Arterial blood gas (APACHE): Difference between revisions

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  '' This article is about collecting the value for APACHE, see [[Arterial blood gas (labs)]] for labs collection.  
  '' This article is about collecting the value for APACHE, see [[Arterial blood gas (labs)]] for labs collection.  


This article is about ABG ('''A'''rterial''' B'''lood '''G'''as) for [[APACHE]].  
This article is about ABGs ('''A'''rterial''' B'''lood '''G'''as) for [[APACHE]].  


== Collection Instructions ==
== Collection Instructions ==
All arterial blood gas results ([[FiO2]],  [[PO2]],  [[CO2]] & [[PH]]) should be obtain from the '''SAME SPECIMEN'''.
Enter available blood gases following usual [[APACHE physiological variable collection]] instructions (worst ones only if you are sure) into the '''[[#ABG Helper]]''' in [[CCMDB.accdb]]'s APACHE tab. Pick the ABG that has the highest score.  


*An ABG result is preferred, but if '''no''' ABG available during the first 24 hours in ICU then select the worst '''[[serum CO2]]'''
'''All arterial blood gas results ([[FiO2]],  [[PO2]],  [[CO2]] & [[PH]]) must be from the same specimen'''.


Select the '''worst deviation from normal''' Arterial Blood Gases (ABG) in the first 24 hours of ICU admission as outlined on the [[APACHE Scoring table]]. '''Do not use [[Venous blood gas|venous gases]].'''
An ABG result is preferred, but if '''no''' ABG available during the first 24 hours in ICU then select the worst '''[[Serum CO2]]'''. '''Do not use [[Venous blood gas (labs)|venous gases]].'''


IF [[FiO2]] ≤ 49% - Base the selection of the '''worst''' ABG on the '''worst''' [[PO2]].
IF [[FiO2]] ≤ 49% - Base the selection of the '''worst''' ABG on the '''worst''' [[PO2]].


IF [[FiO2]] ≥ 50% - Base the selection of the '''worst''' ABG on the '''worst''' [[AaDO2]] (you can use the [[ABG Helper button]] to help determine this.
IF [[FiO2]] ≥ 50% - Base the selection of the '''worst''' ABG on the '''worst''' [[AaDO2]] (you can use the [[#ABG Helper]] to help determine this.


== ABG Helper ==
=== ABG Helper ===
There is an ABG helper in the [[CCMDB.mdb]]. You can enter two or more blood gas values and the program will show the number of apache points each value generates, whether it is the pO2, aADO2 or the ph. Choose the individual blood gas that gives the most apache points. Only one complete blood gas can be used (Do not pick a pH from one blood gas and other values from another blood gas).
There is an ABG helper in the [[CCMDB.accdb]], opened with the [[ABG Helper button]]. You can enter two or more blood gas values and the program will show the number of APACHE points each value generates, whether it is the [[PO2]], [[AaDO2]] or the [[pH]]. Choose the individual blood gas that gives the most APACHE points. Only one complete blood gas can be used; do not pick a pH from one blood gas and other values from another blood gas.


== ABGs as part of apnea tests ==
=== ABGs as part of apnea tests ===
{{Discussion}}
There was confusion whether ABGs done as part of apnea tests should be included since they are as part of an intervention, and we should not use iatrogenically changed values.
Are '''abgs''' taken during an apnea test included or excluded in the calculation of apache scores? [[Apache II General Collection Guidelines]]--[[User:LBilesky|LBilesky]] 13:38, 2016 November 15 (CST)
We will include these because any poor/high scoring results are a reflection of the patient's neurological status when we take away the support of the ventilator. It is a more accurate reflection of the patient's status than the ABG's we take when we are controlling the patient's minute ventilation.


*This is a quote from the APACHE instructions.
== ABG Scoring for APACHE ==
**Keep in mind the diagnosis and try not to include iatrogenically enhanced symptoms, e.g. BP severely high due to inotropes or decreased LOC due to sedation.
* If '''no''' ABG
 
** apply score only for the SerCO2
*Aware of the guidelines. The question isn't asking about iatrogenically affected BP or iatrogenically enhanced neurological symptoms. I was asking about the '''ABG's''' taken during an apnea test. The patients are not sedated. They are neurologically impaired by the critical illness that brought them to the ICU. The question is do we include or exclude the''' abg''' result taken during an apnea test in our apache score done in the first 24 hours if it is the worst value? [[User:GHall|GHall]] 06:51, 2016 November 17 (CST)
** '''ignore pH component'''
**I would include it, because the poor numbers are a reflection of the patient's neurological status when we take away the support of the ventilator. It is a more accurate reflection of the patient's status than the ABG's we take when we are controlling the patient's minute ventilation.[[User:Mlagadi|Mlagadi]] 08:20, 2016 November 17 (CST)
* else (ie. ABG present)
** apply pH score
** if FIO2 >= 50
*** apply worst AaDO2 score
** else (ie FIO2 < 50)
*** apply worst PO2 score


== See also ==
== See also ==
* [[Venous blood gas]]  
* [[Blood gas, venous]] CCI
* [[Blood gas, arterial]] CCI
* [[Arterial blood gas (labs)]]
* [[Arterial blood gas (labs)]]
* [[Venous blood gas (labs)]]


[[Category:APACHE II Physiological Variables]]
[[Category:APACHE II Physiological Variables]]
[[Category:ABG|*]]
[[Category:ABG| *]]

Latest revision as of 11:42, 22 September 2019

 This article is about collecting the value for APACHE, see Arterial blood gas (labs) for labs collection.

This article is about ABGs (Arterial Blood Gas) for APACHE.

Collection Instructions

Enter available blood gases following usual APACHE physiological variable collection instructions (worst ones only if you are sure) into the #ABG Helper in CCMDB.accdb's APACHE tab. Pick the ABG that has the highest score.

All arterial blood gas results (FiO2, PO2, CO2 & PH) must be from the same specimen.

An ABG result is preferred, but if no ABG available during the first 24 hours in ICU then select the worst Serum CO2. Do not use venous gases.

IF FiO2 ≤ 49% - Base the selection of the worst ABG on the worst PO2.

IF FiO2 ≥ 50% - Base the selection of the worst ABG on the worst AaDO2 (you can use the #ABG Helper to help determine this.

ABG Helper

There is an ABG helper in the CCMDB.accdb, opened with the ABG Helper button. You can enter two or more blood gas values and the program will show the number of APACHE points each value generates, whether it is the PO2, AaDO2 or the pH. Choose the individual blood gas that gives the most APACHE points. Only one complete blood gas can be used; do not pick a pH from one blood gas and other values from another blood gas.

ABGs as part of apnea tests

There was confusion whether ABGs done as part of apnea tests should be included since they are as part of an intervention, and we should not use iatrogenically changed values. We will include these because any poor/high scoring results are a reflection of the patient's neurological status when we take away the support of the ventilator. It is a more accurate reflection of the patient's status than the ABG's we take when we are controlling the patient's minute ventilation.

ABG Scoring for APACHE

  • If no ABG
    • apply score only for the SerCO2
    • ignore pH component
  • else (ie. ABG present)
    • apply pH score
    • if FIO2 >= 50
      • apply worst AaDO2 score
    • else (ie FIO2 < 50)
      • apply worst PO2 score

See also

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