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Faut-il encore réaliser des gazométries artérielles au service des urgences ?

Is it still useful to sample arterial blood gases in emergency department patients?

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Annales françaises de médecine d'urgence

Résumé

Le recours à la gazométrie artérielle constitue jusqu’à présent un acte quotidien du médecin urgentiste, tant à visée d’aide au diagnostic, au pronostic et à la décision thérapeutique pour son patient. Cependant, il s’agit d’une procédure douloureuse et invasive exposant le patient ainsi que le soignant à un risque faible mais réel de complications. Depuis quelques années, divers auteurs se sont intéressés aux techniques alternatives permettant de diminuer le recours à la gazométrie artérielle: l’analyse des gaz du sang veineux et la saturométrie par oxymétrie pulsée. L’objectif de cet article consiste à revoir les indications de l’analyse des gaz du sang et à préciser les circonstances dans lesquelles la gazométrie artérielle peut raisonnablement être évitée ou remplacée par une technique alternative. Des exemples concrets y sont abordés, ainsi que des exercices pratiques, un projet de procédure écrite et le rappel de notions fondamentales en physiologie respiratoire appliquée.

Abstract

Arterial blood gas measurement is a daily diagnostic tool for the emergency physician. These values are also used for evaluating the prognosis of certain conditions and making therapeutic decisions. ABG sampling is however a painful and invasive act, exposing both the patient and the healthworker to a real, though minimal, risk of complication. In the last couple of years, authors have been investigating alternative techniques to replace ABG sampling: venous blood gas sampling and saturometry by pulse oxymetry. This article aims to revise the indications of arterial blood gas analysis, and to study the circumstances in which arterial blood sampling can be avoided, and replaced by an alternative technique. Concrete examples will be analysed, practical exercises given, a written procedure proposed, and fundamental principles of applied respiratory physiology reviewed.

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Authors and Affiliations

  1. Service des urgences, département de médecine aiguë, cliniques universitaires Saint-Luc, Bruxelles, Belgique

    D. Radermecker, F. Thys & F. Verschuren

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  1. D. Radermecker
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  2. F. Thys
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  3. F. Verschuren
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Correspondence to F. Verschuren.

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Radermecker, D., Thys, F. & Verschuren, F. Faut-il encore réaliser des gazométries artérielles au service des urgences ?. Ann. Fr. Med. Urgence 1, 103–111 (2011). https://doi.org/10.1007/s13341-011-0030-7

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  • DOI: https://doi.org/10.1007/s13341-011-0030-7

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