Critical level of oxygen delivery in anesthetized man

Shibutani, K.; Komatsu, Toru; Kubal, K.; Sanchala, Vajubhai T.; Kumar, Vijaya; Bizzarri, Dante V.

doi:10.1097/00003246-198308000-00010

Cited by 356 publications

(66 citation statements)

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“…The steeper portion begins at a point where O2 consumption becomes limited and dependent on the systemic O2 transport ( I, 2). Although such a clear demarcation has been seen in stud ies of health y anesthetized subjects during physiologic manipulation of O 2 supply while O 2 dem and s were kept constant (18), other stud ies using subjects with diseases such as the adult respiratory distress syndrome or chronic obstructive pulmonary disease have not always exhibited a distinct dependent and independent 0 2transport-consumption relationship ( 16,(19)(20)(21)(22), rather, O 2 consumption has been found to be dependent on systemic O 2 transport regardless of the level of transport. In addition to a fall in O 2 consumption as systemic O2 transport decreases, evidence of tissue hypoxia also appears as a hallmark of the critical level (3)(4)(5)(6).…”

Section: Discussionmentioning

confidence: 98%

Oxygen Transport and Metabolism in the Conscious Lamb: The Effects of Hypoxemia

1987

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Printedin U.S.A. METHODS Subjects.A total of seven lambs of mixed breed with documented dates of birth was studied. The lambs were surgically prepared and studied within 24 h after surgery. Two of these lambs, although in good health during the study, died after their initial study, one due to complications of an intracardiac catheter and another due to trauma. The lambs were studied multiple times over the next 2 to 3 months following surgery.Under lidocaine local analgesia, a Tygon catheter was placed either in a hindlimb or carotid artery and advanced into the aorta. A Tygon catheter or balloon flow directed catheter was passed through a jugular vein into the pulmonary artery while pressure was monitored to ensure proper placement. All newborn lambs had a second venous catheter inserted through either the 177 ABSTRACT. We studied the response of O 2 consumption, systemic O 2 transport, arterial blood lactate concentration, base deficit, and respiratory exchange ratio (C0 2 production/O, consumption) to graded alveolar hypoxia (fractional concentration of inspired oxygen 0.21, 0.16, 0.12, and 0.08) in seven intact, conscious chronically catheterized lambs at <1 wk after birth, at 25-40 days and at >40 days. To test whether there was an age related difference in the metabolic response to a decline in O 2 transport due to hypoxemia, we related the changes in blood lactate and base deficit to the systemic O2 transport and to the fractional change in O 2 consumption. Systemic O 2 transport and O 2 consumption decreased with severe hypoxemia, while lactate concentration and respiratory exchange ratio increased in all age groups. The changes in base deficit were not significant. When the hypoxemia-induced reduction in O 2 consumption was <15% of the baseline value (at fractional concentration of inspired oxygen 0.21) there was no elevation in lactate concentration; however, when O2 consumption was reduced by more than 15%, lactate concentration consistently increased by more than 1 mmol/ liter. There were no apparent differences amongst the age groups in this response. Therefore, the newborn lamb does show metabolic consequences of a fall in O2 consumption with hypoxemia which is similar to the older sheep, however, there is a "buffer zone" in which O2 consumption may decrease before evidence of tissue hypoxia can be found. The mechanism by which O 2 consumption can decrease without accumulation of lactate remains speculative. (Pediatr Res 22: 177-183, 1987 Supported by grants from the American Heart Association with funds contributed in part by the Connecticut Heart affiliate and from the National Institute of Child Health and Human Development HD-15834. M. M. and G. M. were supported by a National Heart, Lung and Blood Institute Training Grant HL-07272. G. L. is a recipient of an American Heart Established Investigatorship.In anesthetized adult subjects, the systemic O 2 consumption has been found to be independent of the systemic O 2 transport (product of arterial O 2 content and cardiac output) when the transpor...

