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Latest developments in diagrammatic diagnosis of acid-base
balance disorders
N. Theakos1, A. Loukos2, M. Vasiliou3, P.
Bechrakis1
1Experimental Physiology Laboratory,
2Intensive Care Unit, "Red Cross" Hospital,
3Pulmonary Medicine Department, Medical School, University of Ioannina
SUMMARY: The objective of the present study was to investigate the
diagnostic validity of a new diagrammatic approach to the diagnosis of acid-base
balance disorders as proposed by A. Grogono. In order to examine the diagnostic
validity of the proposed diagram, 3,122 arterial blood gas samples were drawn
from 114 Intensive Care Unit (ICU) patients and were interpreted using the Grogono
diagram and the following approaches as comparators: 1. The Siggaard-Andersen
(S-A) chart, 2. The .Oxygen Status Algorithm. (OSA) software and 3. Two physicians
with more than 10 years of experience in ICU, considered experts in acid-base
balance disorders. Our results showed that: 1. The Grogono diagram presents
the higher diagnostic agreement with the other methods ranging from 59.7% to
72.5%; 2. The diagnostic agreement between the Grogono diagram and the OSA software
(70.5%) is significantly higher (p<0.001) in comparison to that between the
Grogono diagram and the S-A chart (59.7%); 3. The ratios of diagnostic agreement
between the Grogono diagram and each one of the two experts (72.5% and 62.1%,
respectively) are significantly higher (p<0.001) than those calculated for the
.S-A chart. (48.3% and 56.4%, respectively); 4. The two expert physicians disagreed
with each other in the diagnosis of 1/3 of the cases of arterial blood gases
disturbances. Moreover, they presented significant diagnostic variation in the
comparisons with the other methods. In conclusion, the Grogono diagram, although
superior to the S-A chart, cannot be safely used for the diagnosis of acid-base
balance disorders in everyday clinical practice, because it has been shown to
provide inaccurate diagnoses in at least 25% of the cases. Pneumon 2004,
17(2):159-166.
Key words: Arterial blood gases, Acid-base balance disorders, Acid-base
diagram, Grogono diagram, Siggaard-Andersen chart, Oxygen Status Algorithm software.
Correspondence: N. Theakos 3, Kosmas Etolos str. GR-151 25, Athens, Greece
Tel.: 210-6198525, 6972-016995 e-mail: ntheakos@hotmail.com
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