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.

Citations

Citations to this article as recorded by

Reference intervals for venous blood gas measurement in a healthy Chinese population
Sheng Jiang, Qian Zhao, Hua Wang, Min Li, Yuanzhu Ou, Weiwei Lin
Clinica Chimica Acta.2027; 592: 121212. CrossRef
Ultrasound guidance versus conventional technique for radial arterial puncture in patients with shock in the emergency department: a randomized controlled trial
Durmus Ali Ersahin, Ismail Erkan Aydin, Tugce Ersahin, Nalan Kozaci
BMC Emergency Medicine.2026;[Epub] CrossRef
Central venous oxygen saturation vs. oxygen extraction ratio in septic shock resuscitation: Which metric is more informative?
Athanasios Chalkias, Konstantina Katsifa, Stavroula Amanetopoulou, Aikaterini Nodarou, Petros Lampropoulos, Ioannis Thiveos, Konstantinos Sakellaridis, Varvara Grammatikopoulou, Athanasios Prekates, Paraskevi Tselioti
Anesthesiology and Perioperative Science.2026;[Epub] CrossRef
Beyond blood pressure: a comprehensive overview of clinical indices in shock and tissue hypoperfusion
Jooyun Kim, Saeyeon Kim, Ji-Hee Lee, Sua Kim
Acute and Critical Care.2026; 41(2): 201. CrossRef
Impacts of inspired oxygen concentration and arterial oxygen tension on venous and tissue oxygen saturation
Kwok Ming Ho
Acute and Critical Care.2026; 41(2): 436. CrossRef
Closing the Gap: Central Venous-to-Paco 2 Difference in Pediatric Shock
Michelle Adu-Darko
Pediatric Critical Care Medicine.2026; 27(7): 899. CrossRef
A population-adaptive decision-support method for ventilator parameter optimization
Xianhui Lian, Tianliang Hu, Songhua Ma, Dedong Ma
Knowledge-Based Systems.2026; 349: 116490. CrossRef
Vertical Displacement Index and Early Treatment-Related Physiological Improvement in Acute Respiratory Failure: An Exploratory Ultrasound-Based Study
Bedriye Müge Sönmez, İlker Şirin, Gülşen Akçay, Murat Özdemir, Necip Gökhan Güner
Advances in Respiratory Medicine.2026; 94(3): 40. CrossRef
Patient characteristics, vital signs and tcpCO2 dynamics significantly influence tcpCO2 accuracy in extremely preterm infants: an observational study
Lena Olivier, Camelia Lauterbach Oprea, André Stollenwerk, Valerie Pfannschmidt, Thorsten Orlikowsky, Mark Schoberer
Frontiers in Pediatrics.2026;[Epub] CrossRef
Essential Data Elements for Laboratory Test Interoperability: An Expert Consensus-Based Framework
Ha Nui Kim, Min-Sun Kim, Sollip Kim, Kuenyoul Park, Eun-Jung Cho, Hyejin Ryu, YeJin Oh, Shinae Yu, John Hoon Rim, Sang-Mi Kim, Geon Park, Jaehyeon Lee, Hyun-Seung Lee, Hyun-Woo Choi, You Kyoung Lee, Jeong Hwan Shin, Sang-Guk Lee, Young Kyung Lee, Jeong-Ye
Annals of Laboratory Medicine.2026; 46(5): 507. CrossRef
Assessing and Enhancing the Interpretation Quality of Arterial Blood Gas Among Junior Doctors
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
Cureus.2025;[Epub] CrossRef
Using zlog in spider charts for fast diagnosis recognition
Johannes Böhm, Johannes Daubitzer, Thorsten M. Smul, Lisa-Maria Meier, Sven Schneider
Journal of Laboratory Medicine.2025; 49(6): 268. CrossRef
Predictive performance of central venous oxygen saturation, lactate, base excess, and alactic base excess for intradialytic hypotension
Angelica J. Luevanos-Aguilera
BMC Nephrology.2025;[Epub] CrossRef

Original Article

Pulmonary
Effects of high-flow nasal cannula in patients with mild to moderate hypercapnia: a prospective observational study: Kyung Hun Nam, Hyung Koo Kang, Sung-Soon Lee, So-Hee Park, Sung Wook Kang, Jea Jun Hwang, So Young Park, Won Young Kim, Hee Jung Suh, Eun Young Kim, Ga Jin Seo, Younsuck Koh, Sang-Bum Hong, Jin Won Huh, Chae-Man Lim; Acute Crit Care. 2021;36(3):249-255. Published online July 26, 2021; DOI: https://doi.org/10.4266/acc.2020.01102

