Dobutamine and the oxygen uptake/supply relationship in sepsis: from global to regional-nothing is simple and easy

Effects of Dopexamine and Positive End-Expiratory Pressure on Intestinal Blood Flow and Oxygenation*

“…However, one must bear in mind that the net effects of vasoconstrictor therapy on intestinal tissue oxygen perfusion are not easily deduced from systemic BP measurements. 3 In this study, we also measured jejunal mucosal perfusion. In situations of reduced intestinal blood flow, it has been suggested 37,39 that a redistribution of blood flow occurs, preserving intestinal mucosal perfusion better than serosal perfusion.…”

“…2 Such regional hypoxia is not easily diagnosed, and the success of interventions to increase tissue oxygenation might be hard to evaluate. 3 The assessment of regional tissue oxygen perfusion in clinical practice is usually based on indirect indicators, including traditional systemic hemodynamic indexes, and the evaluation of mixed venous saturation and lactate levels in the systemic circulation. Direct measurements of intestinal blood flow and oxygenation (ie, tissue oxygen perfusion) are invasive and time-consuming, and require special skills and instruments that are not readily available at the bedside.…”

Assessment of Graded Intestinal Hypoperfusion and Reperfusion Using Continuous Saline Tonometry in a Porcine Model

“…5 Such regional hypoxia is not easily diagnosed, and the success of interventions to increase tissue oxygenation is difficult to evaluate. 6 Assessment of regional tissue oxygenation and perfusion in clinical practice is usually based on indirect indicators, including traditional systemic hemodynamic indices, evaluation of mixed venous oxygen saturation and lactate levels in the systemic circulation. These conventional hemodynamic and oxygen-derived variables are, however, insensitive to detect intestinal hypoxia and may remain normal in states of early compensated circulatory failure.…”

The systemic delivery and consumption of oxygen in the infant after cardiac surgery

“…As a result, it has been suggested that the understanding of the relationship between the delivery and consumption of oxygen in metabolising tissues may be "one of the pivotal challenges for research in intensive care medicine". 2 In this brief review, I will present a framework in which the relationship between the systemic delivery and consumption of oxygen has been considered in the critically ill, with particular reference to the infant and child in the early hours after cardiac surgery. I will examine the literature to assess whether abnormalities of the relationship between the systemic delivery and consumption of oxygen provide indicators of outcome in this group of patients.…”