Journal article
Absence of supply dependence of oxygen consumption in patients with septic shock
Journal of critical care, Vol.8(4), pp.203-211
1993
DOI: 10.1016/0883-9441(93)90003-4
PMID: 8305957
Abstract
We tested whether oxygen consumption (V̇o
2) was dependent on oxygen delivery (Q̇o
2) in 10 patients with septic shock when Q̇o
2 was changed by the use of the inotropic agent, dobutamine. The mean acute physiology and chronic health evaluation (APACHE) II score of the patients was 27.3 ± 8.1 with a mean blood pressure on entry of 66.8 ± 12.4 mm Hg, and all had been volume resuscitated to a pulmonary artery occlusion pressure of greater than 10 mm Hg. We measured V̇o
2 by analysis of respiratory gases NOW) while calculating V̇o
2 by the Fick equation NOV) at three different OZ deliveries. When the dobutamine infusion rate was increased from 2.5 ± 4.0 to 12.3 ± 6.0 μg/kg/min, thermodilution cardiac output increased from 7.7 ± 2.6 to 10.1 ± 2.7 L/min (P < .01). Accordingly, dobutamine increased Q̇o
2 from 13.5 ± 3.8 to 18.2 ± 4.3 mL/min per kg (increase of 36.4% ± 19.7%;
P < .01), but V̇o
2G did not increase (3.2 ± 0.5 to 3.2 ± 0.6 mL/ min per kg). During these same interventions, the V̇o
2F tended to increase (2.9 ± 0.7 to 3.4 ± 0.8 mL/min per kg,
P < .06), presumably a spurious correlation because of measurement errors shared by the calculation of V̇o
2F and Q̇o
2. Neither lactic acidosis nor acute respiratory distress syndrome (ARDS) conferred supply dependence of V̇o
2G, but the presence of ARDS was predictive of death in this cohort. It is concluded that V̇o
2 is independent of Q̇o
2 in patients with septic shock and lactic acidosis. These data confirm that maximizing Q̇o
2 beyond values achieved by initial fluid and vasoactive drug resuscitation of septic shock does not improve tissue oxygenation as determined by respiratory gas measurement of V̇o
2.
Details
- Title: Subtitle
- Absence of supply dependence of oxygen consumption in patients with septic shock
- Creators
- Constantine A ManthousPaul T SchumackerAnne PohlmanGregory A SchmidtJesse B HallRichard W SamselLawrence D.H Wood
- Resource Type
- Journal article
- Publication Details
- Journal of critical care, Vol.8(4), pp.203-211
- Publisher
- Elsevier Inc
- DOI
- 10.1016/0883-9441(93)90003-4
- PMID
- 8305957
- ISSN
- 0883-9441
- eISSN
- 1557-8615
- Language
- English
- Date published
- 1993
- Academic Unit
- Pulmonary, Critical Care, and Occupational Medicine; Internal Medicine
- Record Identifier
- 9984094768702771
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