Oxygen supply dependency can characterize septic shock
Oxygen supply dependency can characterize septic shock
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DOI：
10.1007/s001340050531
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发表时间：
1998-02-01
影响因子：
38.9
通讯作者：
Vincent, JL
中科院分区：
文献类型：
--
作者：
Friedman, G;De Backer, D;Vincent, JL
目的：为了证明在血流动力学不稳定期间氧耗量（VO 2）依赖于氧输送（DO 2），而在稳定后则独立于DO 2。设计：我们回顾性分析了从10名患者中收集的血流动力学和血气数据，这些患者在脓毒性休克发作期间（A期）和从该发作中恢复后（B期）DO 2发生急性改变。一所大学医院的普通重症监护室。病人：10名重症成人患者（年龄55 +/- 19岁）。干预措施：通过液体挑战、给予血管活性剂或应用呼气末正压来改变DO 2。在A相，VO 2的变化（121 +/- 32 vs 165 +/- 36 ml/min。m（2）; p < 0.001）DO 2的显著变化（415 +/- 153 vs 607 +/- 217 ml/min。m（2）; p < 0.001），但氧摄取率（O2 ER）保持稳定（31.9 +/- 11.2 vs. 30.2 + /-8.9%; NS）。在B阶段，DO 2的变化（412 +/- 118 vs 526 +/- 152 ml/min。（2）. p< 0.001）与O2 ER的相反变化相关（36.1 +/- 4.2 vs 28.9 +/-4.9%; p < 0.001），VO 2无变化（147 +/- 35 vs 149 +/- 33 ml/min。m（2）; NS）。A阶段的平均VO 2/DO 2斜率大于B阶段（0.26 +/- 0.09 vs. 0.08 +/- 0.08; p < 0.004）。A期血乳酸水平高于B期（3.3 +/- 1.8 vs 1.6 +/- 0.6 mEq/l; p < 0.05）。结论：同一危重病人在不同时间存在氧供依赖性和氧供不依赖性。我们的研究结果是一致的概念，VO 2/DO 2依赖性是一个标志的感染性休克。当这种现象存在时，增加DO 2的干预措施可能是合理的。
Objective: To demonstrate that oxygen consumption (VO2) can be dependent on oxygen delivery (DO2) during hemodynamic instability and independent of DO2 following stabilization.Design: We retrospectively reviewed hemodynamic and blood gas data collected from ten patients in whom DO2 was acutely altered during an episode of septic shock (phase A) and after recovery from this episode (phase B).Setting: General intensive care unit of a university hospital.Patients: 10 critically ill adult patients (aged 55 +/- 19 years).Interventions: DO2 was altered by fluid challenge, administration of vasoactive agents, or application of positive end-expiratory pressure.Results: In phase A, changes in VO2 (121 +/- 32 vs 165 +/- 36 ml/min . m(2); p < 0.001) paralleled changes in DO2 (415 +/- 153 vs 607 +/- 217 ml/min . m(2); p < 0.001), but oxygen extraction (O2ER) remained stable (31.9 +/- 11.2 vs. 30.2 + /- 8.9 %; NS). In phase B, changes in DO2, (412 +/- 118 vs 526 +/- 152 ml/min . m(2); p< 0.001) were associated with opposite changes in O2ER (36.1 +/- 4.2 vs 28.9 +/- 4.9 %; p < 0.001), and VO2 was unchanged (147 +/- 35 vs 149 +/- 33 ml/min . m(2); NS). The mean VO2/DO2 slope was greater in phase A than in phase B (0.26 +/- 0.09 vs. 0.08 +/- 0.08; p < 0.004). Blood lactate levels were higher in phase A than in phase B (3.3 +/- 1.8 vs 1.6 +/- 0.6 mEq/l; p < 0.05).Conclusions: Oxygen supply independency and dependency can be found at different times in the same critically ill patient. Our findings are consistent with the concept that VO2/DO2 dependency is a marker of septic shock. Interventions to increase DO2 are probably justified when this phenomenon is preesent.