Relationship between oxygen transport and oxygen uptake in patients with cirrhosis: Effects of vasoactive drugs

Moreau, Richard; Lee, Samuel S.; Hadengue, Antoine; Ozier, Yves; Sicot, C; Lebrec, Didier

doi:10.1002/hep.1840090314

Cited by 50 publications

(13 citation statements)

References 24 publications

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“…To date, Moreau et al 25 are the only investigators to systematically study whole-body oxygenation in patients with CESLD. They found that the administration of dobutamine to patients with cirrhosis resulted in significant increases in both DO 2 and VO 2 without significant changes in the a-vO 2 difference or oxygen extraction ratio.…”

Section: Discussionmentioning

confidence: 99%

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Is there occult tissue ischemia in chronic end-stage liver disease?

et al. 1999

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Whether pathological oxygen supply dependency exists in patients with chronic end-stage liver disease (CESLD) is unknown, although the frequently occurring multiorgan dysfunction seen in these patients may be the result of occult tissue ischemia. In this study, 15 adult patients with CESLD were evaluated for the presence of pathological oxygen supply dependency and, thus, occult tissue ischemia before undergoing orthotopic liver transplantation. Whole-body oxygen consumption (VO 2 ) was measured using indirect calorimetry at baseline, at reduced oxygen delivery (DO 2 ) using positive end-expiratory pressure, and at increased DO 2 using volume infusion. As a group, no significant increase or decrease in VO 2 was observed with changes in DO 2 . However, 4 patients showed increases in VO 2 of 14%, 10.8%, 9.6%, and 8.2% when DO 2 was increased. The study results suggest that pathological oxygen supply dependency is present in a subset of patients with CESLD, and the existence of occult tissue ischemia is speculated. Copyright 1999 by the American Association for the Study of Liver DiseasesU nder normal conditions, whole-body oxygen consumption (VO 2 ) is independent of oxygen delivery (DO 2 ) over a wide range of DO 2 values. As DO 2 decreases from normal levels, oxygen extraction from hemoglobin (Hgb) increases, preserving VO 2 . However, if DO 2 decreases to less than a critical level, VO 2 begins to decrease as oxygen extraction reaches its physiological maximum. This is termed physiological oxygen supply dependency. It has been suggested that in certain disease states, such as adult respiratory distress syndrome (ARDS), 1-4 sepsis, 5-7 and fulminant hepatic failure (FHF), 8 pathological oxygen supply dependency may exist. In this condition, also known as pathological DO 2 dependency, increases in DO 2 to greater than normal or even supranormal levels result in progressive increases in VO 2 , with relative preservation of oxygen extraction. Explanations for this seemingly inappropriate DO 2 dependency remain speculative, but ongoing occult tissue ischemia cannot be conclusively excluded. Although a number of studies have been performed suggesting the presence of pathological DO 2 dependency, inherent methodological flaws, most frequently the use of mathematically coupled calculations for both DO 2 and VO 2 , have favored the false demonstration of pathological DO 2 dependency and thus render these studies inconclusive.Whether patients with chronic end-stage liver disease (CESLD) have pathological DO 2 dependency is unknown. This patient population is unique in that the presence of a hyperdynamic circulation coupled with a high mixed-venous oxygen content is suggestive of luxury capillary perfusion. It can be postulated that the hyperdynamic circulation seen in CESLD is an adaptive response to occult tissue ischemia caused by profound arteriovenous shunting with resultant inadequate organ perfusion. Thus, it is possible that the frequently occurring multiorgan dysfunction seen in CESLD is the result of occult tiss...

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Section: Discussionmentioning

confidence: 99%

“…The present study evaluated essentially the same parameters as Moreau et al, 25 with two major modifications to the study design. First, VO 2 was measured independently of DO 2 to avoid mathematical coupling, 26 which can occur because of the presence of shared variables in the equations for calculating both DO 2 and VO 2 .…”

Section: Discussionmentioning

confidence: 99%

Is there occult tissue ischemia in chronic end-stage liver disease?

et al. 1999

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“…Oxygen and carbon dioxide tensions and pH were measured at 37°C with speci®c electrodes 9 while oxyhaemoglobin saturation was measured using the spectrophotometric method (2500 CO-Oxymeter, Corning Medical, Med®eld, MA). 9 …”

Section: Measurements Of O 2 -Derived Variables and Acid-base Statusmentioning

confidence: 99%

“…Since somatostatin has a portal hypotensive action, 6±8 this substance may enhance the decrease in portal pressure due to b-blockade. On the other hand, since both b-blockers 9,10 and somatostatin 8 decrease cardiac index, a combination of these substances may result in a marked decrease in this variable, making the administration of somatostatin hazardous in b-blocked patients. Thus, more information is needed on the haemodynamic effects of a combination of somatostatin and a non-selective b-blocker.…”

Section: Introductionmentioning

confidence: 99%

“…The aim of the present study was to examine the splanchnic and systemic haemodynamic responses to octreotide (a long-acting somatostatin analogue) in rats with portal vein stenosis receiving propranolol. In addition, since it has been suggested that vasoactive drugs may alter arterial blood gases, 9 the effects of somatostatin on blood gases were also studied.…”

Section: Introductionmentioning

confidence: 99%

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Haemodynamic effects of octreotide in portal hypertensive rats receiving propranolol

Moreau¹,

Cailmail²,

Gadano³

et al. 1997

Aliment Pharmacol Ther

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Background: The aim of this study was to investigate short‐term effects of propranolol (a non‐selective β‐adrenergic antagonist), octreotide (a long‐acting somatostatin analogue), or a combination of these substances on splanchnic and systemic haemodynamics and arterial blood gases in rats with portal vein stenosis. Methods: Splanchnic and systemic haemodynamics were measured using the radioactive microspheres method. Eight rats first received an i.v. infusion of isotonic saline (10 μL/min for 15 min) and then an i.v. infusion of octreotide (8 μg.h/kg for 15 min). Eight other rats first received a bolus i.v. injection of propranolol (2 mg) and an i.v. infusion of octreotide 15 min later. Results: Propranolol or octreotide alone significantly decreased portal pressure (both by 23%), portal tributary blood flow (35 and 10%, respectively) and cardiac index (36 and 26%, respectively). Octreotide administration in rats pretreated with propranolol significantly decreased cardiac index but did not change portal and arterial pressures or portal tributary blood flow. Propranolol significantly increased arterial oxygen tension. Octreotide alone or combined with propranolol significantly decreased oxyhaemoglobin saturation and pH and increased carbon dioxide tension. Conclusions: In rats with portal vein stenosis, the somatostatin analogue, octreotide, accentuates the short‐term decrease in cardiac index due to propranolol. In addition, octreotide altered arterial blood gases and acid‐base status. In contrast, octreotide does not further decrease portal pressure in animals receiving propranolol.

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