Добавил:
Sekretar
kiopkiopkiop18@yandex.ru
t.me/Prokururor I Вовсе не секретарь, но почту проверяю
Опубликованный материал нарушает ваши авторские права? Сообщите нам.
Вуз:
Предмет:
Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_1520_Библиотеки_им_академика_М_И_Перельмана
.pdf
481
33 Stomas
trephine which increases the risk of parastomal hernia [ 22 ] . If an end stoma is con-
structed, it is vital to ensure that the correct (i.e., proximal) end is matured; again another
advantage of the laparoscopic approach is the ability to visualize this directly.
33.10 Colorectal Trauma
The traditional approach to traumatic injuries of the colon has been to either exterior-
ize the injury or, if this is not possible, to repair the injury and create a proximal stoma.
It was believed that forming a colostomy reduced the rate of mortality from intra-
abdominal sepsis. This approach of mandatory colostomy for all injuries arose out of
the surgical doctrine of World War II and persisted unchallenged for several decades.
In contemporary surgery, it is common practice to either close colonic wounds primar-
ily or to resect the injured segment and perform a primary anastomosis. A systematic
review of randomized trials has shown that repair or resection and primary anastomo-
sis is appropriate and safe for most isolated colonic injuries [ 23 ] . However, in the
setting of multiple injuries and damage control surgery, there is good evidence of a
high anastomotic leak rate, suggesting a role for exteriorization in this group [ 24 ] .
The traditional approach to trauma of the rectum was to perform a rectal wash-
out, raise a proximal stoma, and insert presacral drains. This approach has been
challenged, and most authorities would now use a more tailored approach to rectal
trauma. Trauma to the upper (intraperitoneal) rectum can be treated as for colonic
trauma. Trauma to the low rectum may be repaired by a transanal approach with
the selective use of defunctioning stoma if there is particularly destructive injury.
A midrectal injury which is not accessible via the anus may be treated with pre-
sacral drainage and proximal diversion [ 25 ] . This is covered in more detail in
Chap. 41 .
33.11 Complications of Stomas (Box 33.5 )
Box 33.5: Complications of Stomas
Early Late
Psychological morbidity Parastomal hernia
Stoma ischemia Stoma prolapse
High-output stoma Skin irritation
Dehydration Body image and sexual dysfunction
Electrolyte imbalance
Mucocutaneous separation Stoma stenosis
Stoma granulations
Stoma retraction
482
M. Cheetham
Several clinical studies have shown that complications of stomas are extremely
frequent and have a deleterious effect on the patient’s quality of life. Nastro et al.
recently reviewed a large series of patients having a stoma and found major compli-
cations in 46.4% (parastomal hernia was the commonest complication seen in 14%)
[
26 ] . The vast majority of stoma complications can be dealt with by a suitably expe-
rienced stoma therapist [
27 ] , but occasionally revision surgery will be needed.
Psychological problems (such as the patient rejecting their stoma) may be largely
prevented by careful preoperative education. Onward referral to a counseling ser-
vice may be needed for those rare patients with severe psychological reaction to
having a stoma.
33.11.1 Stoma Ischemia
Stoma ischemia is usually evident early in the postoperative period. This may be
caused by either a generalized state of hypotension or a technical problem during the
construction of the stoma. The severity of ischemia may vary from minor mucosal
hypoperfusion to a black, completely necrotic stoma. All newly formed stomas should
be inspected the day following surgery to assess their viability. If the stoma looks
ischemic, it can be useful to use either a proctoscope or a test tube inserted into the
stoma to assess the viability of the bowel under the fascia. Urgent surgery to resect
and refashion the stoma will be needed if the bowel leading up to the stoma is necrotic.
Conversely, if the bowel immediately under the stoma is viable, then an expectant
approach may be taken. It is likely that the mucosa will slough off the stoma and that
the late result will be a stenosed stoma orifi ce. This can be dealt with on its own merit
later and is preferable to a diffi cult relaparotomy in the early postoperative period.
33.11.2 High-Output Stomas
A fully adapted end ileostomy has a daily output of approximately 500 mL. In the
initial postoperative period, ileostomy output is often much greater than this (1,000–
1,800 mL). This high volume of stoma output usually reduces in the fi rst few post-
operative days. Higher output stomas (output greater than 2 L/day) are associated
with proximal stomas (i.e., jejunostomy), intra-abdominal sepsis, and following
resolution of postoperative ileus or small-bowel obstruction. This occurs in about
16% of all small-bowel stomas [
28 ] . If a stoma is producing more than 1,000 mL/
day, then intravenous fl uid replacement with Hartmann’s solution or normal saline
will be needed. Restriction of oral hypotonic fl uids will help reduce stoma output.
