Interpretación de Gases Arteriales Sanguíneos: Revisión de tema

Autores/as

DOI:

https://doi.org/10.53732/rccsalud/2024.e6302

Palabras clave:

gasometría arterial, fisiología oxigenación, alcalosis, acidosis

Resumen

Los gases arteriales son herramientas fundamentales para evaluar objetivamente a pacientes con patologías agudas y crónicas, dado que proporcionan información sobre los índices de oxigenación, ventilación, equilibrio ácido-base y el suministro de oxígeno a nivel celular. Interpretarlos adecuadamente tiene gran importancia clínica, dado que influye en la toma de decisiones permite evaluar la respuesta a intervenciones terapéuticas. Este artículo tiene como objetivo presentar al lector los conceptos básicos de la fisiología del intercambio gaseoso, los trastornos ácido-base más comunes y una interpretación práctica de los gases arteriales. Se utiliza una combinación de ilustraciones gráficas, tablas y algoritmos para facilitar la comprensión y el abordaje clínico de pacientes con alteraciones respiratorias y metabólicas.

Citas

Yee J, Frinak S, Mohiuddin N, Uduman J. Fundamentals of Arterial Blood Gas Interpretation. Kidney360. 2022;3(8):1458-1466. https://doi.org/10.34067/KID.0008102021

Barrett KE, Barman SM, Brooks HL, Yuan JJ, editors. Gas Transport & pH. In Ganong’s Review of Medical Physiology, 26 ed. McGraw Hill; 2019. https://accessmedicine.mhmedical.com/content.aspx?bookid=2525&sectionid=204297654

DuBose JT. Acidosis and Alkalosis. In Loscalzo J, Fauci A, Kasper D, Hauser S, Longo D, Jameson J, editors. Harrison’s Principles of Internal Medicine 20. McGraw Hill; 2022.

Wolf MB. Physicochemical Models of Acid-Base. Semin Nephrol. 2019;39(4):328-339. https://doi.org/10.1016/j.semnephrol.2019.04.003

Kaynar AM: Arterial blood gas interpretation. In: Textbook of Critical Care, edited by Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink PM, 7th Ed., Philadelphia, PA, Elsevier, 2017, pp 167–174.

Woodrow P. Arterial blood gas analysis. Nurs Stand. 2004;18(21):45-52. https://doi.org/10.7748/ns2004.02.18.21.45.c3544

Farmand M. Blood gas analysis and the fundamentals of acid-base balance. Neonatal Netw. 2009;28(2):125-8. https://doi.org/10.1891/0730-0832.28.2.125

Petersson J, Glenny RW. Gas exchange and ventilation-perfusion relationships in the lung. Eur Respir J. 2014;44(4):1023-41. https://doi.org/10.1183/09031936.00037014

Patel S, Jose A, Mohiuddin SS. Physiology, Oxygen Transport And Carbon Dioxide Dissociation Curve. StatPearls. 2023. https://www.ncbi.nlm.nih.gov/books/NBK539815/

Sharma S, Hashmi MF, Burns B. Alveolar Gas Equation. StatPearls. 2022. https://www.ncbi.nlm.nih.gov/books/NBK482268/

Do C, Vasquez PC, Soleimani M. Metabolic Alkalosis Pathogenesis, Diagnosis, and Treatment: Core Curriculum 2022. Am J Kidney Dis. 2022;80(4):536-551. https://doi.org/10.1053/j.ajkd.2021.12.016

Gomella LG, Haist SA, editors. Blood gases and acid–base disorders. In Clinician’s Pocket Reference: The Scut Monkey. 11th ed.: McGraw Hill; 2007.

