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




Amin SB, Slater R, Mohammed TL (2015) Pulmonary calcifications: a pictorial review and approach to formulating a differential diagnosis. Curr Probl Diagn Radiol. pii: S0363-0188(14)00143-1. doi: 10.1067/j.cpradiol.2014.12.005

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

Costa R, Almeida N, Ribeiro F (2015) Body position influences the maximum inspiratory and expiratory mouth pressures of young healthy subjects Physiotherapy; 101(2): 239–241 doi:10.1016/

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

Kulnik ST, MacBean V, Birring SS et al (2015) Accuracy of portable devices in measuring peak cough flow. Physiol. Meas; 36:243 doi:10.1088/0967-3334/36/2/243

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

Perez T, Burgel PR, Paillasseur JL et al (2015) Modified Medical Research Council scale vs Baseline Dyspnea Index to evaluate dyspnea in chronic obstructive pulmonary disease. Int J Chron Obstruct Pulmon Dis;10:1663-72. doi: 10.2147/COPD.S82408

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

Richardson M, Purssell E et al (2015) Who’s afraid of fever? Arch Dis Child; 100(9):818-820. doi:10.1136/archdischild-2014-307483
• Fever is a natural response to infection, some microorganisms being adversely affected and some defence mechanisms performing better at higher body temperatures

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

Schmidt PE, Meredith P, Prytherch DR et al (2015) Impact of introducing an electronic physiological surveillance system on hospital mortality. BMJ Qual Saf; 24:10-20. doi:10.1136/bmjqs-2014-003073
• technology-assisted early-warning scores reduce mortality

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

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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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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