Abstract
Although they were not the first to observe it, a seminal paper by Danek et al. (1980) ushered in a decade of concern for oxygen supply dependency in critically ill patients. That concern continues today with some urgency because of the uncertainty of what it means. The observation made by Danek et al. (1980) was that O2 uptake (VO2) varied directly with O2 delivery (DO2) even at very high delivery rates in patients that were critically ill with adult respiratory distress syndrome (ARDS). A similar linear relationship between VO2 and DO2 was not seen in another group of critically ill ventilator patients who had not been diagnosed with ARDS. In this and in the earlier studies, it appeared that O2 demand was higher than expected and was not satisfied in ARDS patients even if DO2 were raised to well above normal resting levels. The authors suggested that this was due to a possible disturbance of normal regulatory control of blood flow in the periphery as well as a possible disruption of cellular structure with mitochondrial dysfunction.
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References
Archie, J.P., 1981, Mathematic coupling of data — a common source of error. Ann. Surg. 193: 296.
Bakker, J., Coffernils, M., Leon, M., Gris, P., Vincent, J.-L., 1991, Blood lactate levels are superior to oxygen-derived variables in predicting outcome in human septic shock. Chest 99: 956.
Barton, R. and Cerra, F.B., 1989, The hypermetabolism multiple organ failure syndrome. Chest 96: 1153.
Bihari, D., Smithies, M., Gimson, A., and Tinker, J., 1987, The effects of vasodilation with prostacyclin on oxygen delivery and uptake in critically ill patients. N. Engl. J. Med. 317: 397.
Bredle, D.L., Samsel, R.W., Schumacker, P.T., and Cain, S.M., 1989, Critical O2 delivery to skeletal muscle at high and low PO2 in endotoxemic dogs. J. Appl. Physiol. 66: 2553.
Bredle, D.L. and Cain, S.M., 1991, Systemic and muscle O2 uptake/delivery after dopexamine infusion in endotoxic dogs. Crit. Care Med. 19: 198.
Cain, S.M., 1967, Oxygen deficit incurred during hypoxia and its relation to lactate and excess lactate. Am. J. Physiol. 213: 57.
Cain, S.M., 1978, Effects of time and vasoconstrictor tone on O2 extraction during hypoxic hypoxia. J. Appl. Physiol. 45: 219.
Cain, S.M., 1984, Supply dependency of oxygen uptake in ARDS: Myth or reality? Am J. Med. Sci. 288: 119.
Cain, S.M. and Chapler, C.K., 1985, Circulatory responses to 2,4dinitrophenol in dog limb during normoxia and hypoxia. J. Appl. Physiol. 59: 698.
Cain, S.M. and Curtis, S.E., 1991a, Experimental models of pathological oxygen supply dependency. Crit. Care Med. 19: 603.
Cain, S.M. and Curtis, S.E., 1991b, Systemic and regional O2 uptake/delivery and lactate flux in endotoxic dogs infused with dopexamine. Crit. Care Med. 19: 1552.
Curtis, S.E., Bradley, W.E., and Cain, S.M., (this volume), Effects of endotoxin on canine skeletal muscle oxygen delivery-uptake relations during progressive hypoxic hypoxia. Adv. Exp. Med. Biol.
Curtis, S.E. and Cain, S.M., 1992, Regional and systemic oxygen delivery/uptake relations and lactate flux in hyperdynamic, endotoxin-treated dogs. Am. Rev. Resp. Dis. 145: 348.
Danek, S.J., Lynch, J.P., Weg, J.G., and Dantzker, D.R., 1980, The dependence of oxygen uptake on oxygen delivery in the adult respiratory distress syndrome. Am. Rev. Respir. Dis. 122: 387.
Pantzker, P.R., Foresman, B., and Gutierrez, G., 1991, Oxygen supply and utilization relationships. Am. Rev. Respir. Dis. 143: 675.
Fenwick, J.C., Podek, P.M., Ronco, J.J., Phang, P.T., Wiggs, B. and Russell, J.A., 1990, Increased concentrations of plasma lactate predict pathologic dependence of oxygen consumption on oxygen delivery in patients with adult respiratory distress syndrome. J. Crit. Care 5: 81.
Kruse, J.A., Haupt, M.T., Puri, V.K., and Carlson, R.W., 1990, Lactate levels as predictors of the relationship between oxygen delivery and consumption in ARPS. Chest 98: 959.
Messmer, K., Kreimeier, U., and Hammersen, F., 1989, Changes in the microcirculation in sepsis and septic shock. In: “Sepsis,” Reinhart, K. and Eyrich, K.(eds.), Springer-Verlag. Berlin, pp 148.
Nelson, P.P., Beyer, C., Samsel, R.W., Wood, L.P.H., and Schumacker, P.T., 1987, Pathological supply dependence Of O2 uptake during bacteremia in dogs. J. Appl. Physiol. 63: 1487.
Nelson, P.P., Samsel, R.W., Wood, L.P.H., and Schumacker, P.T., 1988, Pathological supply dependence of systemic and intestinal O2 uptake during endotoxemia. J. Appl. Physiol. 64: 2410.
Ronco, J.J., Phang, P.T., Walley, K.R., Wiggs, B., Fenwick, J.C., and Russell, J.A., 1991, Oxygen consumption is independent of changes in oxygen delivery in severe adult respiratory distress syndrome. Am. Rev. Respir. Dis. 143: 1267.
Rowell, L.B., 1986, “Human Circulation,” Oxford Univ. Press, New York, pp 236.
Samsel, R.W., Nelson, P.P., Sanders, W.M., Wood, L.P.H., and Schumacker, P.T., 1988, Effect of endotoxin on systemic and skeletal muscle O2 extraction. J. Appl. Physiol. 65: 1377.
Stacpoole, P.W., 1989, The pharmacology of dichloroacetate. Metabolism 38: 1124.
Tuchschmidt. J., Oblitas, P., and Fried, J.C., 1991, Oxygen consumption in sepsis and shock. Crit. Care Med. 19: 664.
Vary, T.C., Siegel, J.H., Nakatani, T., Sato, T., and Aoyama, H., 1986, Effect of sepsis on activity of pyruvate dehydrogenase complex in skeletal muscle and liver. Am. J. Physiol. 250: E634.
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Cain, S.M. (1992). Oxygen Supply Dependency in the Critically Ill — A Continuing Conundrum. In: Erdmann, W., Bruley, D.F. (eds) Oxygen Transport to Tissue XIV. Advances in Experimental Medicine and Biology, vol 317. Springer, Boston, MA. https://doi.org/10.1007/978-1-4615-3428-0_4
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DOI: https://doi.org/10.1007/978-1-4615-3428-0_4
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