O’Driscoll BR, Howard LS, Earis J, Mak V. Briti-sh Thoracic Society Emergency Oxygen Guide-line Group; BTS Emergency Oxygen Guideline Development Group. BTS guideline for oxygen use in adults in healthcare and emergency set-tings. Thorax. 2017;72(1):ii1-ii90. https://doi.org/10.1136/thoraxjnl-2016-209729

Lee WL, Slutsky AS. Acute Hypoxemic Respiratory Failure and ARDS. In Broaddus VC, Ernst J, King KT, Lazarus S, editors. Murray and Nadel’s Textbook of Respiratory Medicine: Elsevier; 2021. p. 1740-1760

Hopkins E, Sanvictores T, Sharma S. Physiology, Acid Base Balance. StatPearls. 2022. https://pubmed.ncbi.nlm.nih.gov/29939584/

Gallo de Moraes A, Surani S. Effects of diabetic ketoacidosis in the respiratory system. World J Diabetes. 2019;10(1):16-22. https://doi.org/10.4239/wjd.v10.i1.16

Langer T, Pelosi PCP. Respiratory Acid-Base Disorders. In Ronco C, Bellomo R, Kellum JA, Ric-ci Z, editors. Critical Care Nephrology: Elsevier; 2019. p. 411-416.e1

Kaynar AM: Arterial blood gas interpretation. In: Textbook of Critical Care, edited by Vincent JL, Abraham E, Moore FA, Kochanek PM, Fink PM, 7th Ed., Philadelphia, PA, Elsevier, 2017, pp 167–174

Narins RG, Emmett M. Simple and mixed acid-base disorders: a practical approach. Medicine (Baltimore). 1980 May;59(3):161-87.

Narins RG, Jones ER, Stom MC, Rudnick MR, Bastl CP: Diagnostic strategies in disorders of fluid, electrolyte and acid-base homeostasis. Am J Med 72: 496–520, 1982.

Hughes JM. Assessing gas exchange. Chron Respir Dis. 2007;4(4):205-14. https://doi.org/10.1177/1479972307084446

Kellum JA. Determinants of blood pH in health and disease. Crit Care. 2000;4(1):6-14. https://doi.org/10.1186/cc644

Tucker AM, Johnson TN. Acid-base disorders: A primer for clinicians. Nutr Clin Pract. 2022;37(5):980-989. https://doi.org/10.1002/ncp.10881

Rodríguez-Villar S, Do Vale BM, Fletcher HM. The arterial blood gas algorithm: Proposal of a systematic approach to analysis of acid-base disorders. Rev Esp Anestesiol Reanim (Engl Ed). 2020;67(1):20-34. https://doi.org/10.1016/j.redar.2019.04.001

Gomez H, Kellum JA. Understanding Acid Base Disorders. Crit Care Clin. 2015;31(4):849-860. https://doi.org/10.1016/j.ccc.2015.06.016

Berend K. Review of the Diagnostic Evaluation of Normal Anion Gap Metabolic Acidosis. Kidney Dis (Basel). 2017;3(4):149-159. https://doi.org/10.1159/000479279

Kraut JA, Nagami GT. The serum anion gap in the evaluation of acid-base disorders: what are its limitations, and can its effectiveness be improved? Clin J Am Soc Nephrol. 2013;8(11):2018-24. https://doi.org/10.2215/CJN.04040413

Matyukhin I, Patschan S, Ritter O, Patschan D. Etiology and Management of Acute Metabolic Acidosis: An Update. Kidney Blood Press Res. 2020;45(4):523-531. https://doi.org/10.1159/000507813

Emmett M. Review of Clinical Disorders Causing Metabolic Acidosis. Adv Chronic Kidney Dis. 2022;29(4):355-363. https://doi.org/10.1053/j.ackd.2022.07.004

Jung B, Martinez M, Claessens YE, Darmon M, Klouche K, Lautrette A, et al. Diagnosis and management of metabolic acidosis: guidelines from a French expert panel. Ann Intensive Care. 2019;9(92):1-17. https://doi.org/10.1186/s13613-019-0563-2

Fenves AZ, Emmett M. Approach to Patients with High Anion Gap Metabolic Acidosis: Core Curriculum 2021. Am J Kidney Dis. 2021;78(4):590-600. https://doi.org/10.1053/j.ajkd.2021.02.341

Lentz SA, Ackil D. Metabolic Acid-Base Disorders. Emerg Med Clin North Am. 2023;41(4):849-862. https://doi.org/10.1016/j.emc.2023.06.008

Sanghavi S, Albert TJ, Swenson ER. Acid-Base Balance. In Broaddus VC, Ernst J, King KT, La-zarus S, editors. Murray & Nadel’s Textbook of Respiratory Medicine: Elsevier; 2021. p. 154-167.

