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Gaz du sang : Artériels ou
veineux?
Clara Gobert, le 21/04/15
Pourquoi prescrire des gaz du sang ?
- Connaitre la ventilation du patient : pCO2
- Connaitre l’oxygénation du patient : p...
GDS artériels et veineux :
le match
pH :
pH veineux < pH artériel ( - 0.03)
 Pas de correction nécessaire ( 2, 3, 5, 6, 7, 8)
pO2
Corrélation spO2 /saO2
• Carl Matthes en 1935 (11)
• Commercialisation en 1970 par HP
• T. Aoyagi en 1974: mesure de la sp...
SaO2 = (HbO2/( HbO2+Hb))*100
Le système doit
- pouvoir mesurer en continu l’HbO2 et Hb
- reconnaitre la pulsatilité du sig...
Les limites de la spO2
• Interférences intrinsèques: liées à des modifications d’absorption des
ondes lumineuses ( Hb anor...
HCO3-
• Pas de corrections nécessaires
• Bonne corrélation des valeurs veineuses et
artérielles, pour toutes valeurs, mais encor...
pCO2
Méta- analyses ( Bloom 2014 ( 14), Lim 2010 (7),
Kelly 2010 (10) )
Avec un cut off = 45 mmHg
 Se = 100 %
 Sp = 48-57 %
...
Lactates
• Valeurs veineuses = valeurs artérielles , pour
des valeurs normales
• Bloom 2014(1) :232 patients avec VL anorm...
En pratique :
Pour évaluer la ventilation du patient : pCO2
- GDS veineux:
si pvCO2 < 45 mmHg : pas d’hypercapnie
si pvCO2...
Pour évaluer l’oxygénation du patient : pO2 et
sPO2
- sPO2 : si < 92 % = hypoxémie
- Si spO2 non fiable ( vasoconstriction...
Pour connaitre le statut acido-basique du
patient :
HCO 3- et pH => GDS veineux (2)
Pour préciser l’état hémodynamique du patient :
pH , lactates => GDS veineux
Si lactates elevés => GDS artériels
Bibliographie
1. Bloom B, Pott J, and al; The agreement between abnormal veinous lactate and arterial lactate in the
ED : ...
8. Ibrahim I, Ooi SB and al. Point-of-care bedside gas analyser: limited use of venous pCO2 in
emergency patients. J Emerg...
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Gaz du sang veineux ou ateriels

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Quand faire des gaz du sang veineux? Quand faire des gaz du sang artériels?

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Gaz du sang veineux ou ateriels

