The Relationship Between Arterial Blood Gas Parameters and Intensive Care Requirement in Patients Undergoing Catheter Thoracostomy in the Emergency Department
DOI:
https://doi.org/10.58600/eurjther2810Keywords:
arterial blood gas, catheter thoracostomy, emergency department, intensive care requirement, lactate, pleural effusionAbstract
Objective: To evaluate changes in arterial blood gas (ABG) parameters before and after catheter thoracostomy in emergency department patients and to investigate whether specific ABG values could serve as predictors of intensive care unit (ICU) admission.
Methods: This single-center, retrospective observational study included 198 adult patients who underwent catheter thoracostomy in the emergency department between January 2020 and January 2024. ABG parameters—including pH, partial pressure of oxygen (PaO₂), partial pressure of carbon dioxide (PaCO₂), serum lactate, and oxygen saturation (SpO₂)—were recorded before and after the procedure. The primary outcome was ICU admission.
Results: Post-thoracostomy, significant improvements were observed in all ABG parameters: pH (7.31 ± 0.08 → 7.38 ± 0.06), PaO₂ (61.2 ± 13.5 mmHg → 79.4 ± 15.7 mmHg), SpO₂ (89.4 ± 4.5% → 94.7 ± 3.1%), PaCO₂ (45.7 ± 9.1 mmHg → 41.2 ± 7.8 mmHg), and lactate (3.6 ± 2.1 mmol/L → 2.3 ± 1.7 mmol/L) (p < 0.001 for all). ICU admission was required in 65 patients (32.8%). ICU-admitted patients had lower pH, PaO₂, and SpO₂, and higher PaCO₂ and lactate levels post-procedure (p < 0.001). Lactate showed the highest discriminative ability for ICU admission (AUC 0.760; optimal cutoff ≥4.06 mmol/L; sensitivity 54.4%, specificity 93.2%). Binomial logistic regression identified higher lactate (OR 1.88; 95% CI 1.50–235.19), lower pH, lower SpO₂, and higher PaCO₂ as independent predictors of ICU admission, with lactate being the strongest predictor.
Conclusion: Catheter thoracostomy in the emergency department leads to significant improvements in ABG parameters. Among these, elevated lactate levels are the most powerful predictor of ICU admission. ABG analysis, particularly lactate monitoring, may aid early risk stratification and guide ICU resource allocation.
References
Kesieme EB, Dongo A, Ezemba N, Irekpita E, Jebbin N, et al (2012) Tube thoracostomy: complications and its management. Pulm Med. 2012:256878. https://doi.org/10.1155/2012/256878
Marinica AL, Nagaraj MB, Elson M, Vella MA, Holena DN, et al (2023) Evaluating emergency department tube thoracostomy: A single-center use of trauma video review to assess efficiency and technique. Surgery. 173(4):1086–1092. https://doi.org/10.1016/j.surg.2022.12.028
Cothren CC, Moore EE (2006) Emergency department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. World J Emerg Surg. 1:4. https://doi.org/10.1186/1749-7922-1-4
Balzanelli MG, Distratis P, Lazzaro R, Pham VH, Del Prete R, et al (2023) The importance of arterial blood gas analysis as a systemic diagnosis approach in assessing and preventing chronic diseases, from emergency medicine to the daily practice. Eur Rev Med Pharmacol Sci. 27(23):11653–11663. https://doi.org/10.26355/eurrev_202312_34603
Abuzer Ö (2023) Evaluation of Short-Term Mortality Prediction Using Initial Lactate and NEWS+L at Admission in COVID-19 Patients. Disaster Med Public Health Prep. 17:e333. https://doi.org/10.1017/dmp.2022.299
Altunok İ, Aksel G, Eroğlu SE (2019) Correlation between sodium, potassium, hemoglobin, hematocrit, and glucose values as measured by a laboratory autoanalyzer and a blood gas analyzer. Am J Emerg Med. 37(6):1048–1053. https://doi.org/10.1016/j.ajem.2018.08.045
De Waele JJ, Hoste E, Benoit D, Vandewoude K, Delaere S, et al (2003) The effect of tube thoracostomy on oxygenation in ICU patients. J Intensive Care Med. 18(2):100–104. https://doi.org/10.1177/0885066602250358
Mohamed MMG, Patolia S, Nayak R (2024) Needle aspiration versus tube thoracostomy in patients with symptomatic primary spontaneous pneumothorax: an updated meta-analysis of randomized controlled trials. J Thorac Dis. 16(6):4011–4015. https://doi.org/10.21037/jtd-24-60
Ayed AK, Chandrasekaran C, Sukumar M (2006) Aspiration versus tube drainage in primary spontaneous pneumothorax: a randomised study. Eur Respir J. 27(3):477–482. https://doi.org/10.1183/09031936.06.00091505
Blum FE, Lund ET, Hall HA, Tachauer AD, Chedrawy EG, et al (2015) Reevaluation of the utilization of arterial blood gas analysis in the Intensive Care Unit: effects on patient safety and patient outcome. J Crit Care. 30(2):438.e1–438.e5. https://doi.org/10.1016/j.jcrc.2014.10.025
Kundu S, Sen S, Chatterjee S (2023) A study on clinical and arterial blood gas parameters before and after tube thoracostomy among cases of primary and secondary spontaneous pneumothorax. IP Indian J Immunol Respir Med. 8(2):62–68. https://doi.org/10.18231/j.ijirm.2023.014
Ospina-Tascón GA, Bautista-Rincón DF, Umaña M, Tafur JD, Gutiérrez A, et al (2013) Persistently high venous-to-arterial carbon dioxide differences during early resuscitation are associated with poor outcomes in septic shock. Crit Care. 17(6):R294. https://doi.org/10.1186/cc13160
Tang B, Su L, Li D, Wang Y, Liu Q, et al (2021) Stepwise lactate kinetics in critically ill patients: prognostic, influencing factors, and clinical phenotype. BMC Anesthesiol. 21(1):86. https://doi.org/10.1186/s12871-021-01293-x
Özdemir S, Altunok İ (2023) Comparison of the Predictive Ability of the Blood Urea Nitrogen/Albumin, C-Reactive Protein/Albumin, and Lactate/Albumin Ratios for Short-Term Mortality in SARS-CoV-2-Infected Patients. Avicenna J Med. 13(1):43–48. https://doi.org/10.1055/s-0043-1761471
Zhou H, Lan T, Guo S (2019) Stratified and prognostic value of admission lactate and severity scores in patients with community-acquired pneumonia in emergency department: A single-center retrospective cohort study. Medicine (Baltimore). 98(41):e17479. https://doi.org/10.1097/MD.0000000000017479
Işık NI, Kurtoglu Celik G, Işık B (2024) Evaluating emergency department visits for spontaneous and traumatic pneumomediastinum: a retrospective analysis. Ulus Travma Acil Cerrahi Derg. 30(2):107–113. https://doi.org/10.14744/tjtes.2024.66059
Markatis E, Perlepe G, Afthinos A, Pagkratis K, Varsamas C, et al (2022) Mortality Among Hospitalized Patients With Pleural Effusions. A Multicenter, Observational, Prospective Study. Front Med (Lausanne). 9:828783. https://doi.org/10.3389/fmed.2022.828783
Downloads
Published
How to Cite
Issue
Section
Categories
License
Copyright (c) 2025 Kaan Yusufoglu, Abdullah Algın, İbrahim Altundağ, Burcu Genç Yavuz, Mustafa Ahmet Afacan, Şahin Çolak
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
The content of this journal is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
