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Objetivo: Avaliar se a realizacao rotineira da gasometria arterial em todos os pacientes cirroticos pode ser substituida pela oximetria de pulso isolada para a triagem de SHP. Material e metodos: Estudo observacional, individuado e transversal do tipo inquerito, por meio da analise dos prontuarios dos pacientes do ambulatorio de gastroenterologia e hepatologia do Hospital Santa Casa de Misericordia de Vitoria, localizado na cidade de Vitoria - ES, e por meio da analise da gasometria arterial destes pacientes. Como criterios para o diagnostico de cirrose, foram utilizados a historia clinica, o exame fisico, a analise laboratorial e pelo menos um exame de imagem. Resultados: A amostra teve 75,4% de homens, com etiologia alcoolica sendo mais prevalente (53%). A idade media foi de 54 anos, nao tendo correlacao com a PaO 2 (p = 0,754) e com a AaO 2 (p = 0,574). A prevalencia de pacientes Child A foi de 88,2% e Child B de 11,8%. A maioria (88,2%) dos pacientes apresentaram gradiente AaO 2 ≥ 20 mmHg, compativel com criterio diagnostico gasometrico de SHP. Discussao: Nao foi observada correlacao significativa entre a oxigenacao sanguinea medida pela gasometria arterial e pela oximetria de pulso. Pacientes com PaO 2 < 60 mmHg apresentaram SatO 2 minima de 93% e mediana de 97%, DP 2,2, comparado com minima de 85% e mediana de 87%, DP 3,9,  nos pacientes com niveis ≥ 60 mmHg (p = 0,827). Portanto, nota-se que a SatO 2 medida pela oximetria de pulso nao e um bom parâmetro para triagem de SHP nos pacientes cirroticos. Conclusoes: A gasometria arterial e indispensavel em todos os pacientes cirroticos para triagem da Sindrome Hepatopulmonar, independente da classe funcional, nao podendo ser substituida pela oximetria de pulso. Tal conduta visa acelerar o diagnostico dessa sindrome, considerando a inexistencia de correlacao entre os criterios diagnosticos gasometricos ja estabelecidos e os valores obtidos na oximetria de pulso e no escore Child-Pugh. Tendo em vista que a Sindrome Hepatopulmonar e uma indicacao de transplante hepatico, seu diagnostico precoce pode adiantar o processo, melhorando a resposta terapeutica e a sobrevida dos pacientes. Descritores: Sindrome hepatopulmonar, Cirrose hepatica, Transplante de figado, Oximetria, Gasometria ABSTRACT Objective: To evaluate whether routine arterial blood gas analysis in all cirrhotic patients can be replaced by isolated pulse oximetry for HPS screening. Material and methods: Observational, individualized and cross-sectional study, by analyzing the medical records of patients from the gastroenterology and hepatology outpatient clinic of the Santa Casa de Misericordia de Vitoria Hospital, located in the city of Vitoria - ES, and by analyzing the laboratory results of the arterial blood gases of these patients. The criteria for the diagnosis of cirrhosis were clinical history, physical examination, laboratory analysis and at least one imaging exam. Results: A total of 75.4% of the sample consisted of males, with alcoholic etiology being more prevalent (53%). The mean age was 54 years, with no correlation with PaO 2 (p = 0.754) and AaO 2 (p = 0.574). The prevalence of Child A patients was 88.2% and of Child B was 11.8%. The majority (88.2%) of the patients presented a AaO 2 gradient ≥ 20 mmHg, compatible with HPS gasometric diagnostic criteria. Discussion : No significant correlation was observed between blood oxygenation as measured by arterial blood gas and pulse oximetry. Patients with PaO 2 <60 mmHg had a minimum SatO 2 of 93% and a median of 97%, SD 2.2, compared with a minimum of 85% and a median of 87%, SD 3.9, in patients with levels ≥ 60 mmHg (p = 0.827). Therefore, it is noted that SatO 2 measured by pulse oximetry is not a good parameter for screening for SHP in cirrhotic patients. Conclusion : Arterial blood gas analysis is indispensable in all cirrhotic patients in screening for Hepatopulmonary Syndrome, regardless of functional class, and cannot be replaced by pulse oximetry. Such conduct aims to accelerate the diagnosis of this syndrome, considering the inexistence of correlation between the already established gasometric diagnostic criteria and the values obtained in pulse oximetry and Child- Pugh score. Since the existence of Hepatopulmonary Syndrome is an indication for liver transplantation, early diagnosis may accelerate the process, improving therapeutic response and survival in patients. Keywords: Hepatopulmonary syndrome, Liver cirrhosisc Liver transplantation, Oximetry, Gasometry

arquivos médicos dos hospitais e da faculdade de ciências médicas da santa casa de são paulo

Triagem da síndrome hepatopulmonar: oximetria de pulso ou gasometria arterial?/ Hepatopulmonary syndrome screening: pulse oximetry or arterial gasometry?