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Arterial Blood Gas analyser is one of the most important point of care testing in intensive care unit that has immense clinical value in the management of critically ill patients. The technological innovations in Point-of-care devices offer rapid analysis at the patient bed side which produce quick and accurate results. The advancement in the innovations of blood gas analysers that has occurred in the last decades has not brought a respective advance in the field of diagnosis. There are only few graphical visualization tools available for Arterial blood Gas (ABG) interpretation depicting the respiratory and metabolic acid-base disturbances. Davenport or Bicarbonate-pH diagram is a graphical tool to depict the respiratory and metabolic acid-base disturbances which is rarely used in clinical setting. Grogono diagram, despite its higher diagnostic agreement compared to the classic Siggaard-Andersen diagram, is not superior to the Oxygen Status Algorithm software program. The parameters like pH, pCO2, bicarbonate and Standard base excess are routinely utilized for interpretation. The bicarbonate concentration parameter is useful only in patients with normal respiration because it is a variable parameter highly influenced by the changes in the concentration of carbon-dioxide (pCO2). This is solved by measuring Standard bicarbonate. The deviation between these two values denote the respiratory influence. The ratio between bicarbonate and standard bicarbonate value and the differences between bicarbonate/carbonic acid and standard bicarbonate/carbonic acid ratio values render some clues in discriminating various acid base disorders. This concept was applied in a previous research study for the development of a novel four quadrant graphical method for ABG interpretation by the current author using standard base excess values in the x axis and the ratio {(HCO3 Standard HCO3) /carbonic acid} in the y axis. A minor problem with the ratio {(HCO3 Standard HCO3) /carbonic acid} is that as the pCO2 increases, this ratio also increases but afterwards the curve flattens and may not clearly differentiate the different higher levels of pCO2 values. The aim of the current research study is to rectify this problem by the construction of the revised four quadrant graphical tool for ABG interpretation.

Revised Graphical Tool for ABG Interpretation using Modified Bicarbonate/Standard Bicarbonate Ratio