Oxygen transport-dependent splanchnic metabolism in the sepsis syndrome.
OBJECTIVE
Total body oxygen consumption (VO2) may be pathologically oxygen delivery (DO2)-dependent in critically ill patients exhibiting the sepsis syndrome. This observation has been used to infer the presence of occult tissue or organ ischemia that potentially can be eradicated by augmenting DO2. We examined this hypothesis by determining the VO2-DO2 relationship and lactate metabolism in the splanchnic region.


METHODS
Before and after intervention trial.


METHODS
University-affiliated Veterans Affairs Medical Center, Allen Park, Mich.


METHODS
Eighteen surgical patients exhibiting the sepsis syndrome.


METHODS
Systemic and splanchnic oxygen exchange and lactate uptake measurements before and after augmentation of DO2 with blood transfusion.


METHODS
Changes in oxygen exchange and lactate metabolism.


RESULTS
The splanchnic VO2 index rose 9% in association with a 26% regional DO2 index increase indicating an oxygen transport dependency (P < .05). Splanchnic O2 extraction (0.47 +/- 0.04) was significantly greater than the mean systemic level (0.31 +/- 0.02) and showed a greater decline following DO2 index augmentation (0.41 +/- 0.04 vs 0.28 +/- 0.03, respectively). However, splanchnic lactate uptake was not changed significantly in response to the increased DO2 index.


CONCLUSIONS
Although splanchnic oxygen transport dependency and elevated extraction ratios suggest the presence of regional ischemia that should be relieved with an increased DO2 index, the observed changes in lactate uptake do not support this conclusion. The significance of the VO2-DO2 relationship, its role in the pathophysiology of the sepsis syndrome, and its place in the clinical care of the septic surgical patient are in doubt.
Steffes
C P
CP
Department of Surgery, Veterans Affairs Medical Center, Allen Park, Mich.
Dahn
M S
MS
Lange
M P
MP
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002302:Cardiac Output; D006801:Humans; D007773:Lactates / Q000378:metabolism*; D019344:Lactic Acid; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000097:blood / Q000378:metabolism*; D010101:Oxygen Consumption; D018805:Sepsis / Q000097:blood / Q000378:metabolism* / Q000503:physiopathology; D013152:Splanchnic Circulation / Q000502:physiology*
D007773:Lactates; D019344:Lactic Acid; D010100:Oxygen