 6.2 7.452 28.3 127.7 99.4 10.1 20-2.9 3 lpm 6.5

Banana Cake 09 ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac Adm 1 hr 4 hr 24 hr 60 hr 7.449 26.1 58.4 91.7 10.8 18.3-4.2 RA 7.433 28.8 135.6 99.4 9.4 19.4-3.7 5 lpm 5.7 7.471 32.5 136.3 99.6 10.1 23.9 1 5 lpm 6.2 7.452 28.3 127.7 99.4 10.1 20-2.9 3 lpm 6.5 7.474 33.9 68.8 94.9 9.2 25.1 2.1 RA 3.7

Parisian Deputy 09 30 MIN ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac 7.099 34.6 97.9?? 10.8-17.3 RA 24.4

Parisian Deputy 09 ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac 30 MIN 2 HR 7.099 34.6 97.9?? 10.8-17.3 RA 24.4 7.335 43 133.8?? 23.2-1.9 5 lpm 13.2

Parisian Deputy 09 ph Pco2 Po2 SAT Cont HCO3 BE FIO2 Lac 30 MIN 2 HR 12 HR 7.099 34.6 97.9?? 10.8-17.3 RA 24.4 7.335 43 133.8?? 23.2-1.9 5 lpm 13.2 7.440 45.2 168.7?? 31 3.4 5 lpm 6.8

She's Jane 09 ph Pco2 Po2 SAT Cont HCO3 BE 7.200 67.0 35.9?? 26.4-2.2 FIO2 RA ambu Lac 9.3

She's Jane 09 ph 7.200 67.0 35.9?? 26.4-2.2 7.172 89.2 104.6?? 33 2.9 FIO2 RA ambu >15 lpm Lac 9.3 7.6 Pco2 Po2 SAT Cont HCO3 BE

Kool Kat Katie 09 ph BE 7.424 62.4 125.6 98.4 6 41.2 16.2 FIO2 10 lpm Lac 2.8 28-6% Pco2 Po2 SAT Cont HCO3 PCV

Lady Is A Pro 09 ph BE 6.682 64.9 95.2 80.9 16.9 7.8-29.4 FIO2 RA Temp 29.4 (32) Pco2 Po2 SAT Cont HCO3

Lady Is A Pro 09 ph BE 6.682 64.9 95.2 80.9 16.9 7.8-29.4 FIO2 RA 6.791 59.6 248.2 99.4 14.9 9.2-24.4 5 lpm Temp 29.4 (32) 29.4 Pco2 Po2 SAT Cont HCO3

Daydream 07

Daydream 07

Daydream 07 adm ph BE 7.369 38.3 20.3 <30 5.7 22.3-2.2 FIO2 RA Lac 12.7 0.40 Pco2 Po2 SAT Cont HCO3 PCV

Daydream 07 adm ph BE 7.369 38.3 20.3 <30 5.7 22.3-2.2 7.356 39.2 30.5 50.4 9.0 22.1-2.5 FIO2 RA > 15 lpm Lac 12.7 0.40 9.0 Pco2 Po2 SAT Cont HCO3 PCV

Daydream 07 adm ph CV BE 7.369 38.3 20.3 <30 5.7 22.3-2.2 7.356 39.2 30.5 50.4 9.0 22.1-2.5 7.343 44.2 28.6 46.4 7.8 24.2-1.1 FIO2 RA > 15 lpm > 15 lpm Lac 12.7 0.40 9.0 11.4 Pco2 Po2 SAT Cont HCO3 PCV

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

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

Pulmonary Hypertension 1.0 FIO2 trial Pao2 < 100 torr after 15-20 min Shunt fraction > 30% Cause of the hypoxemia extrapulmonary Large cardiac shunt PPHN

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

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

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