Effects of short-term hyperoxia on sytemic hemodynamics, oxygen transport, and microcirculation: An observational study in patients with septic shock and healthy volunteers

Espinoza, Emilio Daniel Valenzuela; Pozo, Mario Omar; Edul, Vanina Siham Kanoore; Furche, Mariano; Motta, María Fernanda; Vázquez, Alejandro; Birri, Paolo Nahuel Rubatto; Dubin, Arnaldo

doi:10.1016/j.jcrc.2019.05.021

Cited by 12 publications

(18 citation statements)

References 43 publications

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“…In the present study, we found a similar reduction in vessel density in the skeletal muscle microcirculation, but no alteration in blood flow quality: several factors may explain this discrepancy, including the use of different sedative agents, and the fact that the CI remained globally unaltered in our rats. This hyperoxia-induced vasoconstriction was not described during sepsis (30,31). Vasoplegia due to an underlying microvascular dysfunction in this particular condition could be responsible for the lack of a vasoconstrictive response to hyperoxia.…”

Section: Discussionmentioning

confidence: 81%

Effects of Normoxia, Hyperoxia, and Mild Hypoxia on Macro-Hemodynamics and the Skeletal Muscle Microcirculation in Anesthetised Rats

et al. 2021

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Objectives: Excessive oxygen (O2) administration may have a negative impact on tissue perfusion by inducing vasoconstriction and oxidative stress. We aimed to evaluate the effects of different inhaled oxygen fractions (FiO2) on macro-hemodynamics and microvascular perfusion in a rat model.Methods: Isoflurane-anesthetised spontaneously breathing male Wistar rats were equipped with arterial (carotid artery) and venous (jugular vein) catheters and tracheotomy, and randomized into three groups: normoxia (FiO2 21%, n = 6), hyperoxia (FiO2 100%, n = 6) and mild hypoxia (FiO2 15%, n = 6). Euvolemia was maintained by infusing Lactate Ringer solution at 10 ml/kg/h. At hourly intervals for 4 h we collected measurements of: mean arterial pressure (MAP); stroke volume index (SVI), heart rate (HR), respiratory rate (by means of echocardiography); arterial and venous blood gases; microvascular density, and flow quality (by means of sidestream dark field videomicroscopy on the hindlimb skeletal muscle).Results: MAP and systemic vascular resistance index increased with hyperoxia and decreased with mild hypoxia (p < 0.001 in both cases, two-way analysis of variance). Hyperoxia induced a reduction in SVI, while this was increased in mild hypoxia (p = 0.002). The HR increased under hyperoxia (p < 0.05 vs. normoxia at 3 h). Cardiax index, as well as systemic O2 delivery, did not significantly vary in the three groups (p = 0.546 and p = 0.691, respectively). At 4 h, microvascular vessel surface (i.e., the percentage of tissue surface occupied by vessels) decreased by 29 ± 4% in the hyperoxia group and increased by 19 ± 7 % in mild hypoxia group (p < 0.001). Total vessel density and perfused vessel density showed similar tendencies (p = 0.003 and p = 0.005, respectively). Parameters of flow quality (microvascular flow index, percentage of perfused vessels, and flow heterogeneity index) remained stable and similar in the three groups.Conclusions: Hyperoxia induces vasoconstriction and reduction in skeletal muscle microvascular density, while mild hypoxia has an opposite effect.

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Section: Discussionmentioning

confidence: 81%

Effects of Normoxia, Hyperoxia, and Mild Hypoxia on Macro-Hemodynamics and the Skeletal Muscle Microcirculation in Anesthetised Rats

et al. 2021

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“…Ten articles provided information about values of P cv-a CO 2 /C a-cv O 2 and lactate in survivors and nonsurvivors mainly from septic shock and were grouped for performing metanalysis. ( 5 , 12 , 17 , 25 , 27 , 28 , 31 - 34 ) In the quantitative synthesis, lactate levels were significantly higher in nonsurvivors than in survivors (pooled SMD = 95%CI 0.94; 0.34 - 1.54; p < 0.00001). We found considerable statistical heterogeneity (I 2 = 92%).…”

