title: Management of a Jehovah's Witness Patient with Sepsis and Profuse Bleeding After Emergency Coronary Artery Bypass Graft Surgery: Rethinking the Critical Threshold of Oxygen Delivery.
abstract: The duration and extent of acute hemodilution that the human body can withstand remains unclear. Many consider 184 mL/m/min to be the oxygen delivery (DO2) threshold below which oxygen consumption (VO2) begins to decrease. We describe a critically ill Jehovah's Witness patient who tolerated a much lower level of DO2, coupled with severe acute anemia that persisted for >10 days without any sequelae. This case challenges the currently accepted critical DO2 threshold and highlights the need for a comprehensive approach to increase DO2 and decrease VO2 for best patient outcomes. Minimizing VO2, which is usually underemphasized in current clinical practice, probably played an important role in the survival of this patient.
authors.affiliation: From the *Department of Anesthesiology and Perioperative Medicine, Medical College of Georgia, Georgia Regents University, Augusta, Georgia; and †Department of Anesthesiology, Mount Sinai Hospital, Englewood, New Jersey.
authors.forename: Tao
authors.initials: T
authors.lastname: Hong
authors.forename: Aryeh
authors.initials: A
authors.lastname: Shander
authors.forename: Shvetank
authors.initials: S
authors.lastname: Agarwal
authors.forename: Manuel
authors.initials: M
authors.lastname: Castresana
mesh_terms: D000740:Anemia / Q000503:physiopathology; D001026:Coronary Artery Bypass / Q000009:adverse effects* / Q000379:methods*; D016638:Critical Illness; D015942:Factor VIIa / Q000008:administration & dosage; D006454:Hemoglobins / Q000378:metabolism; D006470:Hemorrhage / Q000097:blood / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D033221:Jehovah's Witnesses; D008297:Male; D008875:Middle Aged; D010100:Oxygen / Q000008:administration & dosage*; D010101:Oxygen Consumption / Q000502:physiology; D018805:Sepsis / Q000097:blood / Q000503:physiopathology*; D020711:Threshold Limit Values
chemical_list: D006454:Hemoglobins; D015942:Factor VIIa; D010100:Oxygen