Diagnostic Decision

doi:10.1059/0003-4819-105-3-390

Diagnostic Decision

Indications for Arterial Blood Gas Analysis

THOMAS A. RAFFIN, M.D.

Stanford, California

Abstract

Arterial blood gas analysis is used to evaluate oxygen and carbon dioxide gas exchange and acid-base status. Few studies identify indications for arterial blood gas analysis, especially with regard to optimizing the quality of patient care. General indications in severely ill adults usually include pathophysiologic abnormalities that can alter gas exchange or acid-base disturbances. Most commonly identified general indications have not been prospectively studied to determine if this analysis is necessary for diagnosis or management. Clinical settings where analysis is indicated involve patients with acute asthma in the emergency room, postoperative treatment of patients who have had coronary artery bypass graft surgery, stable patients in the intensive care unit, and patients receiving prophylactic supplemental low-flow oxygen by nasal cannula. Advances in noninvasive monitoring have suggested other possible clinical settings. However, further prospective, controlled clinical studies are needed to establish indications for arterial blood gas analysis and the role of noninvasive monitoring.

Article and Author Information

▸From the Department of Medicine, Stanford University School of Medicine, Stanford, California.
▸This paper was commissioned by the Blue Cross-Blue Shield Medical Necessity Project, under auspices of the Society for Research and Education in Primary Care Internal Medicine (SREPCIM), and is the eighth in a series being published in the Diagnosis and Treatment section. Harold C. Sox, Jr., M.D., is the editor for the series, and these papers are also being reviewed by John M. Eisenberg, M.D., and Sankey V. Williams, M.D., our consultants for Diagnostic Decision papers, as well as by selected manuscript consultants. This series will be published in a collective reprint, the availability of which will be announced later. The reprint will include the introductory article by Dr. Sox, which appears on pages 60-66 in the January issue.-The Editor.
▸Requests for reprints should be addressed to Thomas A. Raffln, M.D., Department of Medicine, Stanford University School of Medicine; Stanford, CA 94305.