The role of arterial blood gas analysis in patients with upper aerodigestive tract malignancy and a compromised airway: a prospective cohort study

Abstract Background Malignancies of the upper aerodigestive tract, particularly those affecting the larynx and pharynx, can cause airway obstruction, resulting in symptoms such as breathing difficulty. Early recognition and treatment of breathing difficulties are critical for airway management. Methods The study comprised adult patients (aged ≥ 18 years) diagnosed with upper aerodigestive tract malignancies (e.g., laryngeal and pharyngeal cancer) and presented with stridor or impending stridor. Arterial blood gas (ABG) analysis was performed at the time of admission and 24 hours after tracheostomy. Results Of 50 patients, 50% had stridor (group 1) and 50% had impending stridor (group 2). Pre-tracheostomy ABG revealed that 10 patients (20%) in the stridor group had uncompensated respiratory acidosis. In Group 1, patients had a mean pO2 value of 79.53 mmHg, which improved to 92.12 mmHg 24 hours after the procedure ( p =0.002). The mean pCO2 levels in groups 1 and 2 before and after tracheostomy were 43.70 and 37.56 mmHg ( p =0.305) and 41.95 and 37.98 mmHg ( p =0.662), respectively. The mean HCO3- concentrations of group 1 and group 2 before and after tracheostomy were 22.86 and 23.22 mmol/L ( p =0.179) and 23.09 and 22.92 mmol/L ( p =0.115), respectively. Complications of tracheostomy were more common in group 1 (30%) than in group 2 (10%). Conclusion The most prevalent acid-base disorder in patients with stridor is mild acute primary uncompensated respiratory acidosis. ABG analysis can be tailored to clinical judgment for assessing the severity of airway compromise, predicting the need for airway intervention, and determining the intervention time.