RESPIRATORY ASSESSMENT for ventilated and non-ventilated patients, including blood gases and x-rays.
(for exercise testing, see ‘Exercise’)

To convert: kPa ↔ mmHg -

AARC (2011) Capnography/capnometry during mechanical ventilation. Respir Care; 56(4):503–509

AARC CLINICAL PRACTICE GUIDELINE (2012): transcutaneous monitoring of carbon dioxide and oxygen. Respir Care, 57, 11, 1955-62

AARC (2013) CLINICAL PRACTICE GUIDELINE: blood gas analysis and hemoximetry. Respir Care; 58(10):1694-703




Baldwin CE, Paratz JD, Bersten AD (2013) Muscle strength assessment in critically ill patients with handheld dynamometry: an investigation of reliability, minimal detectable change, and time to peak force generation. J Crit Care, 1, 77-86. doi: 10.1016/j.jcrc.2012.03.001

Bausewein C (2006) Measurement of breathlessness in advanced disease: a systematic review. Respir Med 101, 399-410

Beekman E, Mesters I, Hendriks EJM et al (2013) Course length of 30 metres versus 10 metres has a significant influence on six-minute walk distance in patients with COPD: an experimental crossover study. J Physiother, 59(3)169-176

Benton D (2011) Dehydration influences mood and cognition: a plausible hypothesis? Nutrients, 3, 5, 555–73

Birring SS, Prudon B, Carr AJ et al (2003) Development of a symptom specific health status measure for patients with chronic cough. Thorax, 58, 339-43.

Blann A (2006) Routine Blood Tests Explained. A Guide for Nurses and Allied Health Professionals. M & K Update, Cumbria

Bruusgaard D, Tschudi-Madsen H, Ihlebæk C et al (2012) Symptom load and functional status: results from the Ullensaker population study. BMC Public Health, 12: 1085. doi: 10.1186/1471-2458-12-1085

Carlsten C, Aitken ML, Hallstrand TS (2007) Safety of sputum induction with hypertonic saline solution in exercise-induced bronchoconstriction. Chest; 131(5):1339–44

Chanques G et al (2006) Impact of systematic evaluation of pain and agitation in an intensive care unit. Crit Care Med, 34, 6, 1691-9
• accurate assessment of pain and agitation reduces duration of mechanical ventilation and hospital-acquired infections

Chanques G, Pohlman A, Kress JP et al (2014) Psychometric comparison of three behavioural scales for the assessment of pain in critically ill patients unable to self-report. Crit Care; 18:R160 doi:10.1186/cc14000

Cheuvront SN (2013) Physiologic basis for understanding quantitative dehydration assessment. Am J Clin Nutr; 97(3):455-462. doi:10.3945/ajcn.112.044172

Connolly MA (2001) Black, white and shades of gray: common abnormalities in chest radiographs. AACN Clin Issues, 12, 259-69;jsessionid=D48oT8PdT9msfbUhDRFB24d3SZbnLeBWhzqhIKW51KXDWJZeGiVZ!-477899252!-949856144!9001!-1?index=1&database=ppvovft&results=1&count=10&searchid=1&nav=search (abstract only)
• systematic examination, common abnormalities, examples

Cortés CA, Martínez RM (2013) Manifestations of lobar atelectasis on chest X-rays and correlation with computed tomography findings. Radiologia. 56;(3):257–267. doi:10.1016/j.rx.2013.08.003

Cowley NJ, Owen A (2013) Interpreting arterial blood gas results. BMJ, 346, f16

Cuthbertson BH (2008) Optimising early warning scoring systems. Resuscitation, 77, 153-4
• review of two papers on the effectiveness of early warning scoring systems

Davis AHT (2007) Reliability and validity of the Exercise Self-regulatory Efficacy Scale for individuals with COPD. Heart Lung, 36, 3, 205-16

Desborough MJ, Keeling DM (2013) How to interpret a prolonged prothrombin time or activated partial thromboplastin time. Br J Hosp Med, 74, 1, C10-C12

Dick E (2000) Chest x rays made easy. Student BMJ, 89, 444-6

Dicpinigaitis PV, Lim L, Farmakidis C (2014) Cough syncope. Respir Med; 108(2):244-251

Farkhooy A (2013) Impaired Carbon Monoxide Diffusing Capacity is the strongest predictor of exercise intolerance in COPD. COPD, 10(2):180–185. doi:10.3109/15412555.2012.734873

Garcia-Pachon E (2002) Paradoxical movement of the lateral rib margin (Hoover sign) for detecting obstructive airway disease. Chest, 122, 651-5
• Hoover sign is easy to recognise and useful for detecting obstructive airway disease

Gilbert M (2013) Cardiac output measurement. Anaesth Int Care Med, 14(2):63-67

Greco FA (2004) Interpretation of breath sounds. Am J Respir Crit Care Med, 169, 1260 (letter)

Guenther U, Weykam J, Andorfer U (2012) Implications of objective vs subjective delirium assessment in surgical intensive care patients. Am J Crit Care, 21, e12-e20; doi:10.4037/ajcc2012735

