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Prediletto R, Miniati M, Tonelli L, Formichi B, Di Ricco G, Marini C, Bauleo C, Allescia G, Cocci F, Monti S, Pistolesi M, Giuntini C. Diagnostic value of gas exchange tests in patients with clinical suspicion of pulmonary embolism. Crit Care 1999; 3:111-116. [PMID: 11056733 PMCID: PMC29023 DOI: 10.1186/cc352] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/1998] [Revised: 07/12/1999] [Accepted: 07/14/1999] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE: To assess the value of parameters derived from arterial blood gas tests in the diagnosis of pulmonary embolism. METHOD: We measured alveolar-arterial partial pressure of oxygen [P(A-a)O2] gradient, PaO2 and arterial partial pressure of carbon diaxide (PaCO2) in 773 consecutive patients with suspected pulmonary embolism who were enrolled in the Prospective Investigative Study of Acute Pulmonary Embolism. DIAGNOSIS: The study design required pulmonary angiography in all patients with abnormal perfusion scans. RESULTS: Of 773 scans, 270 were classified as normal/near-normal and 503 as abnormal. Pulmonary embolism was diagnosed by pulmonary angiography in 312 of 503 patients with abnormal scans. Of 312 patients with pulmonary embolism, 12, 14 and 35% had normal P(A-a)O2, PaO2 and PaCO2, respectively. Of 191 patients with abnormal scans and negative angiograms, 11, 13 and 55% had normal P(A-a)O2, PaO2 and PaCO2, respectively. The proportions of patients with normal/near-normal scans who had normal P(A-a)O2, PaO2 and PaCO2 were 20, 25 and 37%, respectively. No differences were observed in the mean values of arterial blood gas data between patients with pulmonary embolism and those who had abnormal scans and negative angiograms. Among the 773 patients with suspected pulmonary embolism, 364 (47%) had prior cardiopulmonary disease. Pulmonary embolism was diagnosed in 151 (41%) of 364 patients with prior cardiopulmonary disease, and in 161 (39%) of 409 patients without prior cardiopulmonary disease. Among patients with pulmonary embolism, there was no difference in arterial blood gas data between patients with and those without prior CPD. CONCLUSION: These data indicate that arterial blood gas tests are of limited value in the diagnostic work-up of pulmonary embolism if they are not interpreted in conjunction with clinical and other laboratory tests.
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Affiliation(s)
- Renato Prediletto
- Istituto di Fisiologia Clinica del Consiglio Nazionale Delle
Ricerche, Pisa, Italy
| | - Massimo Miniati
- Istituto di Fisiologia Clinica del Consiglio Nazionale Delle
Ricerche, Pisa, Italy
| | - Lucia Tonelli
- Dipartimento di Cardiologia, Angiologia e Pneumologia,
Universita' Degli Studi di Pisa, Pisa, Italy
| | - Bruno Formichi
- Istituto di Fisiologia Clinica del Consiglio Nazionale Delle
Ricerche, Pisa, Italy
| | - Giorgio Di Ricco
- Istituto di Fisiologia Clinica del Consiglio Nazionale Delle
Ricerche, Pisa, Italy
| | - Carlo Marini
- Dipartimento di Cardiologia, Angiologia e Pneumologia,
Universita' Degli Studi di Pisa, Pisa, Italy
| | - Carolina Bauleo
- Dipartimento di Cardiologia, Angiologia e Pneumologia,
Universita' Degli Studi di Pisa, Pisa, Italy
| | - Germana Allescia
- Dipartimento di Cardiologia, Angiologia e Pneumologia,
Universita' Degli Studi di Pisa, Pisa, Italy
| | - Franca Cocci
- Dipartimento di Cardiologia, Angiologia e Pneumologia,
Universita' Degli Studi di Pisa, Pisa, Italy
| | - Simonetta Monti
- Dipartimento di Cardiologia, Angiologia e Pneumologia,
Universita' Degli Studi di Pisa, Pisa, Italy
| | - Massimo Pistolesi
- Dipartimento di Fisiopatologia Clinica, Universita' degli
Studi di Firenze, Firenze, Italy
| | - Carlo Giuntini
- Dipartimento di Cardiologia, Angiologia e Pneumologia,
Universita' Degli Studi di Pisa, Pisa, Italy
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