Arterial Blood Gas Analysis of Critically Ill Corona Virus Disease 2019 Patients

Main Article Content

Jitendra Lakhani
Sajani Kapadia
Hetal Pandya
Roop Gill
Rohit Chordiya
Arti Muley


Background/Aims: The aim of present study was to find out profile and sequential pattern of Arterial Blood Gas (ABG) in critically ill Corona Virus Disease 2019 (COVID-19) patients.

Study Design: Observational prospective study.

Methodology: A total of 80 Reverse Transcription Polymerase Chain Reaction (RT PCR) positive cases; that needed ICU admission for their life-threatening conditions were included in this study done at teaching hospital of Gujarat, India. Non consenting patients and patients who could not be followed up as per protocol were excluded. Data of Arterial Blood Gas (ABG), performed on admission, day 5 and day 10 were taken for the analysis. Patients were followed up till they remained in ICU.

Results: Of 80 patients, 3 patients had normal, 24 patients (30%) had primary disorder on ABG while 53 patients (66.25%) had mixed disorders. The most common ABG abnormality observed was respiratory alkalosis with metabolic acidosis in 16 patients (20%) while respiratory alkalosis with metabolic alkalosis in 15 patients (18.75%). There was difference in ABG pattern observed among survivors and non-survivors (P=.04); of which conspicuous was presence of “respiratory acidosis with metabolic acidosis” in 5 non-survivors (15.63%), which was not seen in survivors. Of 80 patients admitted in COVID ICU; 2 improved after day 1; 6 after day 5; 40 after day 10, making total of 48 patients surviving COVID critical condition. Of 32 non-survivors, 14 died within twenty-four hours of admission, 14 within first 5 days and 04 after 10 days of ICU stay.

Conclusion: ABG done on admission and serially in severe COVID-19 patients gives useful information on underlying pathophysiology. Mixed ABG pattern was more common than single disorder which can be sign of multi-organ involvement.  Respiratory acidosis with metabolic acidosis was observed significantly higher in non-survivors. Respiratory alkalosis as a part of single or mixed pattern on ABG was the most common pattern found in critically ill COVID patients.

SARS CoV-2, COVID-19, ABG analysis, mixed acid-base disorder, respiratory alkalosis

Article Details

How to Cite
Lakhani, J., Kapadia, S., Pandya, H., Gill, R., Chordiya, R., & Muley, A. (2021). Arterial Blood Gas Analysis of Critically Ill Corona Virus Disease 2019 Patients. Asian Journal of Research in Infectious Diseases, 6(3), 51-63.
Original Research Article


Verma AK, Paul R. The interpretation of Arterial Blood Gases. Australian Prescriber. 2010;33:124–129.

Mehta P, McAuley DF, Brown M, Sanchez E, Tattersall RS, Manson JJ; HLH Across Speciality Collaboration, UK: COVID-19: Consider cytokine storm syndromes and immunosuppression. The Lancet 2020;395:1033–1034.

Barnes BJ, Adrover JM, Baxter-Stoltzfus A, Borczuk A, Cools-Lartigue J, Crawford JM, Daßler-Plenker J, Guerci P, Huynh C, Knight JS, Loda M, Looney MR, McAllister F, Rayes R, Renaud S, Rousseau S, Salvatore S, Schwartz RE, Spicer JD, Yost CC, Weber A, Zuo Y, Egeblad M. Targeting potential drivers of COVID-19: Neutrophil extracellular traps. The Journal of Experimental Medicine. 2020;217(6):e20200652.

Qin C, Zhou L, Hu Z, Zhang S, Yang S, Tao Y, Xie C, Ma K, Shang K, Wang W, Tian DS. Dysregulation of Immune Response in Patients with Coronavirus 2019 (COVID-19) in Wuhan, China. Clinical Infectious Diseases: An official publication of the Infectious Diseases Society of America. 2020;71(15):762-768.

Chen G, Wu D, Guo W, Cao Y, Huang D, Wang H, Wang T, Zhang X, Chen H, Yu H, Zhang X, Zhang M, Wu S, Song J, Chen T, Han M, Li S, Luo X, Zhao J, Ning Q. Clinical and immunological features of severe and moderate coronavirus disease 2019. The Journal of Clinical Investigation. 2020;130(5):2620-2629.

Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y, Zhang L, Fan G, Xu J, Gu X, Cheng Z, Yu T, Xia J, Wei Y, Wu W, Xie X, Yin W, Li H, Liu M, Xiao Y, Gao H, Guo L, Xie J, Wang G, Jiang R, Gao Z, Jin Q, Wang J, Cao B. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497-506.

Perdomo J, Leung HHL, Ahmadi Z, Yan F, Chong JJH, Passam FH, Chong BH. Neutrophil activation and NETosis are the major drivers of thrombosis in heparin-induced thrombocytopenia. Nature Communications. 2019;10(1):1322.

Yu X and Diamond SL. Fibrin Modulates Shear-Induced NETosis in Sterile Occlusive Thrombi Formed under Haemodynamic Flow. Thrombosis and Haemostasis. 2019;119(4):586-593.

Varjú I and Kolev K: Networks that stop the flow: A fresh look at fibrin and neutrophil extracellular traps. Thrombosis Research. 2019;182:1–11.

Yang X, Yu Y, Xu J, Shu H, Xia J, Liu H, Wu Y, Zhang L, Yu Z, Fang M, Yu T, Wang Y, Pan S, Zou X, Yuan S, Shang Y. Clinical course and outcomes of critically ill patients with SARS-CoV-2 pneumonia in Wuhan, China: A single-centered, retrospective, observational study. The Lancet Respiratory Medicine. 2020;8:475-481.

