Oxygen extraction and perfusion markers in severe sepsis and septic shock: diagnostic, therapeutic and outcome implications.
OBJECTIVE
The purpose of this study is to review the recent literature examining the clinical utility of markers of systemic oxygen extraction and perfusion in the diagnosis, treatment and prognosis of severe sepsis and septic shock.


RESULTS
When sepsis is accompanied by conditions in which systemic oxygen delivery does not meet tissue oxygen demands, tissue hypoperfusion begins. Tissue hypoperfusion leads to oxygen debt, cellular injury, organ dysfunction and death. Tissue hypoperfusion can be characterized using markers of tissue perfusion (central venous oxygen saturation and lactate), which reflect the interaction between systemic oxygen delivery and demands. For the last two decades, studies and quality initiatives incorporating the early detection and interruption of tissue hypoperfusion have been shown to improve mortality and altered sepsis care. Three recent trials, while confirming an all-time improvement in sepsis mortality, challenged the concept that rapid normalization of markers of perfusion confers outcome benefit. By defining and comparing haemodynamic phenotypes using markers of tissue perfusion, we may better understand which patients are more likely to benefit from early goal-directed haemodynamic optimization.


CONCLUSIONS
The phenotypic haemodynamic characterization of patients using perfusion markers has diagnostic, therapeutic and outcome implications in severe sepsis and septic shock. However, irrespective of haemodynamic phenotype, the outcome reflects the quality of care provided at the point of presentation. Utilizing these principles may allow more objective interpretation of resuscitation trials and translate these findings into current practice.
aDepartment of Emergency Medicine, Henry Ford Hospital, Wayne State University, Detroit, Michigan bDepartment of Internal Medicine, Pulmonary and Critical Care Medicine, University of Kentucky, Lexington, Kentucky, USA.
Emanuel P
EP
Rivers
Angel Coz
AC
Yataco
Anja Kathrina
AK
Jaehne
Jasreen
J
Gill
Margaret
M
Disselkamp
D015415:Biomarkers / Q000378:metabolism; D001784:Blood Gas Analysis; D003422:Critical Care; D006801:Humans; D019344:Lactic Acid / Q000378:metabolism*; D010100:Oxygen / Q000378:metabolism*; D010101:Oxygen Consumption; D010477:Perfusion; D017410:Practice Guidelines as Topic; D011379:Prognosis; D012151:Resuscitation; D018805:Sepsis / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy; D012772:Shock, Septic / Q000378:metabolism* / Q000503:physiopathology / Q000628:therapy
D015415:Biomarkers; D019344:Lactic Acid; D010100:Oxygen