Role of initial arterial blood gas variations in predicting the outcome of pneumonia patients with type I/II respiratory failure
Keywords:Arterial blood gas, Pneumonia, Hypoxemia, Hypercapnia, Chronic obstructive pulmonary disease
Background: A correlation between, the early variations in the individual arterial blood gas (ABG) parameters - pH, PaO2, PaCO2 and HCO3-, and the treatment outcome, in pneumonia patients in respiratory failure, has not been well investigated. If a statistically significant variation among the individual ABG parameters would be an early, reliable predictor of the treatment outcome, it would facilitate prompt active management of the patient in respiratory failure from pneumonia before a clinically apparent downward turn culminates.
Methods: This prospective study was conducted on a sample of 42 patients, with clinical evidence of pneumonia and baseline clinical data and 2 arterial blood samples (one, at the baseline and another, within 24 hours from the first) were harvested for ABG analysis. Assessment of the ABG reports classified patients as belonging to group ‘A’ with type I (hypoxemic) respiratory failure or as group ‘B’ with type II (hypercapnic) respiratory failure. Binary logistic regression analysis was performed.
Results: In group A, the individual ABG parameters had a significant positive correlation with the treatment outcome: pH (p=0.034), HCO3- (p=0.034), PaO2 (p=0.035), PaCO2 (p=0.045), whereas in Group B, a non-significant positive correlation, pH (p=0.284), HCO3- (p=0.248), PaO2 (p=0.39), PaCO2 (p=0.240) was observed. In group B, a treatment failure rate of 40.91% was seen, as against 25% in Group A.
Conclusions: Variations among individual ABG parameters can predict treatment outcome in pneumonia patients of type I respiratory failure, and fail to do so in those with type II respiratory failure.
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