Cardiac output, wedge pressure, and oxygen delivery.
The primary goal of the intensive care clinician can be said to be to optimize global DO2. This approach is the primary means by which the greatest killers of the critically ill patient (sepsis, SIRS, multiple organ dysfunction syndrome) may be addressed at present. Optimizing DO2 means delivering just enough to meet the patient's needs, because therapeutic measures taken to increase DO2 are all associated with some degree of risk. When used correctly, the PAC can allow the clinician to determine if DO2 is optimal and, if not, what steps might be best suited to improve on it. Newer generations of PACs are becoming available and can provide valuable additional insights into a patient's cardiovascular status. Nearly all attempts to increase DO2 address one or more of a relatively short list of variables. The specific endpoints of therapy need to be tailored to the individual patient but include clinical, metabolic, organ function, and hemodynamic markers. As clinicians expand our understanding of the key elements found in survivors of critical illness, it is hoped that this knowledge translates into better outcomes.
Mellema
M
M
Physiology Program, Department of Environmental Health, Harvard School of Public Health, Boston, Massachusetts, USA. mmellema@hsph.harvard.edu
D000818:Animals; D002302:Cardiac Output; D002371:Cat Diseases / Q000628:therapy*; D002407:Catheterization, Swan-Ganz / Q000662:veterinary*; D002415:Cats; D004283:Dog Diseases / Q000628:therapy*; D004285:Dogs; D006439:Hemodynamics; D010102:Oxygen Inhalation Therapy / Q000662:veterinary*; D012769:Shock / Q000628:therapy / Q000662:veterinary*