The Effects of Vasodilation with Prostacyclin on Oxygen Delivery and Uptake in Critically Ill Patients

Bihari, David; Smithies, Mark; Gimson, A.; Tinker, J.

doi:10.1097/00132586-198804000-00049

Cited by 39 publications

(75 citation statements)

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“…Administration of ketanserin in hypertensive post-CPB cardiac surgery patients effectively lowered MAP, while sublingual capillary blood flow was preserved [99]. Prostacyclin (cyclic adenosine monophosphate activator, Table 5) was initially propagated as a drug for improvement of oxygen extraction deficits, suspected to cause tissue dysoxia [100]. Since then it has been studied extensively, especially in experimental settings, for its potential beneficial effect on organ perfusion, as it plays a crucial role in the physiological endothelial vasodilatory response to ischemia/reperfusion [101].…”

Section: Vasodilatorsmentioning

confidence: 99%

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients

Boerma

İnce

2012

Applied Physiology in Intensive Care Medicine 2

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Section: Vasodilatorsmentioning

confidence: 99%

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients

Boerma

İnce

2012

Applied Physiology in Intensive Care Medicine 2

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“…Oxygen consumption continues to increase even when a 'normal' or greater oxygen delivery has been achieved. This has been termed 'pathological supply-dependency' [22] and implies that delivery was still Oxygen delivery (ml.min-'.m-2) Classical oxygen delivery-consumption graph demonstrating the plateau.…”

Section: Critical Oxygen Delivery: the Theorymentioning

confidence: 99%

“…Tissue hypoxia is a major factor in the development of multi-organ system failure (MOF) [32]. The application of delivery/consumption theory suggests that if supply-dependency is identified, an oxygen debt is present [22] and delivery should be increased until consumption plateaus. In patients in whom a rise in delivery was associated with no change in consumption, but rather an increase in extraction ratio from 0.3 to 0.7, the mortality was lower than in those in whom increased delivery led to increased consumption [23].…”

Section: Critical Oxygen Delivery: the Theorymentioning

confidence: 99%

Beyond the lung: oxygen delivery and tissue oxygenation

Soni¹,

Fawcett²,

Halliday³

1993

Anaesthesia

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“…Disease processes such as sepsis and adult respiratory distress syndrome (ARDS) [28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45][46] have been hypothesized to induce tissue hypoxia by producing an abnormally elevated anaerobic threshold. Below this threshold or critical level of oxygen delivery, O 2 consumption decreases as O 2 delivery decreases.…”

Section: Evidence For Restrictive and Liberal Approaches To Transfusionsmentioning

confidence: 99%

“…The resultant tissue hypoxia may eventually contribute to the evolution of irreversible multiple system organ failure followed by death. Indeed, two prospective observational studies 34,38 found a significant association between mortality and the finding of pathologic supply dependence.…”

Section: Evidence For Restrictive and Liberal Approaches To Transfusionsmentioning

confidence: 99%

Transfusion Morbidity and Mortality in the ICU

Hébert¹

2000

Transfus Alt Transfus Med

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Transfusion of red blood cells (RBCThis patient population is affected by complex metabolic, respiratory and cardiovascular pathophysiological processes which predispose this patient population to the adverse consequences of anemia such as the potential risk of myocardial infarction and death. It is also possible that critically ill patients are at increased risks of adverse consequences from allogeneic red cell transfusions, particularly the immunosuppressive [11][12][13][14][15][16] 20 . In this article, the background outlining the divergent risks and benefits of anemia and transfusion will be discussed. Studies describing the epidemiology of anemia and current transfusion practices will also be outlined. Transfusion practice variation in critical careTwo observational studies, a survey of critical care physicians and a large cohort study, were conducted to determine individual and hospital practice variation. In a 1993 Canadian survey of critical care practitioners 27 , we documented that 35% of respondents identified 90 g/L as minimum concentration and an additional 40% selected 100 g/L. Overall baseline transfusion thresholds ranged from a low of 50 g/L to 120 g/L. Thresholds were significantly different (p<0.001) between scenarios ( Figure 1). All clinical characteristics evaluated, except congestive heart failure (p>0.05), significantly (p< 0.0001) changed transfusion thresholds of Canadian critical care practitioners. We also noted significant difference among the four clinical scenarios and a number of potential risk factors. There was a significant association between having an academic affiliation and transfusion practice across all scenarios ( p<0.0001). Physicians with an academic affiliation transfused red cells at a lower transfusion threshold than non-academics. When grouped into 4 major geographic locations (West, Ontario, Quebec, East), with no more than 5 academic centers per region, we noted that there was a statistically significant difference (p<0.01) for baseline transfusion thresholds across all scenarios. In a second study we examined the transfusion practice in a cohort of 5298 consecutive patients treated in six tertiary level intensive care units. Twenty-five percent of the critically ill patients in the cohort study received red cell transfusions. The overall number of transfusions per patient-day in the ICU averaged 0.95±1.39 and ranged from 0.82±1.69 to 1.08±1.27 between institutions (p<0.001). The number of transfusions administered were significantly different between institutions even after multivariate adjustments for age, APACHE II score and within four diagnostic categories (cardiovascular disease, respiratory failure, major surgery and trauma) (p<0.0001). A similar analysis using nadir hemoglobin concentrations, the lowest hemoglobin value prior to the first transfusion or the lowest value recorded during the entire ICU stay also demonstrated that there is significant institutional practice variation (p<0.0001) (Figure 2). Further evaluation of transfusion practice using...

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The Effects of Vasodilation with Prostacyclin on Oxygen Delivery and Uptake in Critically Ill Patients

Cited by 39 publications

References 0 publications

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients

The role of vasoactive agents in the resuscitation of microvascular perfusion and tissue oxygenation in critically ill patients

Beyond the lung: oxygen delivery and tissue oxygenation

Transfusion Morbidity and Mortality in the ICU

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