Abstract
Background
Clinicians frequently assume that during arterial puncture for measuring arterial
blood gases patients hyperventilate from pain and anxiety. This assumption leads clinicians
to falsely interpret a PaCO2 and pH near the upper limit of normal as a chronic respiratory acidosis corrected
by an acute respiratory alkalosis.
Objective
Determine if participants hyperventilate during arterial puncture from pain and anxiety.
Methods
We recruited participants from a pulmonary function laboratory referred for arterial
blood gas measurement. We excluded those with heart failure and included those with
any respiratory condition (COPD, asthma, sleep apnea). We measured end tidal PCO2 (PETCO2), respiratory rate, and heart rate 15 min before topical anesthesia, during anesthesia,
during arterial puncture, and 15 min later. We assessed generalized anxiety before
and measured pain during and after arterial puncture.
Results
24 participants were recruited (age: 54 ± 12 years; men: 54%). PaCO2 was 41 ± 5 mmHg. One had acute respiratory alkalosis. Respiratory rate increased
from (19 ± 6 breaths per minute (bpm)) before to a maximum (21 ± 6 bpm) during arterial
puncture (p = 0.001). Heart rate was stable throughout. The lowest PETCO2 during the procedure (35 ± 5) was similar to PETCO2 before the procedure (p = 0.1). The change in PETCO2 and respiratory rate did not correlate with pain, anxiety, or lung function.
Conclusion
Respiratory rate increased slightly during arterial puncture without any change in
PETCO2. Hence, acid–base status must be interpreted without the assumption of procedure
induced hyperventilation.
Keywords
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Article info
Publication history
Published online: April 06, 2017
Accepted:
January 31,
2017
Received in revised form:
January 30,
2017
Received:
November 3,
2016
Footnotes
Specific contributions of each author: Ashima Sahni: literature search, data collection, study design, analysis of data, manuscript preparation, review of manuscript. Hemil Gonzalez: Data collection, study design, analysis of data, manuscript preparation. Aiman Tulaimat: Literature search, study design, analysis of data, manuscript preparation, review of manuscript.
Results dissemination: Data was presented at American Thoracic Society Conference, Denver, Colorado, 2015.
Funding: none.
Conflict of interest: none.
Identification
Copyright
© 2017 Elsevier Inc. All rights reserved.