Close monitoring of electrolytes is important; defi ciencies of sodium, magnesium,
and potassium are common in these patients. Other adjuncts to reduce a high-output
stoma include a low-fi ber diet, proton pump inhibitors (such as omeprazole), and
483
33 Stomas
antimotility agents such as loperamide (in this circumstance, high dose of up to
8 mg four times a day may be needed) or codeine phosphate (central nervous system
side effects and dependence may limit the use of codeine).
33.11.3 Parastomal Hernias
33.11.3.1 Preventing Parastomal Hernias
Traditionally, a stoma is placed though the belly of the rectus abdominis muscle in
the belief that this will prevent herniation. Several retrospective studies have exam-
ined this [ 29– 32 ] , and all but one [ 32 ] found no difference in the rate of parastomal
herniation whether the stoma was placed through or outside the rectus muscle.
Goligher pioneered the use of an extraperitoneal stoma [ 33 ] (the bowel leading
up to the stoma orifi ce is tunneled under the peritoneum). Retrospective studies
have suggested a benefi t is reducing the rate of parastomal hernias compared to the
conventional transperitoneal approach. Despite these data, the extraperitoneal
approach has never been popular.
The recognition that it is safe to use a synthetic mesh to repair parastomal hernias has
lead to surgeons to attempt prophylactic mesh reinforcement of the abdominal wall dur-
ing construction of permanent stomas. In a small randomized controlled trial of the use
of a lightweight mesh placed around the stoma in a sublay position, no patients (0/15)
in the mesh group had a parastomal hernia, compared to 17 out of 21 in the no mesh
group [ 34, 35 ] . Signifi cantly, there were no reported mesh infections in this study.
Stephenson et al. [ 36 ] have recently described a novel method of stoma forma-
tion they call “lateral rectus abdominis positioned stoma” or (LRAPS). This tech-
nique involves making a transverse incision in the anterior rectus sheath. The rectus
abdominis muscle is not split but instead is retracted medially to access the posterior
rectus sheath, which is incised again transversely. The bowel to construct the stoma
is brought out through the combined incision and matured in the conventional way.
Early results of this technique are promising with no parastomal hernias found in
the fi rst 26 patients after a mean follow-up of 13 months.
33.11.3.2 Treating Parastomal Hernias
Parastomal hernias are extremely common. Most are unsightly but do not cause
much in the way of symptoms. Most parastomal hernias do not need surgery, but
symptoms may be helped by the use of a convex stoma appliance or a stoma belt.
With a loop stoma or following Hartmann’s procedure, closing the stoma will allow
the surgeon to obliterate completely the defect in the abdominal wall. If the stoma
is permanent and the hernia is causing signifi cant symptoms, then surgical treatment
may be needed. Overall the results of surgical treatment for parastomal hernias are
disappointing, with high rates of recurrence reported for all techniques.
484
M. Cheetham
The surgical options for parastomal hernias are detailed below in Box 33.6 .
Direct suture of a parastomal hernia has an unacceptably high rate of recurrence
(46–100%) and would only be if use if there was major contamination at the time of
surgery (although one could equally consider using a biological mesh under these
circumstances).
A variety of different techniques of open mesh repair have been described. Using
a laterally placed incision has some advantages in terms of reducing the risk of
contamination and facilitating stoma care postoperatively [
37 ] . A self-adhesive ster-
ile drape is used to exclude the stoma from the operative fi eld. An alternative is to
perform a laparotomy and place the mesh under the stoma. This was fi rst described
using Marlex mesh [ 38 ] , but now surgeons would use a coated mesh. A pooled
analysis of the published results of open mesh repair for parastomal hernia showed
an overall recurrence rate of 7.8% [ 39 ] (although follow-up was short and a variety
of techniques were used in these studies).
