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Understanding ABGs & Lung Function Tests
Muhunthan Thillai, Keith Hattotuwa
CHAPTER 1:
First principles
1.1 Anatomy
Lobes
Airways
The bronchial tree
Alveoli
Pulmonary vasculature
Arteries
Veins
1.2 Physiology
Lung volume
Breathing and lung compliance
Respiration rate
Compliance
Neurological control of breathing
Gas exchange: ventilation, diffusion and perfusion
Alveolar ventilation
Volume of gaseous exchange
Distribution of alveolar air
Alveolar ventilation and gas exchange
Alveolar oxygen tension
Alveolar–capillary diffusion
Gas exchange in the lungs
Ventilation–perfusion ratio
Alveolar–arterial oxygen gradient
Shunt component
Pulmonary blood flow
Perfusion
Pulmonary vascular resistance
O2 and CO2 transport by the blood
Oxygen
Carbon dioxide
pH homeostasis
Base excess
Anion gap
Physiological changes during exercise
Cardiac changes during exercise
Cardiac output and stroke volume
Heart rate
Blood pressure
Perfusion
Respiratory changes during exercise
CHAPTER 2:
Understanding the tests
2.1 Arterial blood gases
Taking ABG samples
Procedure
Electrolytes
2.2 Monitoring ABGs in ventilated and anaesthetised patients
2.3 Lung function tests
Peak expiratory flow
Peak flow charts
Spirometry
Limitations of spirometry
Measurements of lung volume
Total lung capacity
RV/TLC ratio
Dynamic lung volume measurements
Resting minute ventilation
Walking ventilation
Maximum voluntary ventilation
Ventilation indices
Ventilation reserve ratio
Dyspnoea index
Forced expirograph and flow–volume graphs
Forced expirograph
Flow–volume graph
Spirometric data
Forced vital capacity
Forced expiratory volume in 1 second
FEV1:FVC
Maximal midexpiratory flow
Diffusion test
Measurements of respiratory muscle function
Tests of alveolar air distribution
Pulmonary nitrogen washout
Single-breath nitrogen meter test
Alveolar oxygen tension
Disease-specific lung function tests
Bronchoprovocation testing to diagnose asthma
Tests for exercise-induced asthma
Lung function tests in neuromuscular disease
Mouth pressures in neuromuscular disease
Tilt testing
Sleep studies
Simple overnight oximetry
Polysomnography
2.4 Exercise and fitness tests
Cardiopulmonary exercise testing
Interpreting the results of exercise testing
Six-minute walk test
Fitness to fly
Oxygen pressure at altitude
During the flight
The physiological effects of exposure to altitude
Preflight assessment
The 50-metre walk test
Predicting hypoxia
Hypoxic challenge tests
Reproducibility of lung function testing
CHAPTER 3:
Recognising abnormal results
3.1 Arterial blood gas abnormalities
Identification of critical ABG results
Acid–base disturbances
The anion gap
Interpreting the ABG report in five steps
Compensation
Respiratory acidosis
Respiratory alkalosis
Metabolic acidosis
Metabolic alkalosis
Mixed acid-base disturbances
Hypoxia
ratio
The units
mismatch
Respiratory failure
Type I and II respiratory failure
Ventilatory failure
Diffusion failure
Perfusion defects
3.2 Lung function testing abnormalities
Types of ventilatory defects
Obstructive ventilatory defects
Restrictive ventilatory defects
Mixed ventilatory defects
TLCO
CHAPTER 4:
Lung diseases
4.1 Airway disease
Asthma
Changes in lung function
Changes in ABGs
Other tests in asthma
Chronic obstructive pulmonary disease
Emphysema
Chronic bronchitis
Important causes of COPD
Changes in lung function
Changes in ABGs
Acute exacerbations of COPD
Chronic bronchitis
Bronchiectasis
Cystic fibrosis
Sleep apnoea
4.2 Parenchymal disease
Pneumonia (Table 4.6)
Interstitial lung diseases
4.3 Pulmonary vascular disease
Pulmonary embolism
ABGs in pulmonary embolism
Primary pulmonary hypertension
Pulmonary haemorrhage
4.4 Pleural disease
Pneumothorax
Pleural effusion
4.5 Chest wall disorders
CHAPTER 5:
Circulatory dysfunction
5.1 Changes in lung volume
5.2 Changes in ventilation
5.3 Changes in perfusion
5.4 Changes in diffusion
5.5 Cardiac diseases
Diseases of cardiac output
Anaemia and shock
Carbon monoxide poisoning
Polycythaemia
Congenital heart disease
CHAPTER 6:
Neuromuscular disorders
6.1 Respiratory tests in management of neuromuscular disorders
Spirometry
Arterial blood gases
Mouth pressures
Sleep studies
Tilt testing
6.2 Motor neuron disease
Lung function tests in MND
6.3 Myasthenia gravis
Lung function tests in myasthenia gravis
6.4 Guillain–Barré syndrome
6.5 Diaphragm palsy
Lung function tests in diaphragm palsy
6.6 Myopathies
6.7 Vocal cord paralysis
6.8 Trauma and chest wall deformities
6.9 Neuroactive drugs
6.10 Cerebrovascular accidents
CHAPTER 7:
Metabolic, endocrine and renal dysfunction
7.1 Diabetic ketoacidosis
Typical ABGs in diabetic ketoacidosis
Acute severe DKA
Less acute DKA
ABGs during management of diabetic ketoacidosis
7.2 Conn's syndrome
7.3 Lactic acidosis
Typical ABGs in lactic acidosis
7.4 Renal failure
CHAPTER 8:
Other disorders
8.1 Anxiety, pain and hyperventilation
8.2 Vomiting and nasogastric suction
8.3 Diarrhoea
8.4 Starvation
8.5 Diuretics
8.6 Cyanide poisoning
INDEX
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