The concentration of oxygen, lactate and glucose in the central veins, right heart, and pulmonary artery: a study in patients with pulmonary hypertension

Gutiérrez, Guillermo; Venbrux, Anthony C.; Ignacio, Elizabeth A.; Reiner, Jonathan; Chawla, Lakhmir S.; Desai, Amishi

doi:10.1186/cc5739

Cited by 17 publications

(8 citation statements)

References 29 publications

(22 reference statements)

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“…In the critically ill, prior to ECMO initiation, S a O 2 is equal in all regions and the saturation in the superior and inferior vena cava (S svc O 2 and S ivc O 2 , respectively) are usually rather similar. 9,10 Differential hypoxemia occurs when the left ventricle ejects desaturated blood into the ascending aorta and the well-saturated ECMO blood is introduced at a point downstream. Accordingly, these two parallel pumping systems deliver blood of different oxygen saturations depending on lung function and oxygenator performance, respectively.…”

Section: Oxygen Delivery In Ecmo Supportmentioning

confidence: 99%

Differential hypoxemia during venoarterial extracorporeal membrane oxygenation

et al. 2019

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Venoarterial extracorporeal membrane oxygenation, indicated for severe cardio-respiratory failure, may result in anatomic regional differences in oxygen saturation. This depends on cannulation, hemodynamic state, and severity of respiratory failure. Differential hypoxemia, often discrete, may cause clinical problems in peripheral femoro-femoral venoarterial extracorporeal membrane oxygenation, when the upper body is perfused with low saturated blood from the heart and the lower body with well-oxygenated extracorporeal membrane oxygenation blood. The key is to diagnose and manage fulminant differential hypoxemia, that is, a state that may develop where the upper body is deprived of oxygen. We summarize physiology, assessment of diagnosis, and management of fulminant differential hypoxemia during venoarterial extracorporeal membrane oxygenation. A possible solution is implantation of an additional jugular venous return cannula. In this article, we propose an even better solution, to drain the venous blood from the superior vena cava. Drainage from the superior vena cava provides superiority to venovenoarterial configuration in terms of physiological rationale, efficiency, safety, and simplicity in clinical circuit design.

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Section: Oxygen Delivery In Ecmo Supportmentioning

confidence: 99%

Differential hypoxemia during venoarterial extracorporeal membrane oxygenation

et al. 2019

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“…Bronchial circulation is a part of systemic circulation that provides nourishment to the lungs [ 14 ]. Pulmonary arteries unlike systemic arteries are always hypoxic as they conduct relatively deoxygenated blood and the gas exchange occurs at capillary level where lungs excrete carbon dioxide [ 15 , 16 ].…”

Section: Overview Of the Pulmonary Circulationmentioning

confidence: 99%

Hypoxic Pulmonary Vasoconstriction in Humans: Tale or Myth

Hussain¹,

Suleiman²,

George³

et al. 2017

TOCMJ

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Hypoxic Pulmonary vasoconstriction (HPV) describes the physiological adaptive process of lungs to preserves systemic oxygenation. It has clinical implications in the development of pulmonary hypertension which impacts on outcomes of patients undergoing cardiothoracic surgery. This review examines both acute and chronic hypoxic vasoconstriction focusing on the distinct clinical implications and highlights the role of calcium and mitochondria in acute versus the role of reactive oxygen species and Rho GTPases in chronic HPV. Furthermore it identifies gaps of knowledge and need for further research in humans to clearly define this phenomenon and the underlying mechanism.

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“…Kellum et al [ 8 ] showed that in patients with acute lung injury and hyperlactatemia the lung was a major source of lactate. The lactate level has also been shown to be lower in the coronary vein [ 9 , 10 ]. As described by Jalloh et al [ 11 ], the mean arterial-jugular bulb lactate differences were positive in patients with brain injury but were negative in normal controls, which suggested the uptake of lactate in the injured brain.…”

Section: Introductionmentioning

confidence: 99%

Negative central venous to arterial lactate gradient in patients receiving vasopressors is associated with higher ICU 30-day mortality: a retrospective cohort study

Zhang

Liu

et al. 2021

BMC Anesthesiol

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Background Serum lactate has long been used to evaluate hypoxia and predict prognosis in critically ill patients, however, discrepancy in lactate measurements between different sites have not been recognized as a useful tool for monitoring hypoxia and evaluating outcome. Methods Data were obtained from the clinical information system of the intensive care unit (ICU) in a tertiary academic hospital for 1582 ICU patients with vasoactive drug requirement and valid paired blood gas. The mortality rates were compared between patients with sustained negative venous to arterial lactate gradient (VALac) and the others using the Cox proportional hazard model. Predictive factors associated with negative VALac were searched. Results A sustained negative VALac was significantly associated with higher 30 day ICU mortality [Adjusted hazard ratio (HR) = 2.31, 95% confidence interval (CI), 1.07–4.99; p = 0.032. Propensity score- weighted HR: 2.57; 95% CI, 1.17–5.64; p = 0.010]. Arterial lactate in the first blood gas pair, 24-h arterial lactate clearance, use of epinephrine, mean positive end-expiratory pressure level, and extracorporeal membrane oxygenation initiation showed statistically significant association with sustained negative VALac during the first 24 h. Conclusion The sustained negative VALac in the early stage of treatment may suggest additional information about tissue hypoxia than arterial lactate alone. Critical care physicians should pay more attention to the lactate discrepancy between different sites in their clinical practice.

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The concentration of oxygen, lactate and glucose in the central veins, right heart, and pulmonary artery: a study in patients with pulmonary hypertension

Cited by 17 publications

References 29 publications

Differential hypoxemia during venoarterial extracorporeal membrane oxygenation

Differential hypoxemia during venoarterial extracorporeal membrane oxygenation

Hypoxic Pulmonary Vasoconstriction in Humans: Tale or Myth

Negative central venous to arterial lactate gradient in patients receiving vasopressors is associated with higher ICU 30-day mortality: a retrospective cohort study

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