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Section: Discussionmentioning

confidence: 98%

Oxygen Transport and Metabolism in the Conscious Lamb: The Effects of Hypoxemia

1987

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“…Nociceptive surgical stimulations, volume variations due to acute blood losses or transfusions and administration of anesthetic agent can significantly influence this VO 2 -DO 2 relationship. Some studies evaluated the VO 2 -DO 2 relationship in major surgery [111][112][113] and showed a decreased capacity for tissue O 2 extraction which may have lead to tissue hypoxia [114]. These observations demonstrate the importance of adequately evaluating the DO 2 -VO 2 relationship in conjunction with the patient's metabolic demand, which is once again strongly affected by surgical conditions.…”

Section: Protocol For High Risk Surgerymentioning

confidence: 94%

Guiding Goal-Directed Therapy

Suehiro

Joosten

Alexander

2014

Curr Anesthesiol Rep

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Several studies have demonstrated that perioperative hemodynamic optimization (or ''goal directed therapy'') using minimally invasive hemodynamic monitoring technologies has the ability to improve postoperative patients' outcome with lower complication rates, shorter hospital lengths of stay, and lower cost of surgery. This specific concept of goal-directed therapy (GDT) uses perioperative cardiac output monitoring and manipulation of physiologic parameters (dynamic parameters of fluid responsiveness) to guide intravenous fluids and inotropic therapy with the goal of ensuring adequate tissue perfusion. Recently, the evidence related to the implementation of GDT strategies has been considered strong enough to allow for the creation of national recommendations in the UK, in France, and by the European Society of Anaesthesiology. The aims of the programs are to apply best practices to high-risk surgical patients and requires the participation of all clinicians involved in patients' care. Considering the potential clinical and economic benefits of GDT protocols and the positive recommendations from influential scientific societies, more and more hospitals around the world have become interested in implementing hemodynamic optimization in their departments. This review provides the information about the evolution of hemodynamic monitoring from invasive to the more recent noninvasive devices, and how these devices can be used in the operating rooms through well-defined algorithms of GDT.

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“…In both groups with HH (study group and control group 1), DO 2 measurements that combine CO and arterial saturation in oxygen were very low (median values: 376 mL/min · m 2 in study group and 385 mL/min · m 2 in the control group 1 compared with the normal value 11 of 520 to 720 mL/min · m 2 ), and close to the critical limit of 330 mL/min · m 2 , considered as the lower level of DO 2 for tissular viability in several studies. [54][55][56] However, the causes of low DO 2 were quite different in the two groups. In HH associated with CHF (control group 1), low DO 2 resulted from low CO, and arterial saturation in oxygen was normal or slightly decreased, while in HH associated with CRF (study group), low DO 2 resulted only from severe hypoxemia despite high CI ( Table 2).…”

Section: Discussionmentioning

confidence: 99%

Hypoxic hepatitis caused by acute exacerbation of chronic respiratory failure: A case-controlled, hemodynamic study of 17 consecutive cases

et al. 1999

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Out of a prospective series of 142 consecutive episodes of hypoxic (ischemic) hepatitis (HH), we identified 17 episodes associated with an acute exacerbation of chronic respiratory failure (CRF) without left cardiac failure. In the aim to evaluate the role of arterial hypoxemia in the pathogenesis of HH associated with respiratory failure, these 17 episodes of HH (study group) were hemodynamically compared with a control group of 17 episodes of HH associated with congestive heart failure (CHF) (control group 1) and a group of 16 episodes of acute respiratory failure (ARF) not complicated by HH (control group 2). Arterial hypoxemia was significantly more severe in the study group (

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Critical level of oxygen delivery in anesthetized man

Cited by 356 publications

References 0 publications

Oxygen Transport and Metabolism in the Conscious Lamb: The Effects of Hypoxemia

Oxygen Transport and Metabolism in the Conscious Lamb: The Effects of Hypoxemia

Guiding Goal-Directed Therapy

Hypoxic hepatitis caused by acute exacerbation of chronic respiratory failure: A case-controlled, hemodynamic study of 17 consecutive cases

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