Arterial blood gas analysis

• Arterial blood gas (ABG) analysis is a blood test which

measures the acidity (pH) and the levels of oxygen and carbon
dioxide in the blood.
• Samples for blood gas analysis may be obtained from any number of
sites representing different regions of the vascular bed:
• Arterial blood gases (ABG) can be sampled directly from the radial or femoral
artery or withdrawn from an arterial catheter
• Venous samples are taken from a peripheral venous puncture or catheter;
• Mixed venous samples are taken from a pulmonary artery catheter.
• Arterial blood gases (ABGs) are frequently used to monitor the
condition of patients in the critical care setting and to help modify
respiratory interventions.
• Some of the indications for arterial blood gas analysis are-

– Any respiratory distress/failure (acute or chronic)

– Cardiac failure
– Liver failure
– Renal failure
– Hyperglycemic states
– Multiorgan failure
– Sepsis
– Burns
– Poisoning
– Assessment of response to interventions such as mechanical ventilation
Measurement in ABG
• Arterial pH
• Partial pressure of carbon dioxide (PaCo2)
• Partial pressure oxygen (PaO2 ),
• Oxygen saturation (SaO2 ),
• Bicarbonate (HCO3 − ) concentration, and
• Base excess (BE)
• The partial pressure of oxygen– It is the pressure of oxygen in
the arterial blood (dissolved in plasma) and is denoted by P02.
• The partial pressure of carbon dioxide -It is the pressure of
carbon dioxide in the arterial blood and is denoted by PCO2.
• Blood pH-The pH of blood indicates its acidity or alkalinity.
• Bicarbonate (HCO3)- Bicarbonate acts as a buffer in the blood
and helps maintain optimal pH
• Oxygen saturation- Denoted by sO2, it is the amount of oxygen
that is bound to hemoglobin in red blood cells
Normal Values
• pH range 7.35 to 7.45
• PaCO2 range 35 to 45 mm Hg
• PaO2 range 80-100 mm Hg
• HCO3 22-26 mmol/L
• Base Excess ± 2
Acid base terminology
• The “normal” human blood pH is 7.35-7.45, a pH of less than 7.4 is
defined as acidemia.
• The process causing the acidemia is called acidosis.
• There are only two ways in which acidemia can occur:
• (1) a low HCO3 − produces metabolic acidosis; or
• (2) a high PaCO2 , which is called respiratory acidosis
• A pH greater than 7.45 is defined as alkalemia, and the process
causing it is called alkalosis.
• There are also only two ways in which alkalemia can occur:
• (1) a high HCO3 − , which is called metabolic alkalosis; and
• (2) a low PaCO2 , which is called respiratory alkalosis
• These four acid–base states constitute the primary acid–base
disorders, and each elicits a compensatory response.
• If some disease were to cause a decreased HCO3 , the body’s
response would be an attempt to decrease the PaCO2 (a
compensatory respiratory alkalosis) to return the pH toward its
normal value.
• In this manner, respiratory compensation for primary metabolic
disorders begins in a matter of seconds by means of alveolar
hyperventilation or hypoventilation.
• The kidneys compensate for primary respiratory disorders by retaining
or excreting bicarbonate and hydrogen ions.
• However, unlike the rapidity with which respiratory compensatory
activity exhibits its effect, the renal compensatory process requires 12
to 24 hours to effect significant pH change.
Henderson hasselbalch equation
• These equation, suggest the inverse relationship between pH and
PaCO2 is established.
• This relationship is particularly helpful in clinical decision making
regarding the acid–base status of the patient.
• The Henderson–Hasselbalch equation permit us to “quickly” identify
any of the four primary disorders based on pH and CO2 .
• If the normal inverse relationship between pH and PaCO2 is
maintained, the primary problem is most likely respiratory in nature.
• On the other hand, if the relationship is not maintained, the primary
problem is most likely metabolic.
Interpreting abg
• Interpretation of ABG data involves :
• ▪ Assessment of ventilatory status
• ▪ Assessment of oxygenation and hypoxemic status
Assessment of ventilatory status
• 3 steps:
• 1. Determine whether the pH value reflects acidemia or alkalemia.
• 2. Classify the pathophysiologic state of the ventilatory system on the
basis of the relationship between the pH and PaCO2 values. This step
determines whether the blood gas values represent a primary
respiratory or a primary metabolic disorder.
• 3. Determine the adequacy of alveolar ventilation on the basis of the
PaCO2 value:
• • Less than 30 mm Hg = alveolar hyperventilation
• • Between 30 and 50 mm Hg = adequate alveolar ventilation
• • Greater than 50 mm Hg = ventilatory failure
• If the primary problem is metabolic, we classify the problem on the
basis of the relationship between the pH and the PaCO2 .
• The problem is classified as “uncompensated” if the reported pH is
outside the normal range and the reported PaCO2 is within the
normal range.
• Classified as “partially compensated” if both the reported pH and
PaCO2 are outside the normal range.
• Classified as “compensated” if the reported pH is within the normal
range and the reported PaCO2 is outside the normal range
Assessing Oxygenation and Hypoxemic
Status
• The oxygenation status of a patient is assessed by determining the
extent to which the observed PaO2 is above or below the normal
range.
• If a patient’s PaO2 is between 60 and 80 mm Hg, the patient is said to
be mildly hypoxemic; if it is between 40 and 60 mm Hg, moderately
hypoxemic; and if it is less than 40 mm Hg, severely hypoxemic.
• Hypoxemia strongly suggests tissue hypoxia and necessitates further
evaluation