Abstract
Standard hemodynamic support in septic shock is to increase pulmonary capillary wedge pressure to above 15 mmHg by volume replacement and to give inotropic support if the mean arterial pressure (MAP) is not adequate. In an attempt to decrease mortality in critically ill patients, oxygen delivery (DO2) was increased by switching inotropic support from dobutamine alone or in combination with norepinephrine to dopamine alone, or by adding dopexamine, prostacyclin, or hypertonic saline to the treatment. DO2 increased significantly in all patients, but the increase in DO2 was accompanied by only a 10% increase in oxygen consumption (VO2). The increase in VO2 was similar in survivors and nonsurvivors and in patients with and without septic shock. The results indicate that if adequate volume and inotropic support is provided for critically ill patients, the detectable oxygen debt is small and has little effect on patient outcome. When DO2 is adequate, factors other than a tissue oxygen deficit seem to determine patient outcome.
Similar content being viewed by others
References
Shoemaker WC, Appel PL, Kram HB (1988) Prospective trial of supranormal values of survivor as therapeutic goals in high risk surgical patients. Chest 94:1176–1186
Sibbald WJ, Bersten A, Rutledge FS (1989) The role of tissue hypoxia in multiple organ failure. In: Reinhart K, Eyrich K (eds) Clinical aspects of O2 transport and tissue oxygenation. Springer, Berlin Heidelberg New York, pp 102–114
Reinhart K (1989) Oxygen transport and tissue oxygenation in sepsis and septic shock. In: Reinhart K, Eyrich K (eds) Sepsis — an interdisciplinary challenge. Springer, Berlin Heidelberg New York, pp 125–139
Cain SM (1989) Mechanisms of limited oxygen delivery in sepsis and adult respiratory distress syndrome. In: Reinhart K, Eyrich K (eds) Sepsis — an interdisciplinary challenge. Springer, Berlin Heidelberg New York, pp 140–147
Cain SM (1989) Supply dependency of oxygen uptake. In: Reinhart K, Eyrich K (eds) Clinical aspects of O2 transport and tissue oxygenation. Springer, Berlin Heidelberg New York, pp 80–91
Schumaker PT, Cain SM (1987) The concept of critical oxygen delivery. Intensive Care Med 13:223–229
Bihari D, Smithies M, Gimson A, Tinker J (1987) The effects of vasodilatation with prostacyclin on oxygen delivery and uptake in critically ill patients. N Engl J Med 317:397–403
Parker MM, Shelhamer JH, Natanson C et al. (1987) Serial cardiovascular variables in survivors and nonsurvivors of human septic shock: heart rate as an early predictor of prognosis. Crit Care Med 15:923–928
Bone RC, Slotman G, Maunder R et al. (1989) Randomized doubleblind, multicenter study of prostaglandin E1 in patients with the adult respiratory distress syndrome. Chest 96:114–118
Sprung CL, Schein MH, Long WM (1989) Corticosteroids and nonsteroidal anti-inflammatory agents in the sepsis syndrome. In: Reinhart K, Eyrich K (eds) Sepsis — an interdisciplinary challenge. Springer, Berlin Heidelberg New York, pp 87–96
Brown RA, Dixon J, Hall JC et al. (1985) Dopexamine: A novel agonist at peripheral dopamine receptors and β-adrenoceptors. Br J Pharmacol 85:599–605
Braunwald E (1971) Control of myocardial oxygen consumption. Am J Cardiol 27:416–432
Stephens J, Ead H, Spurrell R (1979) Hemodynamic effects of dobutamine with special reference to myocardial blood flow. Br Heart J 42:43–50
Leier CV (1988) Regional blood flow responses to vasodilators and inotropes in congestive heart failure. Am J Cardiol 62:86–93
Border JR, Hasselt J, La Duce J et al. (1987) The gut origin septic states in blunt multiple trauma (ISS=40) in the ICU. Ann Surg 206:427–432
Matuschak GM, Rinaldo JE (1988) Organ interactions in the adult respiratory distress syndrome during sepsis: role of liver in host response. Chest 94:400–404
Mazzoni MC, Borgström P, Arfors KE, Intaglietta M (1988) Dynamic fluid redistribution of hyperosmotic resuscitation of hypovolemic hemorrhage. Am J Physiol 255H:629–634
Reinhart K, Rudolph T, Bredle DL, Cain SM (1989) O2 uptake in bled dogs after resuscitation with hypertonic saline or hydroxyethyl starch. Am J Physiol 257H:238–243
Reines HD, Cook JA, Halushka PV et al. (1982) Plasma thromboxane concentrations are raised in patients dying with septic shock. Lancet 2:174–175
König F, Bloos F, Conrad Ch et al. (1989) Muscle tissue pO2 and oxygen transport-related variables. Anesthesiology 71A:379
Delpy DT, Gordon RE, Hope PI et al. (1982) Noninvasive investigation of cerebral ischemia by phosphorus nuclear magnetic resonance. Pediatrics 70:310–315
Jöbis-Vandervliet FF, Fos E, Sugioka K (1987) Monitoring of cerebral oxygenation and cytochrome aa3 redox state. Int Anesthesiol Clin 25:209–215
Smith DS, Chance B (1987) New techniques, new opportunities, old problems (editorial). Anesthesiology 67:157–159
Johnsson K, Jensen JA, Goodson WH et al. (1987) Assessment of perfusion in postoperative patients using tissue oxygen measurements. Br J Surg 74:263–268
Reinhart K, Bloos F, König F et al. (1990) Oxygen transport related variables and muscle tissue oxygenation in critically ill patients with and without sepsis. In: Advances in experimental medicine and biology: oxygen transport to tissue (in press)
Reinhart K, Bloos F, König F et al. (1989) Oxygen transport and muscle tissue oxygenation in hyperdynamic septic shock. Anesthesiology 71A:1200
Reinhart K (1988) Zum Monitoring des Sauerstofftransportsystems. Anaesthesist 37:1–9
Reinhart K, Schäfer M, Rudolph T, Specht M (1989) Mixed venous oxygen saturation. Appl Cardiopul Pathophysiol 2:315–325
Kersting Th, Reinhart K, Dennhardt R et al. (1985) Effect of low dose dopamine on muscle pO2 in healthy volunteers and intensive care patients. Eur J Anaesthesiol 2:143–147
Duff JH, Groves AV, McLean APH et al. (1969) Defective oxygen consumption in septic shock. Surg Gynecol Obstet 128:1051–1060
Harken AH, Lilo RS, Hufnagel HV (1975) Direct influence of endotoxin on cellular respiration. Surg Gynecol Obstet 140:858–860
Mela L, Bacalzo LV, Miller LD (1971) Defective oxidative metabolism of rat liver mitochondria in hemorrhagic and endotoxin shock. Am J Physiol 220:571–575
Wright CJ, Duff JH, McLean APH, McLean LD (1971) Regional capillary blood flow and oxygen uptake in severe sepsis. Surg Gynecol Obstet 130:637–644
Reinhart K (1989) Monitoring of O2 transport and tissue oxygenation. In: Reinhart K, Eyrich K (eds) Clinical aspects of O2 transport and tissue oxygenation. Springer, Berlin Heidelberg New York, pp 195–211
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Reinhart, K., Hannemann, L. & Kuss, B. Optimal oxygen delivery in critically ill patients. Intensive Care Med 16 (Suppl 2), S149–S155 (1990). https://doi.org/10.1007/BF01785245
Issue Date:
DOI: https://doi.org/10.1007/BF01785245