Gurudatt CL (2012) Sedation in Intensive Care Unit patients: assessment and awareness. Indian J Anaesth, 55, 6, 553–555. doi: 10.4103/0019-5049.90607

Haque RA, Usmani OS, Barnes PJ (2005) Chronic idiopathic cough: a discrete clinical entity? Chest, 127, 1710-13
• chronic cough may be initiated by an upper respiratory tract infection which sensitizes the cough reflex

Hacievliyagil SS, Gunen H (2006) Association between cytokines and induced sputum and severity of COPD. Respir Med, 100, 5, 846-54
• higher levels of cytokines in induced sputum indicate severity of COPD during exacerbation

Hammond K, You D, Collins EG et al (2013) Life-threatening hypokalemia following rapid correction of respiratory acidosis. Heart Lung; 42(4)287-289

Ho JE, Bittner V (2010) Usefulness of heart rate at rest as a predictor of mortality, hospitalization for heart failure, myocardial infarction, and stroke in patients with stable coronary heart disease. Am J Cardiol, 105, 7, 905-911
• for people with CVD, HR at rest of ≥70 beats/min is associated with 40% increase in mortality and double the risk of HF hospitalisation, but not the risk of stroke or MI.

Ikematsu Y (2007) Incidence and characteristics of dysphoria in patients with cardiac tamponade. Heart Lung, 36, 6, 440-9.

Inoue H (2009) A new breath-holding test may noninvasively reveal early lung abnormalities caused by smoking and/or obesity. Chest, 136, 2, 545-553
• the fall in SaO2 during a 20-second breath-hold at resting end-exhalation reveals early lung abnormalities

Jain SN (2011) A pictorial essay: Radiology of lines and tubes in the intensive care unit. Indian J Radiol Imaging, 21, 3, 182–190.

Jones PW (2013) COPD Assessment Test – rationale, development, validation and performance. COPD, 10(2): 269-271. doi:10.3109/15412555.2013.776920

Jones AYM, Jones RD (2000) The effect on sound generation of varying both gas flow rate and the viscosity of sputum-like gel. Lung, 178, 31-40
• absence of crackles does not always indicate absence of secretions

Karbing DS, Kjaergaard S, Smith BW et al (2007) Variation in the PaO2/FiO2 ratio with FiO2: mathematical and experimental description, and clinical relevance. Crit Care, 11:R118
• PaO2/FiO2 quantifies effects of treatment
• PaO2/FiO2 varies with both FiO2 and SaO2
• classifies patients' gas exchange status, including definitions of ALI (27 kPa ≤ PaO2/FiO2 < 40 kPa) and ARDS (PaO2/FiO2 < 27 kPa)
(useful commentary on how this measurement can achieve a balance between accuracy and feasibility is on

Karen KG, Higgins TL (2005) New-generation pulse oximetry in the care of critically ill patients. Am J Crit Care, 14, 26-37

Kassean HK, Jagoo ZB (2005) Managing change in the nursing handover from traditional to bedside handover. BMC Nurs, 4,1
• A handover at the bedside, rather than at the nurses’ station, provides greater satisfaction for patient and staff

Kon SSC (2013) Reliability and validity of 4-metre gait speed in COPD. Eur Respir J, 41(2):333-340. doi: 10.1183/09031936.00162712

Kvale A, Johnsen TB, Ljunggren AD (2002) Examination of respiration in patients with long-lasting musculoskeletal pain. Advances Physiother, 4, 169-81
• fascinating insight into the effect of pain on breathing

Lange NE (2009) Spirometry: don't blow it! Chest, 136, 2, 608-614
• everything you need to know about the practicalities of spirometry.

Lichtenstein DL (2003) The "lung pulse": an early ultrasound sign of complete atelectasis. Int Care Med, 29, 12, 2187-92

Lobo V, Weingrow D, Perera P et al (2014) Thoracic ultrasonography. Crit Care Clinics; 30(1):93-117

Lou J-S (2010) Assessment and management of fatigue in neuromuscular disease. Am J Hospice Palliat Med, 27, 2, 145—57

Malaguti C (2009) Reliability of chest wall mobility and its correlation with pulmonary function in patients with Chronic Obstructive Pulmonary Disease. Respir Care, 54, 12, 1703-11

Manali ED (2010) MRC chronic dyspnea scale: Relationships with cardiopulmonary exercise testing and 6-minute walk test in idiopathic pulmonary fibrosis patients. BMC Pulm Med, 10, 32

McKenzie CA, McKinnon W et al (2005) Differentiating midazolam over-sedation from neurological damage in the intensive care unit. Crit Care, 9, R32-R36
• method to distinguish over-sedation from neurological damage

Miravitlles M, Kruesmann F, Haverstock D et al (2012) Sputum colour and bacteria in chronic bronchitis exacerbations: a pooled analysis. Eur Respir J; 39(6):1354-1360. doi:10.1183/09031936.00042111

Mirsadraee M, Boskabady MH, Attaran D (2013) Diagnosis of chronic obstructive pulmonary disease earlier than current Global Initiative for Obstructive Lung Disease guidelines using a feasible spirometry parameter (maximal-mid expiratory flow/forced vital capacity). Chronic Respir Dis; 10(4):191-196, doi:10.1177/1479972313507461

Monroe VD (2013) Blood pressure lability. Crit Care Nurs Quart; 36(4):425-32

Morice AH (2006) Recommendations for the management of cough in adults. Thorax, 61(Suppl I), i1–i24. doi:10.1136/thx.2006.065144

Murphy R (2006) Capillary blood gases in acute exacerbations of COPD. Respir Med, 100, 4, 682-686
• ear capillary blood gases when combined with continuous pulse oximetry can be used as an alternative to ABGs in patients with exacerbation of COPD.

