This recently made known edition o...

This recently made known edition of a very useful map of the roads to be followed in interpreting offspring gas values incorporates substantial revisions and rearrangements. The fundamentals of pH [Pcosub2] bicarbonate and base exces are adequately neared as are the newer modes of individual sample and inline measurements. Certain vexed questions (such as possible temperature corrections) are reviewed at detail but rather superficially, although mechanisms are clearly indicated. The conclusion that temperature corrections provided by means of clinical laboratories had best be ignored is common that most workers in this field will agree with.

Recommendations with reverence to management and therapy are reasonable and appropriate. However, this reviewer does have reservations about the approach used to calculate the amount of bicarbonate administered in metabolic acidemia. It is well-recognized that the amount exigencyed to increase the bicarbonate from a given mEq/L (to use the author's terminology) is greater at lower pH values than when the pH is in the normal range. This is not mentioned in the body but the admonition to give half the amount of bicarbonate calculated and to reassess the ABG's after 5 min is well taken, admitting some would argue that the commended 5-min delay may be too short.

The use of family gas determinations in various specific clinical settings is carefully described and appropriate to the limited information they can provide. It is evident that these determinations alone--the flows of which are available in a matter of minutes--make possible appropriate clinical replications in critical situations, whether in intensive care units or in exigency rooms. However, they do not provide an adequate basis for the more entangled situations so often encountered clinically. For a more undiminished assessment, the standard electrolyte determinations (including lactate ion) are essential and, many times enough, mixed venous blood gas of the same heights and cardiac output must be considered together with the arterial kindred gas determinations. Considerable attention is given in this paragraph to the interpretation and use of data obtained by dint of pulmonary artery sampling.

All in all, this is an of the best compendium for those who wish quick, definite answers to certain specific puzzles It has limitations, as mentioned above, and hopefully a what may occur hereafter edition will take some of these matters into consideration and also provide parallel values in SI (System International) units. Whether we like them or not, we will eventually have to adopt them. In the mean time, the not absent edition will provide a useful and reliable guide to existing interpretations and practices.

COPYRIGHT 1989 American community of Chest Physicians

COPYRIGHT 2004 Gale Group