Blood Gas Analysis Clinical Guide

Pulmonary

21 articles

Every clinician should have a basic understanding of respiratory physiology and know how to interpret blood gas results to better manage their patients. Blood gas analysis is invaluable in both outpatient and inpatient settings, particularly in critically ill patients. It’s no exaggeration to say that mastering blood-gas interpretation allows us to make life-saving decisions for our sickest patients. The physiologic principles reviewed in this Clinical Guide will equip you with a deep and thorough understanding of your patients’ respiratory problems. The articles in this guide are organized to guide you through a step-by-step approach to evaluating and assessing your patients (the same one followed in our Blood Gas Analysis Course). First, we review how to evaluate your patient’s oxygenation and ventilatory status, followed by the assessment of their acid-base status. In the end, you’ll have a solid foundation of a systematic approach to blood-gas interpretation that will empower you to look at a patient’s blood-gas report and know exactly what to do!

Michael A. Grippi, MD

AUTHOR

Editors:Shelley Jacobs, PhD

Peer reviewers:Franz Wiesbauer, MD MPH Internist

Last update4th Dec 2020

Chapter 1

The basics of blood gas analysis

Development of a deep understanding of arterial blood gas, or ABG, analysis is very much based on a solid appreciation of the underlying pulmonary physiology of gas exchange. This chapter of our Clinical Guide reviews the basic physics of gases in a way that’s intuitive and visually engaging. So, dive right in and lay the foundation for anything that’s to come in later chapters.

Chapter 2

Gas diffusion across the alveolar-capillary membrane

Arterial blood gas values reflect the efficiency of diffusion of gases, in particular, oxygen and carbon dioxide, across the alveolar-capillary membrane. Do you know that the major clinical manifestations of many lung diseases are a direct consequence of their effects on diffusion in the lung? The articles in this chapter review the critically important concept of gas diffusion across the alveolar-capillary membrane and look at relevant factors that affect it.

Chapter 3

All about oxygen transport

The extent to which the body can use oxygen and eliminate carbon dioxide depends not only on the efficiency of gas exchange in the lungs, but also on how well these gases are transported to and from metabolizing tissues. Many important clinical factors affect these transport mechanisms. This chapter addresses the movement of oxygen into and out of red blood cells and its distribution between hemoglobin and the rest of the red cell.

Chapter 4

What determines how oxygen is delivered to peripheral tissues?

Do you recall that oxygen delivery to peripheral tissues depends not only on how much oxygen is loaded into the blood in the lungs but also on the amount of blood pumped out of the left ventricle? The articles in this chapter address the determinants of oxygen delivery to peripheral tissues, including oxygen content of the blood and cardiac output.

Chapter 5

Demystifying the ventilation-perfusion relationship

While it’s easy to think about gas exchange by treating the lungs as a single homogeneous unit, the lungs are very heterogeneous in their structure and function. The heterogeneity has profound effects on gas exchange in health and disease. The articles of this chapter address the relationship between regional lung ventilation and perfusion. We’ll review the effect of alterations in these relationships on gas exchange in various disease states.

Chapter 6

The importance of carbon dioxide removal

It’s appropriate to focus on arterial blood gas analysis to understand how effectively the lungs oxygenate the blood. But equally important is the test’s value in assessing the elimination of the principal metabolic product of aerobic metabolism—carbon dioxide. The arterial carbon dioxide level is a critical parameter in the other major application of arterial blood gas testing—the analysis of your patient’s acid-base status. The articles in this chapter of our Blood Gas Analysis Clinical Guide, review the principal determinants of arterial PCO₂.

Chapter 7

A primer on acid-base balance

Looking at arterial oxygen tension is just one aspect of blood gas analysis. In addition to its valuable role in assessing respiratory function, arterial blood gas analysis is vitally important in evaluating acid-base balance. The articles in this chapter describe the relationship between arterial PCO₂ and ventilation, in particular, alveolar ventilation. The relationship between arterial PCO₂ and pH is reviewed, as are the roles of ventilation and alterations in arterial PCO₂ in adjusting arterial pH.