The surgeon wishing to carry out a laparoscopic repair of a parastomal hernia has
two options, either to use a slit mesh shaped around the stoma or to place a fl at mesh
underneath the whole stomal orifi ce (essentially a laparoscopic version of the opera-
tion described by Sugarbaker [ 38 ] ). The mesh is fi xed using a combination of spiral
tackers and transfascial sutures, as for a laparoscopic incisional hernia repair. The
literature on laparoscopic parastomal hernia repair is scant, but recurrence rates of
up to 44% have reported [ 40 ] . There are currently little data comparing the open and
laparoscopic approach to parastomal hernias. There are some retrospective data to
suggest that the use of a split mesh technique is inferior to the fl at mesh (Sugarbaker)
technique in terms of recurrence [ 41 ] .
33.11.4 Prolapse
Stoma prolapse is more common in loop stomas and is particularly a problem with
transverse loop colostomies. Prolapse of a stoma can be a dramatic and frightening
experience for a patient. The fi rst episode of prolapse will often result in the patients
seeking emergency medical assistance. An acutely prolapsed stoma can usually be
manually replaced; the use of ice packs or topical sugar [ 42 ] is effective in reducing
edema in the prolapsed stomas and allowing less traumatic reduction of the prolapsed
Box 33.6: Treatment Options for Parastomal Hernia
Do nothing
Support belt or corset
Close the stoma
Direct suture repair
Open repair with mesh
Laparoscopic repair (with split mesh or Sugarbaker technique)
Stoma relocation
485
33 Stomas
bowel. If the prolapse is recurrent and causes problems with stoma care, a surgical
solution is necessary. The most satisfactory surgical solution is to close the stoma
(assuming it is a loop). Converting a loop to an end stoma effectively stops prolapse if
it is not feasible to close the stoma. Recurrent prolapse of an end stoma can be more
diffi cult to correct. Surgical options for a prolapsing end colostomy include excising
the redundant colon and revising the stoma (this may be accomplishing using a surgi-
cal stapler under intravenous sedation). Excision of redundant bowel is not useful for
a prolapsing end ileostomy. In these circumstances, a noncutting linear stapler may be
used to fi x the stoma. Three fi rings of the stapler are used with one limb inside and one
outside the stoma, taking care not to incorporate the mesentery in the staple line [
43 ] .
33.11.5 Retraction
Retraction of a stoma is mostly a problem in obese patients when there is tension on
the bowel or mesentery leading to the stoma orifi ce. In many ways, this is the con-
verse of a prolapsing stoma. Retraction is predominantly a problem associated with
ileostomies when the liquid stoma effl uent can cause severe skin reaction and prob-
lems with adherence of the stoma appliance. The use of noncutting linear stapler as
described above for prolapse may be a useful technique in reducing retraction [ 43 ] .
Otherwise, the stoma will need to be revised; this can be a diffi cult undertaking in
an obese patient. If the length of the mesentery is the cause of retraction, stapling
the end ileostomy closed and performing a loop ileostomy immediately proximally
(an end-loop ileostomy) may be helpful.
33.11.6 Stoma Stenosis
Stenosis of a stoma is usually the late result of stoma ischemia or mucocutaneous
separation. Minor degrees of stenosis may be dealt with be dilatation, using either a
gloved fi nger or a suitable sized Hegar’s or St. Mark’s pattern dilator. The patient
should be taught to pass a fi nger or dilator on a daily basis to prevent stenosis from
recurring. If the stenosis is severe, then it may be necessary to dilate the stoma under
general anesthetic or intravenous sedation initially. More severe forms of stenosis
will require revisional surgery; this may be performed using a local peristomal inci-
sion, but the need to gain suffi cient bowel length may necessitate a laparotomy.
33.11.7 Stoma Granulations
Stoma granulations are a common late complication of a stoma. These are small infl am-
matory polyps on the stoma which may bleed. Histologically, these are composed
of granulation tissue. The appearance of stoma granulation is usually related to
trauma (often from cutting the stoma appliance too small) or stomal prolapse. Small
486
M. Cheetham
granulations can be treated with sliver nitrate cautery and attention to stoma care.
Larger polyps should be excised and sent for histological analysis as these may repre-
sent adenomas or, even rarely, adenocarcinomas [ 44 ] .
33.12 Quality of Life with a Stoma
There have been several studies assessing the quality of life of patients with stomas.
These studies have compared patients with colitis who have had an ileoanal pouch
with those who had a proctocolectomy [ 45– 47 ] and rectal cancer patients who have
had restorative surgery with those who have an abdominoperineal excision of the
rectum. When compared with normals, all these groups had a reduced quality of
life. Overall quality of life was similar in the groups with and without stoma.
