Prediction of arterial blood gas values from venous blood gas values in patients with acute respiratory failure receiving mechanical ventilation.

Abstract

Arterial blood gas (ABG) analysis is useful in evaluation of the clinical condition of critically ill patients; however, arterial puncture or insertion of an arterial catheter may cause many complications. This study evaluated whether pH, partial pressure of carbon dioxide (PCO2) and bicarbonate (HCO3-) values of venous blood gas (VBG) could accurately predict their ABG analogs for patients with acute respiratory failure treated by mechanical ventilation in an intensive care unit (ICU). Forty six patients who were admitted to the ICU due to acute respiratory failure and treated by mechanical ventilation were included in this study. Blood for VBG analysis was sampled from the cubital or dorsal palmar veins, while ABG was sampled simultaneously from the radial or brachial arteries via an arterial catheter at the other upper extremity. Regression equations and mean percentage-difference equations were derived to predict arterial pH, PCO2, and HCO3- values from their VBG analogs. The equations were validated by evaluating VBG and ABG samples from a separate group of 11 patients. A total of 46 paired samples from 46 patients were evaluated. The mean percentage differences between the venous and arterial values divided by venous values for pH, PCO2, and HCO3- were (mean +/- SD): deltapH (%), 0.50 +/- 0.45; deltaPCO2 (%), 17.09 +/- 9.60; and deltaHCO3- (%), 9.72 +/- 7.73; respectively. Regression equations for prediction of pH, PCO2 and HCO3- values were: arterial pH (pHa) = 0.45 + 0.94 x venous pH (pHv) [r = 0.83, p < 0.0001]; partial pressure of arterial CO2 (PaCO2) = 3.06 + 0.76 x partial pressure of venous CO2 (PvCO2) [r = 0.86, p < 0.0001]; and arterial HCO3- (HCO3-a) = 2.34 + 0.82 x venous HCO3- (HCO3-v) [r = 0.91, p < 0.0001]. The predicted ABG values from the mean percentage-difference equations were derived as follows: pHa = pHv x 1.005; PaCO2 = PvCO2 x 0.83; and HCO3-a = HCO3-v x 0.90. Validation of the regression equations and mean percentage-difference equations revealed only a small (clinically insignificant) variation between the actual and predicted ABG values. Venous blood gas can accurately predict the ABG values of pH, PCO2 and HCO3- for patients with acute respiratory failure being treated with mechanical ventilation.