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Research ArticleOriginal Research

Quantitative Analysis of Acid-Base Disorders in Patients With Chronic Respiratory Failure in Stable or Unstable Respiratory Condition

Claude Guérin, Pascale Nesme, Véronique Leray, Florent Wallet, Gael Bourdin, Frédérique Bayle, Michèle Germain and Jean-Christophe Richard
Respiratory Care November 2010, 55 (11) 1453-1463;
Claude Guérin
Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse
University of Lyon, Lyon, France.
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  • For correspondence: [email protected]
Pascale Nesme
Service de Pneumologie, Hôpital de la Croix-Rousse and University of Lyon, Lyon, France.
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Véronique Leray
Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse
University of Lyon, Lyon, France.
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Florent Wallet
Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse
University of Lyon, Lyon, France.
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Gael Bourdin
Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse
University of Lyon, Lyon, France.
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Frédérique Bayle
Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse
University of Lyon, Lyon, France.
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Michèle Germain
Laboratoire d'Explorations Fonctionnelles Respiratoires, Hôpital de la Croix-Rousse and University of Lyon, Lyon, France.
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Jean-Christophe Richard
Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse
University of Lyon, Lyon, France.
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Abstract

BACKGROUND: The Stewart approach theorizes that plasma pH depends on PaCO2, the strong ion difference, and the plasma total concentration of non-volatile weak acids (Atot). The conventional approach measures standardized base excess, bicarbonate (HCO3–), and the anion gap.

OBJECTIVE: To describe acid-base disorders with the Stewart approach and the conventional approach in patients with chronic respiratory failure.

METHODS: This was an observational prospective study in a medical intensive care unit and a pneumology ward of a university hospital. There were 128 patients included in the study, of which 14 had more than one admission, resulting in 145 admissions. These were allocated to 4 groups: stable respiratory condition and elevated HCO3– (Group 1, n = 23), stable respiratory condition and non-elevated HCO3– (Group 2, n = 41), unstable respiratory condition and elevated HCO3– (Group 3, n = 44), and unstable respiratory condition and non-elevated HCO3– (Group 4, n = 37). Elevated HCO3– was defined as ≥ 3 standard deviations higher than the mean value we found in 8 healthy volunteers. Measurements were taken on admission.

RESULTS: In groups 1, 2, 3, and 4, the respective mean ± SD values were: HCO3– 33 ± 3 mM, 26 ± 3 mM, 37 ± 4 mM, and 27 ± 3 mM (P < .001); strong ion difference 45 ± 3 mM, 38 ± 4 mM, 46 ± 4 mM, and 36 ± 4 mM (P < .001); and Atot 12 ± 1 mM, 12 ± 1 mM, 10 ± 1 mM, 10 ± 2 mM (P < .001). Non-respiratory disorders related to high strong ion difference were observed in 12% of patients with elevated HCO3–, and in none of those with non-elevated HCO3– (P = .003). Non-respiratory disorders related to low strong ion difference were observed in 9% of patients with non-elevated HCO3–, and in none of those with elevated HCO3– (P = .02). Hypoalbuminemia was common, especially in unstable patients (group 3, 66%; group 4, 65%). Normal standardized base excess (16%), HCO3– (28%), and anion gap (30%) values were common. The Stewart approach detected high effective strong ion difference in 13% of normal standardized base excess, and in 20% of normal anion gap corrected for albuminemia, and low effective strong ion difference in 22% of non-elevated HCO3–.

CONCLUSIONS: In patients with chronic respiratory failure the acid-base pattern is complex, metabolic alkalosis is present in some patients with elevated HCO3–, and metabolic acidosis is present in some with non-elevated HCO3–. The diagnostic performance of the Stewart approach was better than that of the conventional approach, even when corrected anion gap was taken into account.

  • chronic respiratory failure
  • acute respiratory failure
  • acid-base balance
  • metabolic alkalosis
  • respiratory acidosis

Footnotes

  • Correspondence: Claude Guerin MD PhD, Service de Réanimation Médicale et d'Assistance Respiratoire, Hôpital de la Croix Rousse, 103 Grande Rue de la Croix Rousse, 69004 Lyon, France. E-mail claude.guerin{at}chu-lyon.fr.
  • The authors have disclosed no conflicts of interest.

  • Copyright © 2010 by Daedalus Enterprises Inc.
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Respiratory Care: 55 (11)
Respiratory Care
Vol. 55, Issue 11
1 Nov 2010
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Quantitative Analysis of Acid-Base Disorders in Patients With Chronic Respiratory Failure in Stable or Unstable Respiratory Condition
Claude Guérin, Pascale Nesme, Véronique Leray, Florent Wallet, Gael Bourdin, Frédérique Bayle, Michèle Germain, Jean-Christophe Richard
Respiratory Care Nov 2010, 55 (11) 1453-1463;

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Quantitative Analysis of Acid-Base Disorders in Patients With Chronic Respiratory Failure in Stable or Unstable Respiratory Condition
Claude Guérin, Pascale Nesme, Véronique Leray, Florent Wallet, Gael Bourdin, Frédérique Bayle, Michèle Germain, Jean-Christophe Richard
Respiratory Care Nov 2010, 55 (11) 1453-1463;
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Keywords

  • chronic respiratory failure
  • acute respiratory failure
  • acid-base balance
  • metabolic alkalosis
  • respiratory acidosis

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