However, analysis of the various domains recorded by the quality of life instruments
revealed that patients with permanent stomas recorded lower scores in the domains
related to body image and sexuality. Conversely patients with retained anal function
(ileoanal pouch or low anterior resection) recorded worse scores in those domains
related to bowel function. This information underscores the need for careful preop-
erative counseling in these groups of patients.
Key Points
Preoperative counseling A stoma therapist should see and mark all
elective patients
A working knowledge of marking is necessary
for the surgeon, e.g., emergency patients
Types of bowel stoma Ileostomy/colostomy
Loop/end
Defunctioning stomas Low anterior resection
Pouch procedure
When to close Early closure versus late
Laparoscopic or trephine
stoma for diversion
Trauma Stoma unnecessary for isolated colonic injury
May be unnecessary for rectal trauma
Complications of stomas Ischemia
High output
Hernia
Prolapse
Retraction
Granulomas
Stenosis
Quality of life Reduced body image
487
33 Stomas
References
1. Bass EM, Del Pino A, Tan A, et al. Does preoperative stoma marking and education by the
enterostomal therapist affect outcome? Dis Colon Rectum. 1997;40:440–2.
2. Chaudhri S, Brown L, Hassan I, Horgan AF. Preoperative intensive, community-based vs. tra-
ditional stoma education: a randomized, controlled trial. Dis Colon Rectum. 2005;48:504–9.
3. Hall C, Myers C, Phillips RK. The 554 ileostomy. Br J Surg. 1995;82:1385.
4. Courtney ED, Callaghan CJ, Ilett H, et al. The double-spouted loop ileostomy. Colorectal Dis.
2009;11:215–8.
5. Stephenson BM, Myers C, Phillips RK. Minimally raised end colostomy. Int J Colorectal Dis.
1995;10:232–3.
6. Speirs M, Leung E, Hughes D, et al. Ileostomy rod–is it a bridge too far? Colorectal Dis.
2006;8:484–7.
7. Montedori A, Cirocchi R, Farinella E, et al. Covering ileo- or colostomy in anterior resection
for rectal carcinoma. Cochrane Database Syst Rev. 2010;(5):CD006878.
8. Peeters KC, Tollenaar RA, Marijnen CA, et al. Risk factors for anastomotic failure after total
mesorectal excision of rectal cancer. Br J Surg. 2005;92:211–6.
9. Guenaga KF, Lustosa SA, Saad SS, Saonato H, Matos D. Ileostomy or colostomy for tempo-
rary decompression of colorectal anastomosis. Cochrane Database Syst Rev. 2007;(1):
CD004647.
10. Parks AG, Nicholls J. Proctocolectomy without ileostomy for ulcerative colitis. Br Med J.
1978;2:85–8.
11. Launer DP, Sackier PM. Pouch-anal anastomosis without diverting ileostomy. Dis Colon
Rectum. 1991;34:993–8.
12. Remzi FH, Fazio VW, Gorgun F, et al. The outcome after restorative proctocolectomy with or
without defunctioning ileostomy. Dis Colon Rectum. 2006;49:470–7.
13. Joyce MR, Fazio VW, Hull TT, et al. In a select group of patients meeting strict clinical criteria
and undergoing ileal pouch-anal anastomosis, the omission of a diverting ileostomy offers cost
savings to the hospital. Dis Colon Rectum. 2010;53:905–10.
14. Grobler SP, Hosie KB, Keighley MR. Randomized trial of loop ileostomy in restorative proc-
tocolectomy. Br J Surg. 1992;79:903–6.
15. David GG, Slavin JP, Willmott S, Corless DJ, Khan AU. Loop ileostomy following anterior
resection: is it really temporary? Colorectal Dis. 2010;12:428–32.
16. Hull TL, Kobe I, Fazio VW. Comparison of handsewn with stapled loop ileostomy closures.
Dis Colon Rectum. 1996;39:1086–9.
17. Leung TT, MacLean AR, Buie WD, Dixon E. Comparison of stapled versus handsewn loop
ileostomy closure: a meta-analysis. J Gastrointest Surg. 2008;12:939–44.
18. Shelygin YA, Chernyshov SV, Rybakov EG. Stapled ileostomy closure results in reduction of
postoperative morbidity. Tech Coloproctol. 2010;14:19–23.
