Acid-base disorders evaluation in critically ill patients: we can improve our diagnostic ability

被引:41
作者
Boniatti, Marcio Manozzo [1 ]
Cerveira Cardoso, Paulo Ricardo [1 ]
Castilho, Rodrigo Kappel [1 ]
Rios Vieira, Silvia Regina [1 ]
机构
[1] Hosp Clin Porto Alegre, Crit Care Dept, Porto Alegre, RS, Brazil
关键词
Acidosis; Acid base equilibrium; Strong ion gap; Outcomes; Prognosis; INTENSIVE-CARE-UNIT; STRONG ION GAP; UNMEASURED ANIONS; PREDICT MORTALITY; SERUM-PROTEINS; EQUILIBRIA; CHEMISTRY; LACTATE; BALANCE; PH;
D O I
10.1007/s00134-009-1496-2
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
To determine whether Stewart's approach can improve our ability to diagnose acid-base disorders compared to the traditional model. This prospective cohort study took place in a university-affiliated hospital during the period of February-May 2007. We recorded clinical data and acid-base variables from one hundred seventy-five patients at intensive care unit admission. Of the 68 patients with normal standard base excess (SBE) (SBE between -4.9 and +4.9), most (n = 59; 86.8%) had a lower effective strong ion difference (SIDe), and of these, 15 (25.4%) had SIDe < 30 mEq/L. Thus, the evaluation according to Stewart's method would allow an additional diagnosis of metabolic disorder in 33.7% patients. The Stewart approach, compared to the traditional evaluation, results in identification of more patients with major acid-base disturbances.
引用
收藏
页码:1377 / 1382
页数:6
相关论文
共 28 条
[1]   Unmeasured anions identified by the Fencl-Stewart method predict mortality better than base excess, anion gap, and lactate in patients in the pediatric intensive care unit [J].
Balasubramanyan, N ;
Havens, PL ;
Hoffman, GM .
CRITICAL CARE MEDICINE, 1999, 27 (08) :1577-1581
[2]  
BONIATTI MM, 2008, INTENSIVE CARE ME S1, pS241
[3]   The strong ion gap does not have prognostic value in critically ill patients in a mixed medical/surgical adult ICU [J].
Cusack, RJ ;
Rhodes, A ;
Lochhead, P ;
Jordan, B ;
Perry, S ;
Ball, JAS ;
Grounds, RM ;
Bennett, ED .
INTENSIVE CARE MEDICINE, 2002, 28 (07) :864-869
[4]   Unidentified acids of strong prognostic significance in severe malaria [J].
Dondorp, AM ;
Chau, TTH ;
Phu, NH ;
Mai, NTH ;
Loc, PP ;
Van Chuong, L ;
Sinh, DX ;
Taylor, A ;
Hien, TT ;
White, NJ ;
Day, NPJ .
CRITICAL CARE MEDICINE, 2004, 32 (08) :1683-1688
[5]   Comparison of three different methods of evaluation of metabolic acid-base disorders [J].
Dubin, Arnaldo ;
Menises, Maria M. ;
Masevicius, Fabio D. ;
Moseinco, Miriam C. ;
Kutscherauer, Daniela Olmos ;
Ventrice, Elizabeth ;
Laffaire, Enrique ;
Estenssoro, Elisa .
CRITICAL CARE MEDICINE, 2007, 35 (05) :1264-1270
[6]   Diagnosis of metabolic acid-base disturbances in critically ill patients [J].
Fencl, V ;
Jabor, A ;
Kazda, A ;
Figge, J .
AMERICAN JOURNAL OF RESPIRATORY AND CRITICAL CARE MEDICINE, 2000, 162 (06) :2246-2251
[7]   STEWART QUANTITATIVE ACID-BASE CHEMISTRY - APPLICATIONS IN BIOLOGY AND MEDICINE [J].
FENCL, V ;
LEITH, DE .
RESPIRATION PHYSIOLOGY, 1993, 91 (01) :1-16
[8]   Anion gap and hypoalbuminemia [J].
Figge, J ;
Jabor, A ;
Kazda, A ;
Fencl, V .
CRITICAL CARE MEDICINE, 1998, 26 (11) :1807-1810
[9]  
FIGGE J, 1991, J LAB CLIN MED, V117, P453
[10]  
FIGGE J, 1992, J LAB CLIN MED, V120, P713