Narayan M (2013) Fever in the postoperative patient. Emerg Med Clin North Am; 31(4):1045-58

Oikonomou A, Prassopoulos P (2013) Mimics in chest disease: interstitial opacities. Insights Imaging, 4, 1, 9–27. doi: 10.1007/s13244-012-0207-7

Peter JG, Theron G, Singh N et al (2014) Sputum induction to aid diagnosis of smear-negative or sputum-scarce tuberculosis in adults in HIV-endemic settings. Eur Respir J; 43(1):185-94. doi: 10.1183/09031936.00198012

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Puhan MA (2011) The minimal important difference of exercise tests in severe COPD. Eur Respir J, 37, 4, 784-90

Rossi SE (2005) Tree-in-bud pattern at thin-section CT of the lungs. RadioGraphic, 25, 789-801
• small nodules on CT may indicate infection, obliterative bronchiolitis, aspiration or inhalation of foreign substances, immunologic disorders or connective tissue disorders

Rutherford JD (2013) Digital clubbing. Circulation; 127(19):1997-9. doi: 10.1161/CIRCULATIONAHA.112.000163

Scherer S, Hammerich AS (2008) Outcomes in cardiopulmonary physical therapy: Acute Care Index of Function. Cardiopulm Phys Ther J, 19, 3, 95-7
• incorporates mental status, bed mobility, transfers, and mobility

Schmidt M (2011) Dyspnea in mechanically ventilated critically ill patients. Crit Care Med, May.
• SOB is frequent, intense, strongly associated with anxiety, sensitive to ventilator settings and associated with delayed extubation

Sevransky J (2009) Clinical assessment of hemodynamically unstable patients. Curr Opin Crit Care; 15(3): 234–238. doi: 10.1097/MCC.0b013e32832b70e5

Spicuzza L, Scuderi V, Morjaria JB et al (2014) Airway responsiveness to adenosine after a single dose of fluticasone propionate discriminates asthma from COPD. Pulm Pharmacol Therapeutics; 27(1):70-75

Srivastava R (2011) Complicated lives – taking the social history. N Engl J Med, 365, 7, 587-9.

Stocchetti N, Roux PL, Vespa P (2013) Clinical review: neuromonitoring - an update. Crit Care, 17:201 doi:10.1186/cc11513

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Stites M (2013) Observational pain scales in critically ill adults.
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Stroud AE et al (2002) Inter- and intra-rater reliability of cervical auscultation to detect aspiration in patients with dysphagia. Clin Rehab, 16, 640-5
• identifying aspiration by interpretation of swallow sounds

Tantucci C, Pinelli V, Cossi S et al (2006) Reference values and repeatability of inspiratory capacity for men and women ages 65-85. Respir Med, 100, 5, 871-7
• inspiratory capacity may signal the occurrence of dynamic hyperinflation at rest or o exercise

Tomasi CD et al (2012) Comparison of CAM-ICU and ICDSC for the detection of delirium in critically ill patients focusing on relevant clinical outcomes. J Crit Care, 27, 1, 212-217

Vincent JL (2008) Understanding cardiac output. Crit Care, 12, 4, 174
• succinct explanation of the four determinants of cardiac output and how cardiac output is affected by different circumstances

Voepel-Lewis T (2010) Reliability and validity of the face, legs, activity, cry, consolability behavioral tool in assessing acute pain in critically ill patients. Am J Crit Care, 19, 1, 55-61
• behavioural pain scale

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Xu T, Ducote JL, Wong JT et al (2012) Dynamic dual-energy chest radiography: a potential tool for lung tissue motion monitoring and kinetic study. Phys Med Biol, 56, 4, 1191–1205

Zavorsky GS, Wilson B (2010) Pulmonary diffusion and aerobic capacity : is there a relation? Does obesity matter? Act Physiol, 198, 499-507

6MD = 6-minute distance
AARC = American Association for Respiratory Care
ACPRC = Association of Chartered Physiotherapists in Respiratory Care
CVD = cardiovascular disease
ETCO2 = end-tidal CO2 monitor
HCO3− = bicarbonate ion concentration
HF = heart failure
HR = heart rate
IPPV = intermittent positive pressure ventilation
JAMA = Journal of American Medical Association
MI = myocardial infarction
SOB = shortness of breath
SpO2 = saturation of haemoglobin taken by pulse oximeter
VO2 max = maximum oxygen consumption