Role of initial arterial blood gas variations in predicting the outcome of pneumonia patients with type I/II respiratory failure
DOI:
https://doi.org/10.18203/2349-3933.ijam20161082Keywords:
Arterial blood gas, Pneumonia, Hypoxemia, Hypercapnia, Chronic obstructive pulmonary diseaseAbstract
Background: A correlation between, the early variations in the individual arterial blood gas (ABG) parameters - pH, PaO2, PaCO2 and HCO3-, and the treatment outcome, in pneumonia patients in respiratory failure, has not been well investigated. If a statistically significant variation among the individual ABG parameters would be an early, reliable predictor of the treatment outcome, it would facilitate prompt active management of the patient in respiratory failure from pneumonia before a clinically apparent downward turn culminates.
Methods: This prospective study was conducted on a sample of 42 patients, with clinical evidence of pneumonia and baseline clinical data and 2 arterial blood samples (one, at the baseline and another, within 24 hours from the first) were harvested for ABG analysis. Assessment of the ABG reports classified patients as belonging to group ‘A’ with type I (hypoxemic) respiratory failure or as group ‘B’ with type II (hypercapnic) respiratory failure. Binary logistic regression analysis was performed.
Results: In group A, the individual ABG parameters had a significant positive correlation with the treatment outcome: pH (p=0.034), HCO3- (p=0.034), PaO2 (p=0.035), PaCO2 (p=0.045), whereas in Group B, a non-significant positive correlation, pH (p=0.284), HCO3- (p=0.248), PaO2 (p=0.39), PaCO2 (p=0.240) was observed. In group B, a treatment failure rate of 40.91% was seen, as against 25% in Group A.
Conclusions: Variations among individual ABG parameters can predict treatment outcome in pneumonia patients of type I respiratory failure, and fail to do so in those with type II respiratory failure.
References
Ruuskanen O, Lahti E, Jennings LC, Murdoch DR. Viral pneumonia. Lancet. 2011;377:1264-75.
Mohler JG. The basics for clinical blood gas evaluation. In: Wilson AF, ed. Pulmonary Function Testing, Indications and Interpretations. Orleano, Florida: Grune & Stratton; 1985:153-73.
Clark LC. Monitor and control of blood and tissue oxygen tensions. Trans Am Soc Artif Intern Organs. 1956;2:41-8.
Raffin TA. Indications of Arterial Blood Gas Analysis. Ann Intern Med. 1986;105:390-8.
Thorson SH, Marini JJ, Pierson DJ, Hudson LD. Variability of arterial blood gas values in stable patients in the ICU. Chest. 1983;84:14-8.
Sabin S, Taylorjr, Kaplan AL. Clinical experience using a small gauge needle for arterial puncture. Chest. 1978;69:437-9.
Shoemaker WC. Monitoring of the critically ill patient. In: Shoemaker WC, Thompson WL, Holbrookpr, eds. Textbook of Critical Care. Philadelphia: W.B. Saunders. 1984:105-21.
Cissik JH, Salustro J, Patton OL, Louden JA. The effects of sodium heparin on arterial blood gas analysis. CVP. 1977;17-35.
Hess CE, Nicholas AB, Hunt WB, Surrat PM. Pseudohypoxemia secondary to leukemia and thrombocytosis. N Engl J Med. 1979;301:361-3.
Mehta S, Hill NS. Noninvasive ventilation. Am J Resp Crit Care Med. 2001;163(2):540-77.
Confalonieri M, Potena A, Carbone G, Porta RD, Tolley EA, Meduri GU. Acute Respiratory Failure in Patients with Severe Community-acquired Pneumonia. A Prospective Randomized Evaluation of Noninvasive Ventilation. Am J Respir Crit Care Med. 1999;160(5):1585-91.
Jeffrey AA, Warren PM, Flenley DC. Acute hypercapnic respiratory failure in patients with chronic obstructive lung disease: risk factors and use of guidelines for management. Thorax. 1992;47:34-40.
Ruiz M, Ewig S, Marcos MA, Martinez JA, Arancibia F, Mensa J, et al. Etiology of community acquired pneumonia: impact of age, comorbidity and severity. Am J Respir Crit Care Med. 1999;160:397-405.
Farr BM, Bartlett CL, Wadsworth J, Miller DL. Risk factors for community-acquired pneumonia diagnosed upon hospital admission. British thoracic society pneumonia study group. Respir Med. 2000;94:954-63.
Fine MJ, Orloff JJ, Arisumi D, Fang GD, Arena VC, Hanusa BH et al. Prognosis of patients hospitalized with community-acquired pneumonia. Am J Med. 1990;88(5N):1N-8N.
Almirall J, Bolibar I, Balanzo X, Gonzalez CA. Risk factors for community-acquired pneumonia in adults: a population-based case-control study. Eur Respir J. 1999;13:349-55.
Almirall J, Mesalles E, Klamburg J, Parra O, Agido A. Prognostic factors of pneumonia requiring admission to the intensive care unit. Chest. 1995; 107:511-16.
Torres A, Serra-batlles J, Ferrer A, Jiménez P, Celis R, Cobo E et al. Severe community acquired pneumonia. Epidemiology and prognostic factors. Am Rev Respir Dis. 1991;144:312-8.
Garcia-ordonez MA, Garcia-jimenez JM, Paez F, Alvarez F, Poyato B, Franquelo M, et al. Clinical aspects and prognostic factors in elderly patients hospitalised for community-acquired pneumonia. Eur J Clin Microbiol Infect Dis. 2001;20:14-9.
Lim WS, Lewis S, Macfarlane JT. Severity prediction rules in community acquired pneumonia: a validation study. Thorax. 2000;55:219-23.
Lim WS, Van der eerden MM, Laing R, Boersma WG, Karalus N, Town GI, et al. Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax. 2003;58:377-82.
Singh S, Amin AV, Loke YK. Long-term Use of Inhaled Corticosteroids and the Risk of Pneumonia in Chronic Obstructive Pulmonary Disease, a meta-analysis. Arch Intern Med. 2009;169:219-29.
Crim C, Calverley PM, Anderson JA, Celli B. Ferguson GT, Jenkins C et al. Pneumonia risk in COPD patients receiving inhaled corticosteroids alone or in combination: TORCH study results. Eur Respir J. 2009;34:641-7.
Restrepo MI, Mortensen EM, Pugh JA, Anzueto A. COPD is associated with increased mortality in patients with community-acquired pneumonia. Eur Respir J. 2006;28:346-51.
Torres A, Dorca J, Zalacain R, Bello S, El-Ebiary M, Molinos L, et al. Community-acquired pneumonia in chronic obstructive pulmonary disease: a spanish multicenter study. Am J Respir Crit Care Med. 1996;154:1456-61.
Christensen S, Rasmussen L, Hovrath-puho E, Lenler-petersen P, Rhode M, Johnsen SP. Arterial blood gas derangement and level of comorbidity are not predictors of long-term mortality of COPD patients treated with mechanical ventilation. Eur J Anaesth. 2008;25:550-6.
Enserink M. Global health: Some neglected diseases are more neglected than others. Science. 2009;323(5915):700.
