| Does increasing oxygen delivery improve outcome? Yes. | |
| | |
MedLine Citation:
|
PMID: 8839595 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
|
Increasing DO2 to supranormal levels, spontaneously or therapeutically, correlates with better survival in the critically ill patient, but not all patients who attain a DO2I greater than 600 mL/min/m2 survive. Conversely, there is often a 50% or greater survival rate in patients who do not reach normal DO2I values. No investigator has been able to show an incremental increase in survival with increasing DO2I; but studies have shown improved survival rates with increasing SVO2. The observations support the idea that absolute values for DO2I are not as important as the ability to normalize SVO2 when SVO2 is low. Therapeutic interventions may be most effective in those patients demonstrating increased peripheral oxygen extraction (SVO2 = 40% to 60%). These "type A" patients are mounting an appropriate response to increased needs. Several authors have noted increased mortality rates for patients unable to increase a low VO2 despite increased DO2. This is McClave's "type B" physiologic response. Flow dependency is not correlated with mortality. In fact, it is the patient who can raise VO2 when DO2 is increased who tends to survive. Dantzker, Giunta, and Hotchkiss propose that the flow dependency of VO2 may be a normal physiologic response. Clinical outcomes continue to support the necessity of maintaining an optimal DO2 in critically ill patients. The question of what is optimal DO2 has yet to be answered. Vincent nicely summaries the present "state of the art" in treating the critically ill: "Rather than aim at achieving arbitrary target values in all patients, we believe that this process should be based on a careful clinical evaluation of the individual patient, complemented by measurements of cardiac output, determinations of mixed venous oxygen saturation (or the oxygen-extraction ratio), and other measurements of tissue perfusion, such as the base deficit, blood lactate level, or gastric intramucosal pH." In addition, the type or stage of physiologic response should be identified. Independent markers of tissue ischemia should be sought and abnormalities corrected by increasing DO2. SVO2 should be normalized when low, again by increasing DO2. Data continue to support clinical interventions aimed at optimizing DO2. Does increasing DO2 increase the survival rates of critically ill patients? Sometimes. |
| | |
Authors:
|
K M Kelly |
Related Documents
:
|
19668535 - Candida endophthalmitis: a critical diagnosis in the critically ill. 3709195 - Transport of critically ill adults. 1129615 - Breast cancer: a critical review of a patient sample with a ten-year follow-up. 16038385 - A survey for pain and sedation medications in pediatric patients during extracorporeal ... 10084345 - Early intervention in schizophrenia in the elderly. 8323395 - Differential heat shock protein overexpression and its clinical relevance in systemic l... |
Publication Detail:
|
Type: Journal Article; Review |
Journal Detail:
|
Title: Critical care clinics Volume: 12 ISSN: 0749-0704 ISO Abbreviation: Crit Care Clin Publication Date: 1996 Jul |
Date Detail:
|
Created Date: 1996-12-13 Completed Date: 1996-12-13 Revised Date: 2007-11-15 |
Medline Journal Info:
|
Nlm Unique ID: 8507720 Medline TA: Crit Care Clin Country: UNITED STATES |
Other Details:
|
Languages: eng Pagination: 635-44 Citation Subset: IM |
Affiliation:
|
Surgical Intensive Care Unit, Morristown Memorial Hospital, New Jersey, USA. |
Export Citation:
|
APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
|
Critical Illness
/
mortality,
therapy* Hemodynamics Hospital Mortality Humans Intensive Care* Lactic Acid / blood Outcome Assessment (Health Care)* Oxygen Consumption* Oxygen Inhalation Therapy* / standards Predictive Value of Tests Survival Analysis Tissue Distribution |
| Chemical | |
Reg. No./Substance:
|
50-21-5/Lactic Acid |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
Previous Document: High-inflation pressure and positive end-expiratory pressure. Injurious to the lung? Yes.
Next Document: Does increasing oxygen delivery improve outcome in the critically ill? No.