ABG Interpretation and Respiratory Failure

Normal values for ABG analysis

- pH: 7.38 - 7.42
- Normal PaO2: 85 - 100mmHg
- Normal PaCO2: 38 - 42mmHg
- HCO3: 22 - 26 mmol/L
- BE: +/- 2 mEq/L

Acid-base disturbance
- Acidosis: processes that decrease pH of body fluids to values less than normal
- Alkalosis: processes that increase pH of body fluids to values greater than normal
- Respiratory – means a primary change in PaCO2
o Respiratory acidosis: PaCO2 > 42mmHg, decreased pH, most common cause is hypoventilation
o Respiratory alkalosis: PaCO2 < 38mmHg, increased pH, hyperventilation – e.g. fevers from sepsis,
psychogenic drugs, overventilation by mechanical ventilation
- Metabolic (renal) – means a primary change in HCO3-
o Metabolic acidosis: HCO3- < 22mmol/L, decreased pH, causes include accumulation of acids in the
blood as a result of uncontrolled diabetes mellitus or tissue hypoxia
o Metabolic alkalosis: HCO3- > 26mmol/L, increased pH, causes include loss of acidic gastric
secretions by vomiting

Rules of thumb for interpreting oxygen

- PaO2 decreases with age e.g. 20 y.o PaO2 = 95mmHg vs. 80 y.o PaO2 = 75mmHg
- Expected PaO2 = 5 x FiO2

Respiratory failure:
- When the patient loses the ability to ventilate adequately or provide sufficient oxygen to the blood and
systemic organs
- ABG analysis

Types of respiratory failure

- Hypoxaemic (Type 1, lung, O2 gas movement):
o PaO2 < 60mmHg, PaCO2 < 42mmHg (hypoxaemia without hypercapnia)
o Lung disease is severe enough to interfere with O2 exchange
- Hypercapnic (Type 2, pump, CO2 movement, ineffective minute ventilation):
o PaCO2 > 50mmHg
o Respiratory pump is inadequate and cannot maintain ventilation to eliminate the CO2 produced by
metabolism

- Acute: rapid onset, short course and pronounced symptoms

- Chronic: long duration of poor ABG values, with (metabolic) compensation
- Acute on chronic: e.g. acute exacerbation of advanced COPD

Clinical manifestations
- Hypoxaemia:
o Decreased mental acuity
o Agitation followed by somnolence
o Dyspnoea
o Increased RR, change in POB
- Hypercapnia:
o Dyspnoea
o Increased RR, change in POB
 COPD – accessory muscle use, paradoxical breathing, intercostal space/rib indrawing,
pursed-lip breathing
o Agitation, tremor
o Confusion to coma
o Increased ICP (in brain injury), headache (no brain injury)