19. Shalli K, Watson C, McCaffer L, et al. The effect of peri-stomal infi ltration with bupivacaine/
epinephrine on post-operative pain, nausea and ease of surgery in reversal of loop ileostomies.
Int J Colorectal Dis. 2009;24:1435–9.
20. Reid K, Pockney P, Pollitt T, Dragnaic B, Smith SR. Randomized clinical trial of short-term
outcomes following purse-string versus conventional closure of ileostomy wounds. Br J Surg.
2010;97:1511–7.
21. Senapati A, Phillips RK. The trephine colostomy: a permanent left iliac fossa end colostomy
without recourse to laparotomy. Ann R Coll Surg Engl. 1991;73:305–6.
22. Kini SU, Perston Y, Radcliffe AG. Laparoscopically assisted trephine stoma formation. Surg
Laparosc Endosc. 1996;6:371–4.
23. Nelson R, Singer M. Primary repair for penetrating colon injuries. Cochrane Database Syst
Rev. 2003;(3):CD002247.
24. Weinberg JA, Griggin RL, Vandromme HJ, et al. Management of colon wounds in the setting
of damage control laparotomy: a cautionary tale. J Trauma. 2009;67:929–35.
25. Weinberg JA, Fabian TC, Magnoth LJ, et al. Penetrating rectal trauma: management by ana-
tomic distinction improves outcome. J Trauma. 2006;60:508–13.
488
M. Cheetham
26. Nastro P, Knowles CH, McGrath A, et al. Complications of intestinal stomas. Br J Surg.
2010;97:1885–9.
27. Black P. Managing physical postoperative stoma complications. Br J Nurs. 2009;18:S4–10.
28. Baker ML, Williams RN, Nightingale JM. Causes and management of a high output stoma.
Colorectal Dis. 2011;13:191–7.
29. Ortiz H, Sara HJ, Armendariz P, et al. Does the frequency of paracolostomy hernias depend on
the position of the colostomy in the abdominal wall? Int J Colorectal Dis. 1994;9:65–7.
30. Williams JG, Etherington R, Haywood MW, Hughes LE. Paraileostomy hernia: a clinical and
radiological study. Br J Surg. 1990;77:1355–7.
31. Londono-Schimmer EE, Leong AP, Phillips RK. Life table analysis of stomal complications
following colostomy. Dis Colon Rectum. 1994;37:916–20.
32. Sjodahl R, Anderberg B, Bolin T. Parastomal hernia in relation to site of the abdominal stoma.
Br J Surg. 1988;75:339–41.
33. Goligher JC. Extraperitoneal colostomy or ileostomy. Br J Surg. 1958;46:97–103.
34. Janes A, Cengiz Y, Israelsson LA. Preventing parastomal hernia with a prosthetic mesh: a
5-year follow-up of a randomized study. World J Surg. 2009;33:118–21.
35. Janes A, Cengiz Y, Israelsson LA. Randomized clinical trial of the use of a prosthetic mesh to
prevent parastomal hernia. Br J Surg. 2004;91:280–2.
36. Stephenson BM, et al. Minimal anatomical disruption in stoma formation: the lateral rectus
abdominis positioned stoma (LRAPS). Colorectal Dis. 2010;12:1049–52.
37. Amin SN, Armitage NC, Abercrombie JF, Scholefi eld JH. Lateral repair of parastomal hernia.
Ann R Coll Surg Engl. 2001;83:206–8.
38. Sugarbaker PH. Peritoneal approach to prosthetic mesh repair of paraostomy hernias. Ann
Surg. 1985;20:344–6.
39. Carne PW, Robertson GM, Frizelle FA. Parastomal hernia. Br J Surg. 2003;90:784–93.
40. Safadi B. Laparoscopic repair of parastomal hernias: early results. Surg Endosc.
2004;18:676–80.
41. Muysoms EE, Hauters PJ, Van Nieuwenhoue Y, et al. Laparoscopic repair of parastomal her-
nias: a multi-centre retrospective review and shift in technique. Acta Chir Belg.
2008;108:400–4.
42. Fligelstone LJ, Wanendeya N, Palmer BV. Osmotic therapy for acute irreducible stoma pro-
lapse. Br J Surg. 1997;84:390.
43. Skaerlund ML, Jacobsen L, Tottrup A. Ileostomy revision using noncutting linear stapler.
Colorectal Dis. 2008;10:833–6.