Section: Resultsmentioning

confidence: 96%

“…We initially retrieved 172 studies. Seventeen of them, enrolling 1,472 critically ill patients, were included for qualitative (descriptive) synthesis ( 5 - 7 , 12 , 15 - 17 , 25 - 34 ) , and ten, including 704 patients, were included for quantitative synthesis ( 5 , 12 , 17 , 25 , 27 , 28 , 31 - 34 ) ( Figure 1 ). Out of the final seventeen articles included, four were retrospective observational studies,(5,26,33,34) and thirteen(6,7,12,15-17,25,27-32) were prospective observational studies.…”

Section: Resultsmentioning

confidence: 99%

“…Out of the final seventeen articles included, four were retrospective observational studies,(5,26,33,34) and thirteen(6,7,12,15-17,25,27-32) were prospective observational studies. The studies included patients with sepsis or septic shock (n = 12), ( 6 , 7 , 12 , 17 , 25 - 28 , 31 - 34 ) cardiovascular surgery (n = 4), ( 15 , 16 , 29 , 30 ) and/or requirements of Swan-Ganz catheter monitoring (n = 1). ( 5 )…”

Section: Resultsmentioning

confidence: 99%

“…( 15 - 17 , 26 , 29 ) Within this group, only one study had a low risk of bias in 13 of the 14 domains evaluated. ( 29 ) Eleven studies were classified with a quality rating of “fair”, ( 5 - 7 , 12 , 25 , 27 , 30 - 34 ) and the remaining studies were classified as “poor”. ( 28 ) The domains with more “high risk of bias” were blinding of outcome assessors, sample size justification, statistical analyses (key potential confounding variables measured and adjusted statistically), and study population.…”

Section: Resultsmentioning

confidence: 99%

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Comparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis

Dubin¹,

Loudet²,

Hurtado³

et al. 2022

RBTI

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Objective The central venousarterial carbon dioxide pressure to arterial-central venous oxygen content ratio (P cv-a CO 2 /C a-cv O 2 ) is frequently used as a surrogate for tissue oxygenation. We aimed to identify and synthesize literature and quality of evidence supporting P cv-a CO 2 /C a-cv O 2 as a predictor of mortality in critically ill patients compared with lactate. Methods We searched several databases for studies measuring P cv-a CO 2 /C a-cv O 2 in critically ill patients. Independent investigators performed the article screening and data extraction. A random-effects metaanalysis was performed. Pooled standardized mean differences (SMD) were used to compare the prognostic ability of P cv-a CO 2 /C a-cv O 2 and lactate. Results We initially retrieved 172 studies; 17 were included for qualitative description, and 10 were included for quantitative synthesis. The mean P cv-a CO 2 /C a-cv O 2 was higher in nonsurvivors than in survivors (pooled SMD = 0.75; 95%CI 0.34 - 1.17; I 2 = 83%), as was the case with lactate levels (pooled SMD = 0.94; 95%CI 0.34 - 1.54; I 2 = 92%). Both tests were statistically significant predictors of mortality, albeit with overlapping 95%CIs between them. Conclusion Moderate-quality evidence showed little or no difference in the ability of P cv-a CO 2 /C a-cv O 2 , compared with lactate, to predict mortality. Nevertheless, our conclusions are limited by the considerable heterogeneity among the studies. PROSPERO registration: CRD42019130387

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Letter to the editor: The effects of hyperoxia on sublingual microcirculation: An unsolved puzzle

Dubin¹,

Pozo

2020

Journal of Critical Care

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Effects of short-term hyperoxia on sytemic hemodynamics, oxygen transport, and microcirculation: An observational study in patients with septic shock and healthy volunteers

Cited by 12 publications

References 43 publications

Effects of Normoxia, Hyperoxia, and Mild Hypoxia on Macro-Hemodynamics and the Skeletal Muscle Microcirculation in Anesthetised Rats

Effects of Normoxia, Hyperoxia, and Mild Hypoxia on Macro-Hemodynamics and the Skeletal Muscle Microcirculation in Anesthetised Rats

Comparison of central venous minus arterial carbon dioxide pressure to arterial minus central venous oxygen content ratio and lactate levels as predictors of mortality in critically ill patients: a systematic review and meta-analysis

Letter to the editor: The effects of hyperoxia on sublingual microcirculation: An unsolved puzzle

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