Preliminary observations in systemic oxygen consumption during targeted temperature management after cardiac arrest

Uber, Amy; Grossestreuer, Anne V.; Ross, Catherine E.; Patel, Parth; Trehan, Ambica; Donnino, Michael W.; Berg, Katherine M.

doi:10.1016/j.resuscitation.2018.04.001

Cited by 16 publications

(19 citation statements)

References 17 publications

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“…Newer technology allows for direct, non-invasive, and continuous measurement of VO 2 and carbon dioxide production (VCO 2 ) in patients who are mechanically ventilated (16,17). Our group has used this technology previously to evaluate whether VO 2 is associated with survival after cardiac arrest (10). The same study also explored the ratio between VO 2 and lactate as a possible more sensitive marker of the adequacy of VO 2 for a specific patient at a specific moment and found a stronger association with mortality using this ratio than using VO 2 alone.…”

Section: Introductionmentioning

confidence: 99%

Association Between the Oxygen Consumption: Lactate Ratio and Survival in Critically Ill Patients With Sepsis

Hoeyer-Nielsen

Holmberg

Grossestreuer

et al. 2020

Shock

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Introduction: Mitochondrial dysfunction leading to impairment of oxygen extraction, referred to as cytopathic hypoxia, contributes to morbidity in sepsis. Oxygen consumption (VO 2 ) may be a useful measure of the severity of cytopathic hypoxia. We monitored VO 2 and carbon dioxide production (VCO 2 ) in septic patients and investigated the association with hospital survival. Methods: We retrospectively identified adult (!18 years) septic patients from a larger prospective observational cohort of critically ill patients on mechanical ventilation. A gas-exchange monitor recorded continuous VO 2 and VCO 2 for up to 48 h. We then tested the association of median VO 2 , VCO 2 , respiratory quotient (RQ), and the VO 2 :lactate ratio with survival. Results: A total of 46 septic patients were included in the analysis, of whom 28 (61%) survived. Overall median VO 2 was not associated with survival (3.72 mL/kg/min [IQR: 3.39, 4.92] in survivors and 3.42 mL/ kg/min [IQR: 2.97, 5.26] in non-survivors, P ¼ 0.12). The overall median VCO 2 and RQ were also not associated with survival. Adjusting for age and the presence of shock did not change these results. The VO 2 :lactate ratio was associated with survival (adjusted OR 2.17 [95% CI 1.12, 4.22] per unit increase in ratio, P ¼ 0.03). The percent change in median VCO 2 was 11.6% [IQR: À8.2, 28.7] in survivors compared with À8.3% [IQR: À18.0, 4.7] in non-survivors (P ¼ 0.03). The percent changes in median VO 2 and RQ were not different between groups. Conclusion: The VO 2 :lactate ratio was significantly higher in survivors, while there was no association between median VO 2 alone and survival. There was a significant difference in change in VCO 2 over time between survivors and non-survivors.

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Section: Introductionmentioning

confidence: 99%

Association Between the Oxygen Consumption: Lactate Ratio and Survival in Critically Ill Patients With Sepsis

Hoeyer-Nielsen

Holmberg

Grossestreuer

et al. 2020

Shock

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“…This association is thought due to lactate being a marker of poor perfusion and impaired aerobic metabolism, not because lactate is itself harmful. Low Vo 2 has also been associated with mortality in these patient populations (2)(3)(4)21). The importance of lactate and Vo 2 is thought to be as indicators of both impaired tissue perfusion related to hypotension and alterations in oxygen extraction.…”

Section: Discussionmentioning

confidence: 99%

The Effect of a Single Dose of Thiamine on Oxygen Consumption in Patients Requiring Mechanical Ventilation for Acute Illness: A Phase II, Randomized, Double-Blind, Placebo-Controlled Trial

