Open AccessIs venous blood gas performed in the E mergency D epartment predictive of outcome during acute on chronic hypercarbic respiratory failure?
Author(s) -
Domaradzki Lisa,
Gosala Sahithi,
Iskandarani Khaled,
Van de Louw Andry
Publication year - 2018
Publication title -
the clinical respiratory journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.789
H-Index - 33
eISSN - 1752-699X
pISSN - 1752-6981
DOI - 10.1111/crj.12746
Subject(s) - medicine , intubation , venous blood , arterial blood , emergency department , anesthesia , respiratory failure , mechanical ventilation , surgery , psychiatry
Background During acute on chronic hypercarbic respiratory failure (AHRF), arterial pH is associated with non‐invasive ventilation (NIV) failure and mortality. Venous blood gas (VBG) has been proposed as a substitute for arterial blood gas, based on a good agreement between venous and arterial values. We assessed the predictive value of admission VBG on intubation rate, NIV failure and mortality during AHRF. Methods Retrospective chart review of inpatients admitted between 2009 and 2015 with AHRF who had VBG performed on admission. Demographic, clinical and biological data were collected throughout the hospital course. Results 196 patients were included and hospital survival was not significantly associated with initial venous pH, PCO 2 orHCO 3 – . Patients requiring intubation had significantly lower venous pH [7.29 (7.24–7.33) vs 7.31 (7.28–7.36), P = .04] while venous PCO 2 andHCO 3 –did not differ as compared to non‐intubated patients. Intubation within 48 h of admission was associated with significantly lower venous pH [7.28 (7.24–7.30) vs 7.32 (7.28–7.37), P = .002] and higher PCO 2 [72 (63–92) mm Hg vs 62 (52–75) mm Hg, P = .04]. Among 69 patients receiving NIV, there were no differences in venous pH [7.29 (7.25–7.31) vs 7.30 (7.27–7.35), P = .3] or PCO 2 [68 (44–74) mm Hg vs 70 (55–97) mm Hg, P = .23] associated with subsequent intubation. Using c statistics, we observed poor performances of venous pH, PCO 2 orHCO 3 –for prediction of NIV failure, intubation or hospital mortality. Conclusions Our results do not support the use of VBG on admission as a predictor for NIV failure, intubation and mortality during AHRF.