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Abstract PDF

Background
Evidence for using high-flow nasal cannula (HFNC) in hypercapnia is still limited. Most of the clinical studies had been conducted retrospectively, and there had been conflicting reports for the effects of HFNC on hypercapnia correction in prospective studies. Therefore, more evidence is needed to understand the effect of the HFNC in hypercapnia.
Methods
We conducted a multicenter prospective observational study after applying HFNC to 45 hospitalized subjects who had moderate hypercapnia (arterial partial pressure of carbon dioxide [PaCO2], 43–70 mm Hg) without severe respiratory acidosis (pH <7.30). The primary outcome was a change in PaCO2 level in the first 24 hours of HFNC use. The secondary outcomes were changes in other parameters of arterial blood gas analysis, changes in respiration rates, and clinical outcomes.
Results
There was a significant decrease in PaCO2 in the first hour of HFNC application (-3.80 mm Hg; 95% confidence interval, -6.35 to -1.24; P<0.001). Reduction of PaCO2 was more prominent in subjects who did not have underlying obstructive lung disease. There was a correction in pH, but no significant changes in respiratory rate, bicarbonate, and arterial partial pressure of oxygen/fraction of inspired oxygen ratio. Mechanical ventilation was not required for 93.3% (42/45) of our study population.
Conclusions
We suggest that HFNC could be a safe alternative for oxygen delivery in hypercapnia patients who do not need immediate mechanical ventilation. With HFNC oxygenation, correction of hypercapnia could be expected, especially in patients who do not have obstructive lung diseases.

Citations

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Management of hypercapnic acute respiratory failure with high-flow nasal cannula therapy: A narrative review
Christophe Girault, Elise Artaud-Macari, Pierre-Louis Declercq, Jean-Pierre Frat, Jean-Damien Ricard, Arnaud W. Thille, Gaëtan Béduneau
Annals of Intensive Care.2026; 16: 100053. CrossRef
Efficacy of high-flow nasal cannula versus conventional face mask oxygen therapy on ipsilateral cerebral haemodynamics during the immediate post-extubation phase following carotid endarterectomy: protocol for a randomised controlled trial
Zice Liu, Yi An, Lixia Li, Zhongjia Li, Chuanyu Liang, Pei Wang, Ke Cui, Manke Luo, Shuning Zhang, Xue Li, Shuai Ruan, Tianlong Wang, Qinghai Liu, Lei Zhao
BMJ Open.2026; 16(7): e120038. CrossRef
A high-flow nasal cannula versus noninvasive ventilation in acute exacerbations of chronic obstructive pulmonary disease
Oguzhan Haciosman, Huseyin Ergenc, Adem Az, Yunus Dogan, Ozgur Sogut
The American Journal of Emergency Medicine.2025; 87: 38. CrossRef
Successful Asymmetric Nasal High-Flow Therapy in CO₂ Narcosis Triggered by Pneumonia in an Elderly Patient: A Case Report
Keita Takahashi, Shigeto Ishikawa, Akari Kusaka, Hiroyuki Takeuchi, Tomohiko Akahoshi
Cureus.2025;[Epub] CrossRef
Gas composition and pressure in the hypopharynx during high-flow oxygen therapy through a nasal cannula in healthy volunteers with different breathing patterns
Andrey I. Yaroshetskiy, Anna P. Krasnoshchekova, Fedor D. Tkachenko, Alina V. Rubashchenko, Daniil D. Zubarev, Vasiliy D. Konanykhin, Maxim I. Savelenok, Maxim M. Nosenko, Zamira M. Merzhoeva, Sergey N. Avdeev
BMC Anesthesiology.2025;[Epub] CrossRef
Oxygénothérapie nasale à haut débit et insuffisance respiratoire aiguë hypercapnique
C. Girault, E. Artaud-Macari, G. Jolly, D. Carpentier, A. Cuvelier, G. Béduneau
Revue des Maladies Respiratoires.2024; 41(7): 498. CrossRef
Safety and efficacy of high flow nasal canula in patients with mild hypercapnia
Mohammed A. Ibrahim, Magdy Emara, Mohammed Shehta
The Egyptian Journal of Bronchology.2023;[Epub] CrossRef
Current status of treatment of acute respiratory failure in Korea
Yong Jun Choi, Jae Hwa Cho
Journal of the Korean Medical Association.2022; 65(3): 124. CrossRef
High-flow nasal cannula: Evaluation of the perceptions of various performance aspects among Chinese clinical staff and establishment of a multidimensional clinical evaluation system
Ruoxuan Wen, Xingshuo Hu, Tengchen Wei, Kaifei Wang, Zhimei Duan, Zhanqi Zhao, Lixin Xie, Fei Xie
Frontiers in Medicine.2022;[Epub] CrossRef
The Application Progress of HFNC in Respiratory Diseases
迪吴
Advances in Clinical Medicine.2022; 12(11): 10617. CrossRef

