Acute and Critical Care

Review Article

Surgery
Clinical applications of blood gas analysis: a comparative review of arterial and venous blood gas monitoring in critical care: Gyeo Ra Lee; Acute Crit Care. 2025;40(2):153-159. Published online May 30, 2025; DOI: https://doi.org/10.4266/acc.000900

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Blood gas analysis is an essential diagnostic tool used for assessing acid-base balance, ventilation, and oxygenation in critically ill patients. Arterial blood gas analysis (ABGA) remains the gold standard, primarily due to its accuracy in measuring oxygenation. Venous blood gas analysis (VBGA), in contrast, serves as a less invasive alternative and is particularly useful for evaluating acid-base status and metabolic function. Important parameters such as oxygen saturation of central venous blood (ScvO₂) and venous-to-arterial carbon dioxide pressure difference (∆pv-aCO₂) provide critical insights into hemodynamic status, cardiac output, and tissue perfusion. Although VBGA cannot replace ABGA for the precise assessment of oxygenation, it remains a valuable tool in clinical scenarios involving hemodynamic monitoring, shock management, and critical care decision-making.

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Abubakr Muhammed, Mohaned Altijani Abdalgadir Hamdnaalla, Fakher Aldeen Raft Fakher Aldeen Noman, Ahmed Altayeb Abbas Fadlallah, Mohammed Ali Mohammed Ali, Hanaa Ahmed Khalifa Elamin, Hala Aamir Abdelraouf Ahmed , Ameer Abdallatif Saeed Elkhazin, Hala Ome
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Original Articles

Blood Gases during Cardiopulmonary Resuscitation in Predicting Arrest Cause between Primary Cardiac Arrest and Asphyxial Arrest: Sei Jong Bae, Byung Kook Lee, Ki Tae Kim, Kyung Woon Jeung, Hyoung Youn Lee, Yong Hun Jung, Geo Sung Lee, Sun Pyo Kim, Seung Joon Lee; Korean J Crit Care Med. 2013;28(1):33-40.; DOI: https://doi.org/10.4266/kjccm.2013.28.1.33

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Abstract PDF: BACKGROUND
If acid-base status and electrolytes on blood gases during cardiopulmonary resuscitation (CPR) differ between the arrest causes, this difference may aid in differentiating the arrest cause. We sought to assess the ability of blood gases during CPR to predict the arrest cause between primary cardiac arrest and asphyxial arrest.
METHODS
A retrospective study was conducted on adult out-of-hospital cardiac arrest patients for whom blood gas analysis was performed during CPR on emergency department arrival. Patients were divided into two groups according to the arrest cause: a primary cardiac arrest group and an asphyxial arrest group. Acid-base status and electrolytes during CPR were compared between the two groups.
RESULTS
Presumed arterial samples showed higher potassium in the asphyxial arrest group (p < 0.001). On the other hand, presumed venous samples showed higher potassium (p = 0.001) and PCO2 (p < 0.001) and lower pH (p = 0.008) and oxygen saturation (p = 0.01) in the asphyxial arrest group. Multiple logistic regression analyses revealed that arterial potassium (OR 5.207, 95% CI 1.430-18.964, p = 0.012) and venous PCO2 (OR 1.049, 95% CI 1.021-1.078, p < 0.001) were independent predictors of asphyxial arrest. Receiver operating characteristic curve analyses indicated an optimal cut-off value for arterial potassium of 6.1 mEq/L (sensitivity 100% and specificity 86.4%) and for venous PCO2 of 70.9 mmHg (sensitivity 84.6% and specificity 65.9%).
CONCLUSIONS
The present study indicates that blood gases during CPR can be used to predict the arrest cause. These findings should be confirmed through further studies.

Relationship between the Changes of Arterial Blood Gas by Positioning from Prone to Supine and Patients' Survival in ARDS: Mi Young Kim, Sang Bum Hong, Chae Man Lim, Younsuck Koh; Korean J Crit Care Med. 2007;22(2):71-76.

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Abstract PDF: BACKGROUND
Prone positioning has been adopted as a strategy to improve oxygenation in patients with refractory acute respiratory distress syndrome (ARDS). After returning to supine position, most of patients show arterial blood gas changes. However, the clinical implications have not been elucidated. This study was aimed to observe the relationship between the arterial blood gas changes followed by changing position from prone to supine and survival of ARDS.
METHODS
We analyzed medical data of 53 ARDS patients, who showed improved arterial oxygenation (defined as the increase in PaO2/FiO2 by > or =20 mmHg within 8~12 hour after prone positioning) in a medical intensive care unit from January, 2000 to July, 2006. The patients were returned to supine position when they showed their PaO2/FiO2 > or =150 mmHg. We compared the arterial blood gas changes between the survivor and the nonsurvivor.
RESULTS
The survivor has significant pH improvement after position change (the survivor 0.01+/-0.06 vs. the nonsurvivor -0.03+/-0.08; p=.03). The PaO2/FiO2 and FiO2 changes were not different between the survivor (14.44 +/-69.68 and -2.2+/-4.3, respectively) and the nonsurvivor (-7.17+/-83.94 and 1.8+/-6.0, respectively; p=.314 and .843). The patients whose PaO2/FiO2 were deteriorated had higher mortality without statistical significance (p=.305). The PaCO2 changes were not different between two groups (-0.05+/-11.46 vs. 3.47+/-17.62, p=.390).
CONCLUSIONS
The early changes in pH differed significantly between the survivor and the nonsurvivor after returning patients to supine position from prone. Whether this marker can be a predictor of survival should be studied further.

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