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The Alveolar-arterial O2 Gradient as Perceived by Hospital-based Health Care Professionals: A Survey of 100 Individuals FREE TO VIEW

Shakeel Amanullah, MD; Jason M. Golbin, DO; Anthony C. Theodoris, MD; Steven J. Lowenstein, RRT; Murray R. Rogers, MD, FCCP; Klaus D. Lessnau, MD, FCCP
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Lenox Hill Hospital, New York, NY


Chest. 2003;124(4_MeetingAbstracts):86S. doi:10.1378/chest.124.4_MeetingAbstracts.86S
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PURPOSE:  This study was performed to evaluate the understanding of an increased alveolar-arterial oxygen gradient (Aa-gradient) among hospital-based health care professionals in an university-affiliated teaching hospital.

METHODS:  A common clinical scenario was chosen with a setting of “pure” oxygen inhalation (FiO2 of 1.0) and a “normal” arterial PO2 of 100 mm Hg with a pCO2 of 40 mm Hg. One hundred subjects, consisting of students, medical residents, fellows of different subspecialties, attendings, nurses and respiratory therapists, were interviewed. Evaluation with and without a personal digital assistant device (PDA)-based Aa-gradient program was performed (MedCalc 2001). A subgroup of twenty individuals was randomized with a coin toss. The study group was unbiased and had no prior knowledge of the study question. EpiInfo, version 6, Statcalc, was used for evaluation.

RESULTS:  Of the randomized 20 subjects, 10 out of 10 individuals had correct answers with the use of a PDA. Only 2 out of 10 subjects estimated an Aa-gradient of greater than 200 without prior PDA use (p = 0.0003, confidence interval 1.5-17.3). A scatter plot shows the estimated A-a gradient (AaDO2) and the level of education. The mean estimated Aa-gradient was 128 with a range of 0-500. Four subjects stated that they did not know the answer and 7 individuals were excluded because of prior knowledge of the study results.

CONCLUSION:  Appreciation of the large Aa-gradient in patients with a pO2 of 100 on FiO2 of 1.0 was not evident. Increased awareness is useful because an Aa-gradient of 563 is potentially fatal if adequate intervention is not undertaken. The PDA-based program significantly improved awareness of acute lung injury and acute respiratory distress syndrome.

CLINICAL IMPLICATIONS:  A real-time PDA-based Aa-gradient program increases the appreciation of acute lung injury and acute respiratory distress syndrome. This may change the aggressiveness of the diagnostic and therapeutic approach to critically ill patients.

DISCLOSURE:  S. Amanullah, None.

Monday, October 27, 2003

2:30 PM - 4:00 PM




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