Dependence of oxygen consumption on oxygen delivery in children with hyperdynamic septic shock and how oxygen extraction

Lucking, Steven E.; Williams, Thomas M.; Chaten, Frank C.; Metz, Richard I.; Mickell, John J.

doi:10.1097/00003246-199012000-00002

Cited by 78 publications

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“…2 The Innocor inert gas rebreathing unit is based on the breath-by-breath method of gas analysis. In order to use this technique in intubated patients receiving mechanical ventilation, we added a flow meter (Hans Rudolph flow meter, models 4500B and 8411B, Hans Rudolph Inc) between the endotracheal tube and the connection with the ventilator.…”

Section: Resultsmentioning

confidence: 99%

“…The Innocor estimates the difference between inspired and expired oxygen concentration by integrating the product of oxygen concentration and flow in the respiratory gas over a complete respiratory cycle. 18,19 Mass Spectrometry to Measure VȮ 2 We used the Amis 2000 mass spectrometer and collected all expired gas in a mixing chamber. An indicator gas, argon, was added to the input port of the chamber.…”

Section: Resultsmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10] However, outside of research investigations, cardiac output is measured infrequently.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3][4] Low cardiac output syndrome adversely affects the outcomes of critically ill children on the intensive care unit. [5][6][7][8][9][10] Cardiac output may be calculated by using the Fick equation if VȮ 2 , hemoglobin level, and the arterial-venous oxygen difference are known.…”

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confidence: 99%

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Measurement of Oxygen Consumption in Critically Ill Children: Breath-by-Breath Method vs Mass Spectrometry

Guo

Cui

Bobhate

et al. 2016

American Journal of Critical Care

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Background Measurement of oxygen consumption (VȮ 2 ) is difficult in children but is essential to calculate cardiac index and systemic vascular resistance. Objective To compare measurements of VȮ 2 using respiratory mass spec trometry and the breath-by-breath method. Methods VȮ 2 was measured simultaneously and continuously for 10 minutes by using respiratory mass spectrometry and the breath-by-breath method in children receiving mechanical ventilation via cuffed endotracheal tubes. Results Sixteen children (7 boys ) were studied. The correlation between measurements of VȮ 2 by the 2 methods was good (R = 0.924). Mean VȮ 2 measured by mass spectrometry was 63 (95% CI, 47-78) mL/min vs 65 (95% CI, 47-83) mL/min measured by the breath-by-breath method. The mean VȮ 2 difference between the 2 methods was 3 (95% CI, -9 to 5) mL/min and statistically insignificant. Bland-Altman analysis showed that the 95% limits of agreement were between -28 and + 23. Cardiac index did not differ significantly when calculated using VȮ 2 measured with one method or the other (mean difference, 0.1; 95% CI, -0.2 to 0.3). Conclusions Measurements of VȮ 2 did not differ between mass spectrometry and the breath-by-breath method. Use of the breath-by-breath method may facilitate calculation of cardiac index and systemic vascular resistance in critically ill children.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

“…[1][2][3][4][5][6][7][8][9][10] However, outside of research investigations, cardiac output is measured infrequently.…”

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Measurement of Oxygen Consumption in Critically Ill Children: Breath-by-Breath Method vs Mass Spectrometry

Guo

Cui

Bobhate

et al. 2016

American Journal of Critical Care

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“…Patients undergoing coronary revascularization were included in two studies 21 2 mo -6 yrs x 1-2 h Thermodilution used for DO 2 and VO 2 measurements. Lucking et al 93 Septic shock 7 10-15 mL/kg Yes Yes Yes NA 8 measurement sets in 7 patients. (1990) 4 mo -15 yrs x 1-3 h Thermodilution used for DO 2 and VO 2 measurements.…”

Section: Evidence For Restrictive and Liberal Approaches To Transfusionsmentioning

confidence: 99%

Transfusion Morbidity and Mortality in the ICU

Hébert¹

2000

Transfus Alt Transfus Med

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Transfusion of red blood cells (RBCThis patient population is affected by complex metabolic, respiratory and cardiovascular pathophysiological processes which predispose this patient population to the adverse consequences of anemia such as the potential risk of myocardial infarction and death. It is also possible that critically ill patients are at increased risks of adverse consequences from allogeneic red cell transfusions, particularly the immunosuppressive [11][12][13][14][15][16] 20 . In this article, the background outlining the divergent risks and benefits of anemia and transfusion will be discussed. Studies describing the epidemiology of anemia and current transfusion practices will also be outlined. Transfusion practice variation in critical careTwo observational studies, a survey of critical care physicians and a large cohort study, were conducted to determine individual and hospital practice variation. In a 1993 Canadian survey of critical care practitioners 27 , we documented that 35% of respondents identified 90 g/L as minimum concentration and an additional 40% selected 100 g/L. Overall baseline transfusion thresholds ranged from a low of 50 g/L to 120 g/L. Thresholds were significantly different (p<0.001) between scenarios ( Figure 1). All clinical characteristics evaluated, except congestive heart failure (p>0.05), significantly (p< 0.0001) changed transfusion thresholds of Canadian critical care practitioners. We also noted significant difference among the four clinical scenarios and a number of potential risk factors. There was a significant association between having an academic affiliation and transfusion practice across all scenarios ( p<0.0001). Physicians with an academic affiliation transfused red cells at a lower transfusion threshold than non-academics. When grouped into 4 major geographic locations (West, Ontario, Quebec, East), with no more than 5 academic centers per region, we noted that there was a statistically significant difference (p<0.01) for baseline transfusion thresholds across all scenarios. In a second study we examined the transfusion practice in a cohort of 5298 consecutive patients treated in six tertiary level intensive care units. Twenty-five percent of the critically ill patients in the cohort study received red cell transfusions. The overall number of transfusions per patient-day in the ICU averaged 0.95±1.39 and ranged from 0.82±1.69 to 1.08±1.27 between institutions (p<0.001). The number of transfusions administered were significantly different between institutions even after multivariate adjustments for age, APACHE II score and within four diagnostic categories (cardiovascular disease, respiratory failure, major surgery and trauma) (p<0.0001). A similar analysis using nadir hemoglobin concentrations, the lowest hemoglobin value prior to the first transfusion or the lowest value recorded during the entire ICU stay also demonstrated that there is significant institutional practice variation (p<0.0001) (Figure 2). Further evaluation of transfusion practice using...

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Blood Lactate Concentrations in Sepsis

Kruse¹

The Sepsis Text

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Dependence of oxygen consumption on oxygen delivery in children with hyperdynamic septic shock and how oxygen extraction

Cited by 78 publications

References 0 publications

Measurement of Oxygen Consumption in Critically Ill Children: Breath-by-Breath Method vs Mass Spectrometry

Measurement of Oxygen Consumption in Critically Ill Children: Breath-by-Breath Method vs Mass Spectrometry

Transfusion Morbidity and Mortality in the ICU

Blood Lactate Concentrations in Sepsis

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