Significance of pathologic oxygen supply dependency in critically ill patients: Comparison between measured and calculated methods

Hanique, G.; Dugernier, Thierry; Laterre, Pierre‐François; Dougnac, A; Roeseler, Jean; Reynaert, Marc

doi:10.1007/bf02425048

Cited by 93 publications

(40 citation statements)

References 39 publications

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“…V O 2 from indirect calorimetry and the reverse Fick method have been measured in previous studies, while others have not confirmed this [2][3][4][5][6][7][8][9]. These studies have employed a variety of methodologies and devices for measurement of _ V O 2 within a breathing system, but use of the Datex Deltatrac has been very popular [2-5, 7, 9, 24].…”

Section: Significant Differences Between _mentioning

confidence: 99%

“…This is the commonest method of gas uptake measurement used in the clinical setting, and is the underlying principle employed by some commercially available devices. However a number of studies have found significant discrepancies between _ V O 2 measured by indirect calorimetry and the reverse Fick method [2][3][4][5][6][7][8][9]. This difference has been attributed to significant levels of O 2 consumption by lung tissue.…”

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confidence: 99%

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Measured pulmonary oxygen consumption: difference between systemic oxygen uptake measured by the reverse Fick method and indirect calorimetry in cardiac surgery

Peyton

Robinson

2005

Anaesthesia

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SummaryMeasurement of oxygen uptake by indirect calorimetry was compared with the reverse Fick method in a series of patients undergoing cardiac surgery. Oxygen uptake measurements for indirect calorimetry were made using a calibrated measurement system utilizing the Haldane transformation in a simple semiclosed breathing system based upon a modified Bain circuit. Pulmonary blood flow for the reverse Fick method was measured using bolus thermodilution. The results were (mean [standard deviation]): indirect calorimetry 167[26] ml.min

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Section: Significant Differences Between _mentioning

confidence: 99%

mentioning

confidence: 99%

Measured pulmonary oxygen consumption: difference between systemic oxygen uptake measured by the reverse Fick method and indirect calorimetry in cardiac surgery

Peyton

Robinson

2005

Anaesthesia

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“…Hanique et al 8 found that in patients with ARDS, sepsis, or FHF, 8 of 32 patients studied showed pathological DO 2 dependency when VO 2 was determined independently of DO 2 . Of those 8 patients, 3 had FHF.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, elevation of serum lactate levels in patients with CESLD may not be representative of tissue ischemia because hepatic clearance of lactate can be impaired. 8,18 The existence of pathological DO 2 dependency is still controversial in situations other than severe decrements in DO 2 . [20][21][22] In such altered physiological conditions as ARDS and sepsis, the body of published data is open to criticism, and to date there is no definitive study proving the existence of pathological DO 2 dependency.…”

Section: Discussionmentioning

confidence: 99%

“…This is termed physiological oxygen supply dependency. It has been suggested that in certain disease states, such as adult respiratory distress syndrome (ARDS), [1][2][3][4] sepsis, [5][6][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.…”

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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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Advances in Critical Care Monitoring

Barie

1997

Arch Surg

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A critical evaluation of monitoring in critical illness must recognize first that there are many different types of monitoring that may take place, and that each type of monitor may be evaluated appropriately by different standards. Monitoring may occur with imaging devices, analyzers that require the permanent removal of tissue or fluid for analysis, or monitors that observe physiology with either invasive or noninvasive methods without requiring an ex vivo sample.

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Significance of pathologic oxygen supply dependency in critically ill patients: Comparison between measured and calculated methods

Cited by 93 publications

References 39 publications

Measured pulmonary oxygen consumption: difference between systemic oxygen uptake measured by the reverse Fick method and indirect calorimetry in cardiac surgery

Measured pulmonary oxygen consumption: difference between systemic oxygen uptake measured by the reverse Fick method and indirect calorimetry in cardiac surgery

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

Advances in Critical Care Monitoring

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