Bhatraju PK, Ghassemieh BJ, Nichols M, Kim R, Jerome KR, Nalla AK, Greninger AL, Pipavath S, Wurfel MM, Evans L, Kritek PA, West TE, Luks A, Gerbino A, Dale CR, Goldman JD, O'Mahony S, Mikacenic C. Covid-19 in Critically Ill Patients in the Seattle Region - Case Series. The New England Journal of Medicine. 2020;382(21):2012-2022.

Grasselli G, Zangrillo A, Zanella A, Antonelli M, Cabrini L, Castelli A, Cereda D, Coluccello A, Foti G, Fumagalli R, Iotti G, Latronico N, Lorini L, Merler S, Natalini G, Piatti A, Ranieri MV, Scandroglio AM, Storti E, Cecconi M, Pesenti A; COVID-19 Lombardy ICU Network. Baseline Characteristics and Outcomes of 1591 Patients Infected With SARS-CoV-2 Admitted to ICUs of the Lombardy Region, Italy. The Journal of American Medical Association. 2020;323(16):1574-1581.

Tobin MJ, Laghi F, Jubran A. Ventilatory failure, ventilator support, and ventilator weaning. Comprehensive Physiology. 2012;2(4):2871–2921.

ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute Respiratory Distress Syndrome: The Berlin Definition.The Journal of American Medical Association. 2012;307(23):2526-2533.

Molloy EJ, Bearer CF. Covid-19 in children and altered inflammatory responses. Pediatric Research. 2020;88(3):340-341.

Park SE. Epidemiology, virology, and clinical features of severe acute respiratory syndrome -coronavirus-2 (SARS-CoV-2; Coronavirus Disease-19). Clinical and Experimental Pediatrics. 2020;63(4):119-124.

Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J, Wang B, Xiang H, Cheng Z, Xiong Y, Zhao Y, Li Y, Wang X, Peng Z. Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China. The Journal of American Medical Association. 2020;323(11):1061-1069.

Chen N, Zhou M, Dong X, Qu J, Gong F, Han Y, Qiu Y, Wang J, Liu Y, Wei Y, Xia J, Yu T, Zhang X, Zhang L. Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: A descriptive study. The Lancet. 2020;395(10223):507-513.

Lakhani JD, Chordiya R, Mota T, Trivedi S, Lakhani Sucheta J. Arterial blood gas analysis in patients of sepsis. International Journal of Pharmaceutical Research. 2020;(Supplementary Issue 1):370-378.

Lakhani Som J, Khara R, Lakhani SJ, Shah C, Lakhani JD. Clinical and microbiological profile of skin and soft tissue infections (SSTI) leading to sepsis. Indian Journal of Clinical and Experimental Dermatology. 2018;4(3):158-164.

Desai SR and Lakhani JD. Clinical profile of patients with multi-organ dysfunction syndrome in patients of sepsis in rural set up MICU People’s Journal of Scientific Research. 2014;7(2):28-32.

Chhetri S, Khamis F, Pandak N, Al Khalili H, Said E, Petersen E. A fatal case of COVID-19 due to metabolic acidosis following dysregulate inflammatory response (cytokine storm). ID Cases. 2020;21:e00829.
DOI: 10.1016/j.idcr.2020.e00829

Desai S, Lakhani JD. Utility of SOFA and APACHE II score in sepsis in rural set up MICU. The Journal of the Association of Physicians of India. 2013;61(9):608‐611.

Pandya H, Muley A, Gill R, Jeevana. Comparison of Various clinical scoring systems in predicting progression and outcome in COVID 19 Infection. Asian Journal of Research in Infectious Diseases. 2020;5(3): 9-19.

Mehta TR, Shah CT, Lakhani JD. Can pulse oximetric saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio surrogate PaO2/FiO2 ratio in diagnosing acute respiratory failure? International Journal of Biomedical and Advance Research. 2016;7(5):242–246.

Gardner WN. The pathophysiology of hyperventilation disorders. Chest. 1996;109:516–534.

Andersen LW, Mackenhauer J, Roberts JC, Berg KM, Cocchi MN, Donnino MW. Etiology and therapeutic approach to elevated lactate levels. Mayo Clinic Proceedings. 2013;88(10): 1127‐1140.

Guan WJ, Ni ZY, Hu Y, Liang WH, Ou CQ, He JX, Liu L, Shan H, Lei CL, Hui DSC, Du B, Li LJ, Zeng G, Yuen KY, Chen RC, Tang CL, Wang T, Chen PY, Xiang J, Li SY, Wang JL, Liang ZJ, Peng YX, Wei L, Liu Y, Hu YH, Peng P, Wang JM, Liu JY, Chen Z, Li G, Zheng ZJ, Qiu SQ, Luo J, Ye CJ, Zhu SY, Zhong NS. Clinical characteristics of coronavirus disease 2019 in China. New England Journal of Medicine. 2020;382:1708–1720.

Chen D, Li X, Song Q, Hu C, Su F, Dai J, Ye Y, Huang J, Zhang X. Assessment of hypokalemia and clinical characteristics in patients with coronavirus disease 2019 in Wenzhou, China. Journal of American Medical Association Network Open. 2020;3(6):e2011122.
DOI: 10.1001/jamanetworkopen.2020.11122
PMID: 32525548; PMCID: PMC7290402.

Gennari FJ, Kassirer JP. Respiratory alkalosis. In: Cohen JJ, Kassirer JP (eds). Acid-Base. Boston: Little, Brown and Co. 1982;349–376.

Ottestad W, Søvik S. COVID-19 patients with respiratory failure: What can we learn from aviation medicine? British Journal of Anaesthesia. 2020;125(3):e280-e281.