Pocket Tutor Understanding ABGs & Lung Function Tests Muhunthan Thillai, Keith Hattotuwa, Peter SJ Bailey
INDEX
Note: Page numbers in bold or italic refer to tables or figures respectively.
A
Acidaemia 73
Acid–base disturbances 7375
arterial blood gas values in 74
metabolic acidosis 7879, 80
metabolic alkalosis 7980, 81
mixed 8082
respiratory acidosis 7677, 78
respiratory alkalosis 77, 79
Acidosis 22, 73
lactic 146147, 148
metabolic 7879, 80, 141, 145, 156, 158
respiratory 7677, 78
Alkalaemia 73
Alkalosis 22, 73
metabolic 7980, 81
respiratory 77, 79, 153
Alveolar air 13
distribution of 1213
Alveolar air distribution, tests of 54
nitrogen washout 5455
partial pressure of alveolar oxygen tension 55
single breath nitrogen meter testing 55
Alveolar–arterial oxygen gradient 1617
Alveolar–capillary diffusion 1314
Alveolar dead space 112
Alveolar gas equation 13
Alveolar hypoventilation 84
Alveolar ventilation 1113
calculation of 12
distribution of alveolar air 1213
in healthy adults 12
influence of 12
Alveolar wall 5, 5
Alveoli 5, 56
Amiloride 159
Anaemia 119, 124, 125
Anaesthetics 138139, 139
Anatomical dead space 6, 12, 54
Anatomical shunting 16
Anion gap 2324, 75, 78
high 7879
normal 78
Apnoea/hypopnoea index (AHI) 115
Aspirin poisoning 155
Asthma 9394
ABG testing in 97, 97, 98
acute and life-threatening 98
bronchoprovocation test for 5556
classic 95
cough in 94
exercise-induced 95
lung function in, changes in 94
occupational 95
peak flow recordings in 95, 95
spirometry in 9394, 96, 97
B
Base excess 23
Becker muscular dystrophy 136 see also Myopathies
Benzodiazepines 138, 139, 155
Bilevel positive airway pressure (BiPAP) 101, 103, 117
Body plethysmography 50, 50
Breathing, neurological control of 24, 2425
Breathing reserve ratio see Ventilation reserve ratio
Bronchial arteries 6
Bronchial tree 23, 3
Bronchiectasis 105106, 106
arterial blood gases in 106
lung function in, changes in 105106, 106
Bronchiolitis obliterans organising pneumonia (BOOP) 108
Bronchoprovocation test 5556
Bronchopulmonary segments 3, 4
Buffering systems 21
bicarbonate–carbonic acid buffering system 2122
renal system buffering 22
respiratory system buffering 22
C
Capillary blood gas (CBG) 34, 3435
Carbonic acid 22
Carbonic anhydrase 21, 21, 22
Carbon monoxide poisoning 160161
Cardiac diseases 121125
anaemia and shock 124, 125
cardiac output, diseases of 121122
congenital heart diseases 122124, 123, 124
polycythaemia 124125
Cardiopulmonary exercise testing 6165
anaerobic threshold 65
graph 63
indications for measuring maximal oxygen uptake 64
maximal oxygen uptake 62, 64
maximum voluntary ventilation 65
values obtained in 62
VE:VCO2 ratio 65
Vo2 peak 6465
CBG see Capillary blood gas (CBG)
Chemoreceptors 24
Chest wall disorder 117
Chest wall trauma 137138, 138
Chronic bronchitis 99 see also Chronic obstructive pulmonary disease (COPD)
Chronic obstructive pulmonary disease (COPD) 7, 82, 99105
acute exacerbations of 102103, 103
arterial blood gases in 102, 102
chronic bronchitis 99
emphysema 99
long-term oxygen in 105
lung function in, changes in 100102, 101
lung transplantation in 99
noninvasive ventilation in 104105
and oxygen-induced hypercapnia 103104
smoking and 99100, 100
Circulatory dysfunction 119
diffusion, changes in 120121
lung volume, changes in 119
pathophysiology of 119121
perfusion, changes in 120
ventilation, changes in 119120
Closed-circuit helium dilution 51
Compensation 22
Compliance 7
Congenital heart diseases 122124, 123, 124
Conn's syndrome 146, 146, 147
Continuous positive airway pressure (CPAP) 101, 117
COPD see Chronic obstructive pulmonary disease (COPD)
Cor pulmonale 119, 122
CPAP see Continuous positive airway pressure (CPAP)
Cyanide poisoning 160, 161
Cystic fibrosis
ABG, changes in 107
lung function in, changes in 107, 107
D
Dead space 9
Diabetic ketoacidosis (DKA) 141145
acute severe 142144, 143
fluid intake in 144
ketone production in body 142
management 145
sub-acute 144, 144145
Diaphragm palsy 133135
aetiology of 135
