pO2-profiles in human muscle tissue as indicator of therapeutical effect in septic shock patients.
Automatically stepwise driven pO2 electrodes were transcutaneously inserted into muscle tissue of severely ill septic shock patients. The pO2 profile was plotted from 200 individual measurements registered during 5 minutes and a histogram plotted for documentation. Arterial and venous blood gases, cardiac output, systemic and pulmonary vascular resistance were measured continuously on-line. In septicemia multiple drug schemes are suggested all intending to increase oxygen supply to the tissue and to improve oxygen demand/supply mismatch. So far the attending physician is bound to conclude and continue respectively change the treatment scheme according to the above described macrophysiological parameters. Perfusion distribution and local inhomogenities of tissue oxygen supply remain undetected. In the described study pretreatment pO2 profiles in musculus quadriceps femoris were obtained and measurements repeated in intervals of 10 minutes after start of pharmacological treatment. The changes of pO2 profiles of 20 patients, monitored in such a way over days and weeks, were carefully correlated to the described cardiocirculatory parameters and blood gas analyses. Dopamine was used to improve cardiac function and tissue oxygen supply as well. The investigations show that resulting changes of cardiovascular and blood gas parameters do not always indicate that tissue oxygen supply has really improved. On the other hand there was never an improvement in tissue oxygen supply when no changes of the other parameters had occurred. It is advised to add as a further diagnostic parameter tissue pO2 measurements to get insight if improvement in cardiac and pulmonary function really has the intended effect of improvement of tissue oxygen supply.
Naumann
C P
CP
Department of Anesthesiology, Swiss Paraplegic Center, Nottwil.
Ruetsch
Y A
YA
Fleckenstein
W
W
Fennema
M
M
Erdmann
W
W
Zäch
G A
GA
D001322:Autoanalysis / Q000379:methods; D001794:Blood Pressure; D004298:Dopamine / Q000627:therapeutic use; D004563:Electrochemistry / Q000295:instrumentation / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D008991:Monitoring, Physiologic / Q000295:instrumentation / Q000379:methods; D009102:Multiple Organ Failure / Q000097:blood / Q000503:physiopathology* / Q000628:therapy; D009132:Muscles / Q000098:blood supply / Q000503:physiopathology*; D010100:Oxygen / Q000032:analysis* / Q000097:blood; D010101:Oxygen Consumption; D010313:Partial Pressure; D011175:Positive-Pressure Respiration; D012772:Shock, Septic / Q000097:blood / Q000503:physiopathology* / Q000628:therapy
D010100:Oxygen; D004298:Dopamine