Oxygen delivery and consumption and P50 in patients with acute myocardial infarction.

Abstract

We investigated the relationship between oxygen delivery (DO2), oxygen consumption (V02), and influence of oxyhemoglobin dissociation (P50) on VO2 in 40 patients with complicated myocardial infarction. A decrease in V02 and an increase in P50 were observed as DO2 decreased due to pump failure. In a given range of DO2, VO2 was related to P50 in survivors (r values .472 to .647, p < .01). Each millimeter of mercury increase in P50 was associated with a 5.2 to 6.5 ml/min m2 increase in VO2 when DO2 was less than 450 ml/min m2. No similar correlation was found for nonsurvivors. Lactate was higher in nonsurvivors despite the fact that DO2 and V02 were similar in the two groups.The lack of compensatory increases in P50 may be pathologic in nonsurvivors. However, the value of V02 as an indicator of tissue oxygenation or survival in patients with acute myocardial infarction is questionable.Circulation 73, No. 6, 1183No. 6, -1185No. 6, , 1986 IN ADULTS with respiratory distress syndrome or in shock and in anesthesized patients, oxygen consumption (V02) has been demonstrated to be related to oxygen delivery (D02). 1' The cause of supply dependency of oxygen uptake under certain conditions and its pathophysiologic implications are uncertain.5 When DO2 is decreased, one of the compensatory mechanisms by which V02 is maintained is a decrease in oxygen affinity for hemoglobin, i.e., an increase in oxyhemoglobin dissociation (P50), to facilitate oxygen unloading and increased 02 extraction. Elevated P50 has been found in patients with anemia and low cardiac output and those living at high altitudes.6 In patients with acute myocardial infarction, elevated P is thought to improve V02 when DO2 is decreased due to low cardiac output.2 Conversely, the clinical significance of VO2 has been questioned,7 even though some investigators have observed lower VO2 in nonsurvivors than survivors of septic shock.8 The purpose of our study was to evaluate the relationship of DO2, V02, and P50 and the effect of P50 on V02 after acute myocardial infarction. Methods Forty consecutive patients who required hemodynamic monitoring among 147 patients with acute myocardial infarction who were admitted to our institution between January 1983 and July 1984 were evaluated. Diagnosis of acute myocardial infarction was made by history, the electrocardiogram, and measurement of the creatine kinase-MB isoenzyme level. Hemodynamic monitoring was instituted for management of cardiogenic shock in 18 patients, pulmonary edema in 12, persistent chest pain in nine, and uncontrolled arrhythmia in one. A pulmonary arterial catheter was inserted through the internal jugular or subclavian vein and an arterial catheter was inserted in the radial artery of each patient. Cardiac output was measured by the thermodilution technique in triplicate, or until three measurements varied less than 5%. Simultaneous arterial and mixed venous blood were also drawn for analysis of pH, Po2, So2, Pco2, hemoglobin, and arterial lactate. From these data, DO2 and V02 were calcu...

Interrelationship between oxygen‐related variables in patients with acute myocardial infarction: an interpretative review

“…The majority of patients who develop delayed cardiogenic shock following AMI often slip slowly into shock with clinical evidence of a low cardiac output, prior to the development of hypotension and metabolic (lactic) acidosis. Accordingly, the association of normal lactate concentrations with decreased IVO 2 is repeatedly observed in patients with cardiogenic shock, as this review shows (Yang et al. , 1986; Astiz et al.…”

“…A pathological IVO 2 /IDO 2 dependency was found in the three reports which examined these relationships (Yang et al. , 1986; Sumimoto et al.…”

“…In this series, lactate levels in the final phase of the Normalized CI group ( n = 9) were in the normal range (Table 2). Yang also found lactate levels in the normal range in survivors with IDO 2 < 250 ml min −1 m −2 which were associated with IVO 2 levels of 116 ± 2, ml min −1 m −2 (Yang et al. , 1986).…”

“…Despite the fact that decreases in systemic oxygen demand in patients with AMI were first observed in several studies many years ago (da Luz et al. , 1975; Yang et al. , 1986; Jorge, 1989; Creamer et al.…”

“…The tendency line intersects the family of constant IVO 2 hyperbolae in a descending trend following IDO 2 decreases. Yang et al. (1986) and Lim et al.…”