12/27/2023 0 Comments Shunt vs dead space on abg![]() However, knowing that a patient has a decreased Pa (that is, is hypoxemic) does not necessarily translate into knowing why the patient is hypoxemic. ![]() Traditionally, the clinical evaluation of oxygen status has relied on intermittent monitoring of arterial blood gas (ABG) values, specifically Pa. On the other hand, a patient may be hypoxemic without being cyanotic. Although cyanosis is frequently described as the hallmark of arterial hypoxemia, for a variety of reasons-such as ambient lighting conditions or the patient's skin pigmentation-it may not always be detected. In any given patient who has ARDS, total oxygen stores are drastically reduced. The principal physiologic consequence of the acute respiratory distress syndrome (ARDS) is impaired pulmonary oxygen exchange leading to hypoxemia. Therefore, several oxygenation indices have been developed to guide the assessment of the cause of hypoxemia and the selection of a management strategy. However, the changes in lung function that cause hypoxemia cannot be inferred from measurements of Pa. Because the physical findings of hypoxemia are nonspecific, the clinician may not be able to adequately assess the severity of oxygen depletion without measuring Pa. Looking beyond Pa for assessment and managementĪBSTRACT: An essential goal in the treatment of the acute respiratory distress syndrome is the maintenance of adequate oxygenation, but deciding on the most appropriate therapeutic option depends on clinical judgment as to whether intrapulmonary shunting or a combination of shunting and ventilation-perfusion disturbance or mismatch is responsible for impaired pulmonary gas exchange and resultant hypoxemia.
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