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Blood: gas analysis

ISSN 2398-2969


Synonym(s): Arterial blood gas ABG analysis

Overview

  • Complete information about pulmonary gas exchange, acid-base and electrolyte status of the patient is provided by measuring pH, PO2 (partial pressure of oxygen), PCO 2 (partial pressure of carbon dioxide), electrolytes and metabolites on arterial or venous blood.
  • Other parameters, such as HCO3 (bicarbonate), TCO2 (total CO2 ), SaO2 (arterial oxygen saturation), AnGap (anion gap) and BE (base excess) can also be calculated using specific formulas.
  • Useful monitoring tool to evaluate pulmonary function, blood oxygenation, ventilation and acid-base status of a conscious patient which may be suffering from disease, or of a patient which may be undergoing prolonged anesthesia.

Uses

Alone

  • Point-of-care analyzers allow immediated results and guarantee improved diagnostic performance.
  • Early therapeutic management is possible with improved and more favorable outcome.
  • Furthermore, considering the limitations of techniques such as capnography and pulse oximetry     Anesthesia: intra- and post-operative care  if used alone, blood gas analysis is advised for correct and precise evaluation of ventilation and perfusion in conscious and anesthetized rabbits.

In combination

  • Peripheral vasoconstriction and ventilation/perfusion inadequacy do not affect this diagnostic method. This is as opposed to non-invasive techniques such as pulse oximetry and capnography which can be of limited efficacy if used alone in severely ill patients.
  • Blood gas analysis will indicate deterioration of SaO2  before any drop is SPO2  can be detected by the pulse oximeter, implying that pulse oximetry alone should not be relied upon to predict SaO2 .
  • The correlation between ETCO2 measured via capnography, and PaCO2 obtained via arterial blood gas analysis, is high making capnography a valid monitoring tool. Nevertheless, ETCO2 values in conscious rabbits should be interpreted with caution, especially considering that rabbits are near obligate nasal breathers which tend to readily hyperventilate.
  • A capnogram should be evaluated concurrently to identify hyperventilation, white blood gas analysis is performed to properly quantify the PaCO2 .

Other points

  • A real indication of the respiratory and metabolic status of a patient can be easily and rapidly obtained.

Sampling

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Tests

Methodologies

  • Different laboratory systems are available which consist of compact, chemistry analyzers capable of performing hematology, biochemistry and immunoassays, and of measuring electrolytes and blood gas parameters.

Availability

  • Readily available.

Validity

  • Studies are warranted to provide sufficient evidence that point-of-care analyzers produce reliable measurements comparable to reference laboratories, and in agreement with references provided by bench top analyzers.
  • Instrument-specific reference intervals are needed. It is advisable to use the same instrument when multiple assessments of a single patient are performed.

Validity

Sensitivity

  • Limited data available.

Specificity

  • Limited data available.

Technique intrinsic limitations

Technician extrinsic limitations

  • It is possible to transfer the sample to a lithium heparin tube before loading into the rotor.
  • Air bubbles or excessive pressure during sampling.
  • Erroneous sampling of venous rather than arterial blood.

Result Data

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Eatwell K et al (2013) Use of arterial blood gas analysis as a superior method for evaluating respiratory function in pet rabbits. Vet Rec 173 (7), 166 PubMed.
  • Eatwell K, Mancinelli E, Headley J, Benato L, Shaw D J, Self I & Meredith A (2013) Comparison of invasive and non-invasive methods of respiratory monitoring in domestic rabbits (Oryctolagus cuniculus). Vet Rec [accepted for publication Apr 2013].
  • Ardiaca M, Bonvehi C & Montesinos A (2013) Point-of-care blood gas and electrolyte analysis in rabbits. Vet Clin Exot Anim 16, 175-195 PubMed.
  • Benato L, Chesnel M, Eatwell K & Meredith A (2013) Arterial blood gas parameters in pet rabbits anaesthetized using a combination of fentanyl-fluanisone-midazolam-isofluorane. JSAP May 10. doi: 10.1111/jsap.12081 PubMed.
  • Stanford M (2004) Practical use of capnography in exotic animal anaesthesia. Exotic DVM (3), 49-52.

Other sources of information

  • Adams A P (1989) Capnography and Pulse Oximetery. In: Recent Advances in Anaesthesia and Analgesia. Eds: Atkins R S & Adams A P. Churchill Livingston, UK. pp 155-175.