  1. 1. Gaz du sang : Artériels ou veineux? Clara Gobert, le 21/04/15
  2. 2. Pourquoi prescrire des gaz du sang ? - Connaitre la ventilation du patient : pCO2 - Connaitre l’oxygénation du patient : pO2 - Connaitre sa situation acido-basique : pH et HCO3- - Apprécier l’état hémodynamique :pH et lactates
  3. 3. GDS artériels et veineux : le match
  4. 4. pH :
  5. 5. pH veineux < pH artériel ( - 0.03)  Pas de correction nécessaire ( 2, 3, 5, 6, 7, 8)
  6. 6. pO2
  7. 7. Corrélation spO2 /saO2 • Carl Matthes en 1935 (11) • Commercialisation en 1970 par HP • T. Aoyagi en 1974: mesure de la spO2 en analysant les pulsations de signaux lumineux traversant les tissus
  8. 8. SaO2 = (HbO2/( HbO2+Hb))*100 Le système doit - pouvoir mesurer en continu l’HbO2 et Hb - reconnaitre la pulsatilité du signal = différence d’absorption des ondes lumineuses Avantages : mesure continue, non invasive
  9. 9. Les limites de la spO2 • Interférences intrinsèques: liées à des modifications d’absorption des ondes lumineuses ( Hb anormale) : HbCO, metHb • Interférences extrinsèques : vasoconstriction périphérique (hypothermie, hypovolémie, choc cardiogénique,) mouvements du patient • Cut off : 92% ( Se = 100%, sp = 86%) • Bon test de dépistage, insuffisant pour les patients instables ou avec décompensation respiratoire (9) • Surestimation de 3% en moyenne chez les patients en choc septique ou sepsis sévère ( 13) • Non modifié par anémie, acidose, hyperlactatémie, drogues vasopressives • ATTENTION quand valeurs < 98% chez patients en choc septique
  10. 10. HCO3-
  11. 11. • Pas de corrections nécessaires • Bonne corrélation des valeurs veineuses et artérielles, pour toutes valeurs, mais encore plus pour des valeurs normales IC 95% ( 0.56 – 1.50) (1)
  12. 12. pCO2
  13. 13. Méta- analyses ( Bloom 2014 ( 14), Lim 2010 (7), Kelly 2010 (10) ) Avec un cut off = 45 mmHg  Se = 100 %  Sp = 48-57 %  Bonne VPN = bon test de dépistage = Insuffisant pour étude de la ventilation
  14. 14. Lactates • Valeurs veineuses = valeurs artérielles , pour des valeurs normales • Bloom 2014(1) :232 patients avec VL anormaux Pour cut off = 2 mmol/l : 36 % FP pour cut off = 4 mmol/l : 18 % FP
  15. 15. En pratique : Pour évaluer la ventilation du patient : pCO2 - GDS veineux: si pvCO2 < 45 mmHg : pas d’hypercapnie si pvCO2 > 45 mmHg => GDS Artériels
  16. 16. Pour évaluer l’oxygénation du patient : pO2 et sPO2 - sPO2 : si < 92 % = hypoxémie - Si spO2 non fiable ( vasoconstriction périphérique) => GDS artériels
  17. 17. Pour connaitre le statut acido-basique du patient : HCO 3- et pH => GDS veineux (2)
  18. 18. Pour préciser l’état hémodynamique du patient : pH , lactates => GDS veineux Si lactates elevés => GDS artériels
  19. 19. Bibliographie 1. Bloom B, Pott J, and al; The agreement between abnormal veinous lactate and arterial lactate in the ED : a retrospective chart review. Am J Emerg Med.2014 Jun; 32(6): 596-600 2. Gokel Y, Paydas S, and al; Comparison of blood gas and acid-base measurements in arterial and venous blood samples in patient with uremic acidosis and diabetic ketoacidosis in the emergency room. Am J Nephrol.2000 Jul-Aug;20(4): 319-23 3. AM, Klim S. Agreement between arterial and venous pH and pCO2 in patient undergoing non invasive ventilation in the emergency department. Emerg Med Australas.2013 Jun; 25(3): 203-6. 4. Kelly AM, Kerr D and al. Validation of venous pCO2 to screen for arterial hypercarbia in patient with chronic obstructive airways disease. J Emerg Med.2005 May; 28(4):377-9. 5. Kelly AM. Review article : Can venous blood gas analysis replace arterial in emergency medical care? Emerg Med Australas. 2010 Dec; 22(6): 493-8. 6. Malatesha G, Singh NK and al. Comparison of arterial and venous pH, bicarbonate, pCO2, and pO2 in initial emergency department assessment. Emerg Med J. 2007; 24: 569-571. 7. Lim BL, Kelly AM. A meta-analysis on the utility of peripheral venous blood gas analyses in exacerbations of chronic obstructive pulmonary disease in the emergency department. Eur J Emerg Med. 2010 Oct; 17(5): 246-8.
  20. 20. 8. Ibrahim I, Ooi SB and al. Point-of-care bedside gas analyser: limited use of venous pCO2 in emergency patients. J Emerg Med. 2011 Aug; 41(2): 117-23. 9. Kelly AM, McAlpine R and al. How occurate are pulse oximeters in patients with acute exacerbation of chronic obstructive airways disease? Respir Med. 2001 May; 95(5):336-40. 10. Kelly AM, Kyle E. Venous pCO2 and pH can be used to screen for significant hypercarbia in emergency with acute respiratory disease. J Emerg Med. 2002 Janv; 22 (1): 15-9. 11. Feissel M. La pléthysmographie de l’oxymètre de pouls : un ancien tracé plein d’avenir? Principes et applications cliniques. Réanimation. 2007; 16 : 124-131. 12. Severinghaus JW. Takuo Aoyagi : dicovery of pulse oxymetry. Anesth Analg.2007 Dec; 105 (6); S1-4 13. Wilson BJ, Cowan HJ and al. The accuracy of pulse oximetry in emergency department patients with severe sepsis and septic shock: a retrospective cohort study. BMC Emerg Med. 2010, 10: 9. 14. Bloom BM, Grundligh J and al. The role oh venous blood gas in the emergency department : a systematic review and meta-analysis. Eur J Emerg Med. 2014 Apr; 21(2); 81-8

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