Respiratory system

The respiratory system is frequently the first involved in multisystem disease. The chest radiograph may be entirely normal or may exhibit patchy peripheral infiltrates. Blood gases and acid-base abnormalities may be subtle. In early stages of acute lung injury P°2 may fall slightly. There may be a compensated metabolic acidosis only as the arterial pH may be normal owing to compensatory hyperventilation. As lung injury and oxygenation become worse despite increasing the inspired oxygen concentration, CO2 elimination may be hindered, leading to a rise in Pco2 with a consequent mixed metabolic and respiratory acidosis. Blood lactate concentration may rise secondary to tissue hypoperfusion. Owing to the shift of the oxyhemoglobin dissociation curve, oxygen availability is better represented by direct measurement of arterial oxygen saturation rather than partial pressure. A more complete picture of oxygen transport is achieved by measuring mixed venous oxygen saturation and calculating the total body oxygen availability and oxygen consumption.

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