Berg

Grossestreuer

Andersen

et al. 2021

Critical Care Explorations

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IMPORTANCE:Lower oxygen consumption is associated with worse survival in septic shock and in other forms of critical illness. No treatment that increases oxygen extraction, a key determinant of oxygen consumption, has been found. Thiamine is required for aerobic metabolism, and deficiency is common in the critically ill. OBJECTIVES:We evaluated the effect of thiamine on oxygen consumption in patients requiring mechanical ventilation for an acute illness. DESIGN:Phase II, randomized, double-blind, and placebo-controlled trial. SETTING AND PARTICIPANTS:ICUs in a tertiary care hospital in the United States. Patients admitted to the ICU and requiring mechanical ventilation were screened for enrollment. INTERVENTIONS:After enrollment, baseline measurement of oxygen consumption and baseline laboratories including lactate, central venous oxygen saturation, and pyruvate dehydrogenase, a single dose of 200 mg IV thiamine or placebo was administered. Oxygen consumption was then monitored for 6 additional hours and repeat laboratories were drawn at the end of the protocol. MAIN OUTCOMES AND MEASURES:The primary outcome was the change in oxygen consumption. Analysis was done using linear regression with a first-order autoregressive variance-covariance structure to account for repeated measures within subjects. Secondary outcomes included change in lactate, central venous oxygen saturation, and pyruvate dehydrogenase quantity and activity. RESULTS:Sixty-seven patients were enrolled. After excluding 11 patients due to inadequate quantity or quality of oxygen consumption data, 56 patients were included. There was no difference in change in oxygen consumption in the 6 hours after study drug. Results for secondary outcomes were similarly negative. In the prespecified subgroup of 18 thiamine deficient patients, there was a difference in the two oxygen consumption curves (p = 0.006), although no difference in median oxygen consumption or area under the curve. CONCLUSIONS AND RELEVANCE:A single dose of IV thiamine did not alter oxygen consumption in patients requiring mechanical ventilation for acute illness.

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“…Indirect calorimetry (IC) can simultaneously and noninvasively measure VCO 2 and VO 2 . It has already been used in ICUs for measuring energy expenditure and oxygen consumption [ 14 , 15 ]. IC will provide information not only for estimated nutritional requirements but also for tissue metabolism [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Changes in carbon dioxide production and oxygen uptake evaluated using indirect calorimetry in mechanically ventilated patients with sepsis

et al. 2021

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Background Several clinical guidelines recommend monitoring blood lactate levels and central venous oxygen saturation for hemodynamic management of patients with sepsis. We hypothesized that carbon dioxide production (VCO2) and oxygen extraction (VO2) evaluated using indirect calorimetry (IC) might provide additional information to understand the dynamic metabolic changes in sepsis. Methods Adult patients with sepsis who required mechanical ventilation in the intensive care unit (ICU) of our hospital between September 2019 and March 2020 were prospectively enrolled. Sepsis was diagnosed according to Sepsis-3. Continuous measurement of VCO2 and VO2 using IC for 2 h was conducted within 24 h after tracheal intubation, and the changes in VCO2 and VO2 over 2 h were calculated as the slopes by linear regression analysis. Furthermore, temporal lactate changes were evaluated. The primary outcome was 28-day survival. Results Thirty-four patients with sepsis were enrolled, 26 of whom survived 76%. Significant differences in the slope of VCO2 (− 1.412 vs. − 0.446) (p = 0.012) and VO2 (− 2.098 vs. − 0.851) (p = 0.023) changes were observed between non-survivors and survivors. Of note, all eight non-survivors and 17 of the 26 survivors showed negative slopes of VCO2 and VO2 changes. For these patients, 17 survivors had a median lactate of − 2.4% changes per hour (%/h), whereas non-survivors had a median lactate of 2.6%/hr (p = 0.023). Conclusions The non-survivors in this study showed temporal decreases in both VCO2 and VO2 along with lactate elevation. Monitoring the temporal changes in VCO2 and VO2 along with blood lactate levels may be useful in predicting the prognosis of sepsis.

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Preliminary observations in systemic oxygen consumption during targeted temperature management after cardiac arrest

Cited by 16 publications

References 17 publications

Association Between the Oxygen Consumption: Lactate Ratio and Survival in Critically Ill Patients With Sepsis

Association Between the Oxygen Consumption: Lactate Ratio and Survival in Critically Ill Patients With Sepsis

The Effect of a Single Dose of Thiamine on Oxygen Consumption in Patients Requiring Mechanical Ventilation for Acute Illness: A Phase II, Randomized, Double-Blind, Placebo-Controlled Trial

Changes in carbon dioxide production and oxygen uptake evaluated using indirect calorimetry in mechanically ventilated patients with sepsis

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