44. Attanoos R, Billings PJ, Hughes LE, Williams JG. Ileostomy polyps, adenomas, and adenocar-
cinomas. Gut. 1995;37:840–4.
45. O’Bichere A, Wilkinson K, Rumbles S, et al. Functional outcome after restorative panprocto-
colectomy for ulcerative colitis decreases an otherwise enhanced quality of life. Br J Surg.
2000;87:802–7.
46. Camilleri-Brennan J, Munro A, Steele RJ. Does an ileoanal pouch offer a better quality of life
than a permanent ileostomy for patients with ulcerative colitis? J Gastrointest Surg.
2003;7:814–9.
47. Seidel SA, Newman AM, Sharp KW. Ileoanal pouch versus ileostomy: is there a difference in
quality of life? Am Surg. 2000;66:540–6.
489
S.R. Brown et al. (eds.), Contemporary Coloproctology,
DOI 10.1007/978-0-85729-889-8_34, © Springer-Verlag London Limited 2012
34.1 M62 Experiences of Intensive Care Medicine
This chapter is not intended to be an account of the basics of intensive care medi-
cine, or even an introduction to such: the subject is far too large, and there are
already many excellent texts available. Rather, it is written to refl ect those intensive
care topics covered in the series of lectures delivered to the M62 audience over the
past few years. While intentionally limited in its objectives, it is hoped that it will
provide a basic reference guide to the areas covered and will certainly point the
reader in the direction of further information should that be required.
The topics are listed in the order they have appeared in the lecture series, with the
exception of the lecture on acidosis, which is so intimately related to arterial blood
gases that the two topics are considered together.
34.2 Arterial Blood Gases and Acidosis
Any doctor practicing in acute medicine needs to be able to interpret arterial blood
gases: they are used ever more frequently to guide treatment and to recognize when a
patient is unwell. This section covers the basics of blood gas analysis before moving
onto some clinical examples of how they can be used to illustrate these principles.
J. R. Goodall
Department of Critical Care ,
Salford Royal Hospital ,
Stott Lane , Salford, Greater Manchester
M6 8HD , UK
e-mail: jonathan.goodall@srht.nhs.uk
Chapter 34
Intensive Care: The Basics
Jonathon R. Goodall
490
J.R. Goodall
34.3 Defi nitions and Normal Values
It is always necessary to have a grasp of the basic terminology before being able to
fully understand a subject: unfortunately in the area of acid–base balance and
blood gas analysis, terms are often used “loosely” and interchangeably, suggesting
that the basic terminology is not fully understood. Table 34.1 outlines the correct
defi nitions.
34.4 Interpreting Blood Gases
Although the results of a blood gas sample are presented as a single entity, interpre-
tation is made much more simple if oxygenation and acid–base status are initially
looked at independently.
Table 34.1 Normal values and ranges
Normal values
pH 7.35–7.45
Hydrogen ion concentration in the sample
H
+
35–45 nmol·L
−1
Negative log of the H + concentration. As a log scale is
used, small changes in pH represent huge changes
in H + concentration
pCO
2
Partial pressure of carbon dioxide
PaCO
2
4.5–6 kPa Partial pressure of carbon dioxide in arterial blood
PaO
2
11–14 kPa Partial pressure of oxygen in arterial blood
Actual HCO
3
22–26 mmol·L
−1
Plasma bicarbonate present in the blood sample (as
calculated from the results of the measured pH and
PCO
2
values in the blood sample)
Standard HCO
3
22–26 mmol·L
−1
The calculated plasma bicarbonate that would be
present in the sample if the:
PCO
2
was 5.3 kPa
Temp. 37°C
Blood fully oxygenated
At sea level
Standard bicarbonate, therefore, removes the respira-
tory component of the acid–base disturbance
Base excess ±2.0 The amount of base that needs to be added to (or
removed from) a sample to achieve pH of 7.4 if the:
PCO
2
was 5.3 kPa
Temp. 37°C
Base excess (BE) also removes the respiratory
component of the acid–base disturbance. A positive
BE describes a metabolic alkalosis; a negative BE,
a metabolic acidosis
SaO
2
³ 95% The % of Hb in arterial blood saturated with O
2
as
measured in a blood sample
SpO
2
>95% The % of Hb in arterial blood saturated with O
2
as
measured by pulse oximetry
Соседние файлы в папке Библиотека им академика М.И. Перельмана