Review Article

Cardiology/Infection
How Do I Integrate Hemodynamic Variables When Managing Septic Shock?: Olfa Hamzaoui, Jean-Louis Teboul; Korean J Crit Care Med. 2016;31(4):265-275. Published online November 30, 2016; DOI: https://doi.org/10.4266/kjccm.2016.00927

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Abstract PDF

Hemodynamic management of sepsis-induced circulatory failure is complex since this pathological state includes multiple cardiovascular derangements that can vary from patient to patient according to the degree of hypovolemia, of vascular tone depression, of myocardial depression and of microvascular dysfunction. The treatment of the sepsis-induced circulatory failure is thus not univocal and should be adapted on an individual basis. As physical examination is insufficient to obtain a comprehensive picture of the hemodynamic status, numerous hemodynamic variables more or less invasively collected, have been proposed to well assess the severity of each component of the circulatory failure and to monitor the response to therapy. In this article, we first describe the hemodynamic variables, which are the most relevant to be used, emphasizing on their physiological meaning, their validation and their limitations in patients with septic shock. We then proposed a general approach for managing patients with septic shock by describing the logical steps that need to be followed in order to select and deliver the most appropriate therapies. This therapeutic approach is essentially based on knowledge of physiology, of pathophysiology of sepsis, and of published data from clinical studies that addressed the issue of hemodynamic management of septic shock.

Citations

Citations to this article as recorded by

Enhancement in Performance of Septic Shock Prediction Using National Early Warning Score, Initial Triage Information, and Machine Learning Analysis
Hyoungju Yun, Jeong Ho Park, Dong Hyun Choi, Sang Do Shin, Myoung-jin Jang, Hyoun-Joong Kong, Suk Wha Kim
The Journal of Emergency Medicine.2021; 61(1): 1. CrossRef

Case Report

Clinical Trial of Tracheal Gas Insufflation to Control Hypercapnia Occured during Laparoscopic Surgery: A Case Report: Seong Sik Kang; Korean J Crit Care Med. 2004;19(1):61-64.

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Abstract PDF: Despite numerous benefits of laparoscopic procedures, during carbon dioxide-induced pneumoperitoneum, the serious hypercapnia and respiratory acidosis in hypercapnic patients with decreased pulmonary compliance may be developed. Tracheal gas insufflation (TGI) has been shown to be a useful adjunct to controlled mechanical hypoventilation. However, the utility of TGI in hypercapnic management during laparoscopic surgery was not reported yet. We report a case that TGI superimposed on controlled mechanical ventilation corrected hypercapnia induced by carbon dioxide-induced pneumoperitoneum during laparoscopic salphingo-oophorectomy. There was no specific anesthetic problem during operation, patients was discharged uneventfully.

Original Article

Comparison of Ventilations with LMA and Endotracheal Tube during Closed Circuit Anesthesia: Il Woo Shin, Kyeong Eon Park, Hee Dong Chung, Ju Tae Sohn, Heon Keun Lee, Young Kyun Chung; Korean J Crit Care Med. 2004;19(2):126-129.

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Abstract PDF: BACKGROUND
LMA has larger dead-space than tracheal tube, ventilation may be influenced by difference of dead space. Closed circuit mechanical ventilation has high risk of hypercarbia because of inadequate CO2 elimination or gas supply. Thus, end-tidal carbon dioxide tension (EtCO2) and arterial carbon dioxide tension (PaCO2) were compared during closed circuit mechanical ventilation with LMA or tracheal tube. METHODS: Thirty adult patients scheduled for general anesthesia were divided into 2 groups. After induction of general anesthesia, laryngeal mask airway (Group 1, n=15) or tracheal tube (Group 2, n=15) were randomly inserted and closed circuit mechanical ventilation was initiated. When steady state had been reached, PaCO2 and EtCO2 were recorded. RESULTS: The PaCO2 was 32.2+/-2.8 (Group 1), 31.5+/-2.2 (Group 2) and the EtCO2 was 33.0+/-2.9, 31.6+/-2.4 respectively and there was no statistical significance between groups. The difference of arterial and end-tidal carbon dioxide tension in each group was -0.8+/-2.6, -0.03+/-2.2 respectively and there was no statistical significance between groups. CONCLUSIONS: The results indicate that in patients who are mechanically ventilated via the closed circuit system, EtCO2, PaCO2, and the difference between arterial and end-tidal carbon dioxide tension were not significantly different between groups.

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