bilateral paralysis 133
chest examination in 134
lung function in, changes in 134135
Diaphragm stimulation 135
Diarrhoea 156157
with abdominal pain 157, 158
arterial blood gases in 157
distal gut 157
infective, and metabolic acidosis 156, 157
Diffusing capacity
carbon monoxide 5354
oxygen 14
Diuretics 159, 159
DKA see Diabetic ketoacidosis (DKA)
Doxapram 138, 139
Duchenne muscular dystrophy 136 see also Myopathies
Dynamic lung volume measurements 5153
Dyspnoea index 53
E
Emphysema 99 see also Chronic obstructive pulmonary disease (COPD)
End-tidal sample of expired air 13
Endurance shuttle walk test (ESWT) 66
ERV see Expiratory reserve volume (ERV)
Exercise-induced asthma, tests for 5657
Exercise, physiological changes during 25
blood pressure 26
cardiac output 26
heart rate 26
perfusion 26
respiratory changes 2627
stroke volume 26
Expiration 7
Expiratory reserve volume (ERV) 8, 9, 9
F
Flail chest 137
Forced vital capacity (FVC) 110, 128
Framingham risk score 122
Functional residual capacity (FRC) 9, 9, 49
Functional shunting 16
FVC see Forced vital capacity (FVC)
G
Gas diffusion, measurements of 5355
Gas exchange, in alveoli 1018
clinical determinants of 1518
diffusion 1314
perfusion 1415
ventilation 1113
Gas flow meter 51
Gas transport, in blood 18
carbon dioxide 2021
oxygen 1820
Guillain–Barré syndrome 133, 134
H
Haemoglobin saturation curve 20
Haldane effect 104
Hypercapnic alkalaemia 81
Hyperglycaemia 143
Hypertonic saline 56
Hyperventilation 153155
arterial blood gases in 153, 154
cycle of 154
management 154155
and pain 155
and respiratory alkalosis 153
Hypoxaemic ventilatory drive 104
Hypoxia 82, 8486
abnormal diffusion and 84
alveolar hypoventilation and 84
low inspired oxygen and 84
severe 84
shunts and 84
ventilation–perfusion mismatch and 84, 8586
ventilation–perfusion ratio and 85
Hypoxic challenge test 7071
I
Incremental shuttle walk test (ISWT) 66
Inspiration 7
Inspiratory capacity (IC) 8, 9
Inspiratory reserve volume (IRV) 8, 9
Interstitial lung disease 109111
ABG changes in 109110
CT scan 109
lung function in, changes in 110
IRV see Inspiratory reserve volume (IRV)
K
KCO (transfer coefficient for CO) 54
Kussmaul's breathing 143, 155
L
Lactic acidosis 146147
arterial blood gases in 146147, 148
causes of 148
D-lactic acidosis 147
Lambert–Eaton myasthenic syndrome (LEMS) 132
Long-term oxygen therapy (LTOT), in COPD 105
Lung diseases 93
asthma 9398
bronchiectasis 105106
chronic obstructive pulmonary disease 99105
interstitial lung disease 109111
obesity and 116117
obstructive sleep apnoea 114116
pleural disease 113114
pneumonia 108109
pulmonary vascular diseases 111113
M
Maximal expiratory pressure (MEP) 57, 57, 129, 129
Maximal inspiratory pressure (MIP) 57, 57, 129, 129
Maximum voluntary ventilation (MVV) 5152
Metabolic acidosis 7879, 141, 145, 156 see also Diabetic ketoacidosis (DKA)
Metabolic alkalosis 7980, 81, 159
Methaemoglobinaemia 159160
Methylene blue, intravenous 159160
Miller–Fisher variant 133
Mitral stenosis 121
Motor neurone disease (MND) 130131
forms of 130
lung function in, changes in 131, 131
noninvasive ventilation in 131
and ventilatory failure 131
Myasthenia gravis 132, 132133
Myopathies 135136, 136
Myotonic dystrophy 135
N
Nasogastric suction 155, 156
Neuroactive drugs 138139, 139
Neuromuscular disease, lung function tests in 56, 57
Neuromuscular disorders 127
arterial blood gases in 129
diaphragm palsy 133135
Guillain–Barré syndrome 133
lung function tests in 127128
motor neurone disease 130131
mouth pressure in 129, 129130
myasthenia gravis 132133
myopathies 135136, 136
neuroactive drugs 138139
respiratory disturbances in 127
sleep studies in 130
spirometry in 128129
stroke 139, 139
trauma and chest wall deformities 137138, 138
ventilatory support in 128, 129
vocal cord paralysis 136137
Noninvasive ventilation (NIV)
in COPD 104105
in motor neurone disease 131
Non-rapid eye movement (NREM) sleep 61
Normal anion gap acidosis 156
O
Obesity hypoventilation syndrome 117
