Absence of supply dependence of oxygen consumption in patients with septic shock.
We tested whether oxygen consumption (VO2) was dependent on oxygen delivery (QO2) in 10 patients with septic shock when QO2 was changed by the use of the inotropic agent, dobutamine. The mean acute physiology and chronic health evaluation (APACHE) II score of the patients was 27.3 +/- 8.1 with a mean blood pressure on entry of 66.8 +/- 12.4 mm Hg, and all had been volume resuscitated to a pulmonary artery occlusion pressure of greater than 10 mm Hg. We measured VO2 by analysis of respiratory gases (VO2G) while calculating VO2 by the Fick equation (VO2F) at three different O2 deliveries. When the dobutamine infusion rate was increased from 2.5 +/- 4.0 to 12.3 +/- 6.0 micrograms/kg/min, thermodilution cardiac output increased from 7.7 +/- 2.6 to 10.1 +/- 2.7 L/min (P < .01). Accordingly, dobutamine increased QO2 from 13.5 +/- 3.8 to 18.2 +/- 4.3 mL/min per kg (increase of 36.4% +/- 19.7%; P < .01), but VO2G did not increase (3.2 +/- 0.5 to 3.2 +/- 0.6 mL/min per kg). During these same interventions, the VO2F tended to increase (2.9 +/- 0.7 to 3.4 +/- 0.8 mL/min per kg, P < .06), presumably a spurious correlation because of measurement errors shared by the calculation of VO2F and QO2. Neither lactic acidosis nor acute respiratory distress syndrome (ARDS) conferred supply dependence of VO2G, but the presence of ARDS was predictive of death in this cohort. It is concluded that VO2 is independent of QO2 in patients with septic shock and lactic acidosis. These data confirm that maximizing QO2 beyond values achieved by initial fluid and vasoactive drug resuscitation of septic shock does not improve tissue oxygenation as determined by respiratory gas measurement of VO2.
Manthous
C A
CA
University of Chicago, Department of Medicine, Section of Pulmonary and Critical Care, Illinois.
Schumacker
P T
PT
Pohlman
A
A
Schmidt
G A
GA
Hall
J B
JB
Samsel
R W
RW
Wood
L D
LD
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015308:Anaerobic Threshold; D001784:Blood Gas Analysis; D002153:Calorimetry, Indirect; D002245:Carbon Dioxide / Q000032:analysis*; D002302:Cardiac Output / Q000187:drug effects*; D004280:Dobutamine / Q000494:pharmacology*; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D010092:Oximetry; D010100:Oxygen / Q000032:analysis*; D010101:Oxygen Consumption / Q000187:drug effects*; D010102:Oxygen Inhalation Therapy; D011446:Prospective Studies; D011659:Pulmonary Gas Exchange; D012720:Severity of Illness Index; D012772:Shock, Septic / Q000150:complications / Q000378:metabolism* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D015996:Survival Rate; D013815:Thermodilution
D002245:Carbon Dioxide; D004280:Dobutamine; D010100:Oxygen