Kelen GD, Nicolaou DD, Cline DM. Acid-Base Disorders. In Tintinalli JE, Stapczynski J, Ma O, Yealy DM, Meckler GD, Cline DM, editors. Tintinalli’s Emergency Medicine: A Comprehensive Study Guide: McGraw Hill; 2016.

Gomella LG, Haist SA, editors. Blood gases and acid–base disorders. In Clinician’s Pocket Refe-rence: The Scut Monkey. 11th ed.: McGraw Hill; 2007

Emmett M. Metabolic Alkalosis: A Brief Pathophysiologic Review. Clin J Am Soc Nephrol. 2020;15(12):1848-1856. https://doi.org/10.2215/CJN.16041219

Seifter JL. Acid-Base Disorders. In Goldman L, Schafer A, editors. Goldman-Cecil Medicine.: Elsevier; 2016. p. 762-774.

Krapf R, Beeler I, Hertner D, Hulter HN. Chronic respiratory alkalosis. The effect of sustained hyperventilation on renal regulation of acid-base equilibrium. N Engl J Med. 1991;324(20):1394-401. https://doi.org/10.1056/NEJM199105163242003

Khanna A, Kurtzman NA. Metabolic alkalosis. J Nephrol. 2006 Mar-Apr;19 Suppl 9:S86-96.

Park M, Sidebotham D. Metabolic alkalosis and mixed acid-base disturbance in anaesthesia and critical care. BJA Educ. 2023;23(4):128-135. https://doi.org/10.1016/j.bjae.2023.01.002

Tinawi M. Pathophysiology, Evaluation, and Management of Metabolic Alkalosis. Cureus. 2021;13(1):e12841. https://doi.org/10.7759/cureus.12841

Gledhill N, Beirne GJ, Dempsey JA. Renal response to short-term hypocapnia in man. Kidney Int. 1975;8(6):376-84. https://doi.org/10.1038/ki.1975.130

Elkinton JR, Huth EJ, Webster GD Jr, McCANCE RA. The renal excretion of hydrogen ion in renal tubular acidosis. I. quantitative assessment of the response to ammonium chloride as an acid load. Am J Med. 1960;29(4):554–75. https://doi.org/10.1016/0002-9343(60)90090-5

Brinkman JE, Sharma S. Respiratory Alkalosis. StatPearls. 2023. https://www.ncbi.nlm.nih.gov/books/NBK482117/

Seifter JL. Integration of acid-base and electrolyte disorders. N Engl J Med.

;372(4):391-2. https://doi.org/10.1056/NEJMc1414731

Palmer BF, Clegg DJ. Respiratory Acidosis and Respiratory Alkalosis: Core Curriculum 2023. Am J Kidney Dis. 2023;82(3):347-359. https://doi.org/10.1053/j.ajkd.2023.02.004

Johnson RA. A Quick Reference on Respiratory Alkalosis. Vet Clin North Am Small Anim Pract. 2017;47(2):181-184. https://doi.org/10.1016/j.cvsm.2016.10.005

Batlle DC, von Riotte A, Schlueter W. Urinary sodium in the evaluation of hyperchloremic metabolic acidosis. N Engl J Med. 1987;316(3):140-4. https://www.nejm.org/doi/full/10.1056/NEJM198701153160305

Rodriguez Soriano J, Boichis H, Stark H, Edelmann CM Jr. Proximal renal tubular acidosis. A defect in bicarbonate reabsorption with normal urinary acidification. Pediatr Res. 1967;1(2):81-98. https://doi.org/10.1203/00006450-196703000-00001

Oh M, Carroll HJ. Value and determinants of urine anion gap. Nephron. 2002;90(3):252-5. https://doi.org/10.1159/000049059

Publicado

2024-09-24

Cómo citar

1.
Martin Arsanios DA, Serrano J, Tíjaro Merchán VA, Perdomo Rodríguez LS, Delgado Cañaveral MC, Vargas Angel DC, Contreras Villamizar K. Interpretación de Gases Arteriales Sanguíneos: Revisión de tema . Rev. cient. cienc. salud [Internet]. 24 de septiembre de 2024 [citado 21 de diciembre de 2024];6:01-20. Disponible en: https://upacifico.edu.py:8043/index.php/PublicacionesUP_Salud/article/view/561