Obstructive sleep apnoea/hypopnoea syndrome (OSAHS) 114116
ABG changes in 116
diagnosis of 115
episode of apnoea 115
High Epworth Sleepiness Score 115
hypopnoeic episode 115
sleep studies 115116, 116
Oxygen content 19
Oxygen-induced hypercapnia 103104
Oxygen saturation 19
P
Parenchymal disease
interstitial lung disease 109111
pneumonia 108109
Partial pressure 11
of alveolar oxygen tension 55
of oxygen 19
of respiratory gases 10, 11
Peak expiratory flow rate (PEFR) 3940, 40
peak flow meter 39, 40
peak flow nomogram 41
Peak flow diary 41
PEFR see Peak expiratory flow rate (PEFR)
Perfusion 1415
pH homeostasis 21
anion gap 2324
base excess 23
buffering systems 2122
Plasma bicarbonate 22
Pleural effusion 113114, 114
Pneumonia 108109, 150
ABG changes in 108, 109
lung function in, changes in 108, 108
Pneumothorax 113, 114
Poisoning
aspirin 155
carbon monoxide 160161
cyanide 160, 161
Polycythaemia 119, 124125
primary 124
secondary 125, 125
Polysomnography 61
Positive airway pressure 101
Potassium-sparing diuretics 159
Primary pulmonary hypertension 113
Pulmonary arteries 6
Pulmonary arterioles 4, 6
Pulmonary blood flow 14
Pulmonary embolism 111112, 112, 112
Pulmonary fibrosis 7
Pulmonary haemorrhage 113
Pulmonary nitrogen washout 5455
Pulmonary surfactant 6
Pulmonary vascular congestion 119
Pulmonary vascular resistance 1415
Pulmonary vasculature 6
arteries 6
veins 6
R
Rapid eye movement (REM) sleep 61
Renal failure 147151
acute 147
arterial blood gases in 149, 150, 151
causes of 148149, 149
chronic 147148
post-renal failure 149, 149
pre-renal failure 149, 149
Residual volume (RV) 9, 49
Respiration 7
Respiratory acidosis 7677, 78
Respiratory alkalosis 77, 79
Respiratory drive 24
carbon dioxide and oxygen 2425
metabolic acidosis 25
Respiratory failure 82
causes of 82
diffusion failure 86
hypoxia and 82, 8486
perfusion defects 8687
types of 83, 83
ventilatory failure 86
Respiratory lobule 3, 4, 5
Respiratory muscle strength 56
Respiratory quotient 13
Respiratory rate 10
Respiratory sleep study 5860, 59
Respiratory stimulants and depressants 138139, 139
Resting minute ventilation (RMV) 51
Restrictive lung diseases 89
RV:TLC ratio 49
S
Salicylates 138, 139
Shunt fraction 1718
Simple overnight oximetry 58
Single breath nitrogen meter testing 55
Six-minute walk (6MWT) 66
Sleep disorder 115 see also Obstructive sleep apnoea/hypopnoea syndrome (OSAHS)
Sleep studies 58
clinical indications for 58
polysomnography 61
respiratory sleep study 5860, 59
simple overnight oximetry 58
Slow vital capacity (SVC) 128
Sniff pressure 57
Sniff/twitch testing 135
Spirometry 37, 41, 56, 87
contraindications to 38
electronic hand-held spirometer 42
FEV1:FVC ratio 43, 44
flow–volume loops 42, 45, 46
forced expiratory flow (FEF) 44
forced expiratory volume in 1 s (FEV1) 43, 56
forced vital capacity (FVC) 43
good and poor technique 4649, 47, 48
lung defect, identification of 87, 88
parameters measured by 38
procedure of measurement 4243
reproducibility 46
ventilatory defects, patterns of 8791, 89
volume–time curves 42, 44, 45
Spironolactone 159
Starvation 157158
arterial blood gases in 158
and metabolic acidosis 158
in pregnancy 158
Static lung volume measurements 4951
Stroke 139, 139
Supplemental oxygen 155, 159, 160
T
Tidal volume (VT) 8, 9, 49
Total lung capacity (TLC) 10, 49
Trachea 3, 3
Trauma to chest 137138, 138
V
VC see Vital capacity (VC)
Venous blood gas (VBG) 34, 3435
Venous blood sampling 144
Ventilation 7
and lung volumes 810
mechanism of 7, 8
Ventilation–perfusion mismatch 15, 84, 8586, 103104
Ventilation–perfusion ratio 1516, 84, 85
Ventilation reserve ratio 5253
Ventilatory defects 87
flow–volume loop patterns in disease 90
mixed 91
obstructive 8788, 90
patterns of, on flow–volume loops 89
restrictive 8889, 91
Vital capacity (VC) 9, 9, 49, 57
determinants of 9
Vocal cord paralysis 136137, 137
Vomiting and nasogastric suction 155, 156
W
Walking ventilation (WV) 51
Wright respirometer 51
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