Chest
Volume 85, Issue 3, March 1984, Pages 336-340
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The Relationship Between Oxygen Delivery and Consumption during Fluid Resuscitation of Hypovolemic and Septic Shock

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The effects of increasing oxygen delivery (D˙O2) on oxygen consumption (V˙O2) in eight patients with septic shock and five patients with hypovolemic shock were studied during fluid resuscitation. In the septic shock group,D˙O2 increased from 315 ± 29 to 424 ± 25 ml/min/m2 (p <0.01) andV˙O2 increased from 134 ± 8 to 151 ± 7 ml/min/m2 (p <0.01). In the hypovolemic shock group,D˙O2 increased from 239 ± 26 to 386 ± 48 ml/min/m2 (p <0.01) andV˙O2 increased from 96 ± 9 to 135 ± 6 ml/min/m* (p <0.01). There was no significant difference in either the increase inD˙O2 orV˙O2 between the septic shock and hypovolemic shock patients. We conclude that increasingD˙O2 by fluid resuscitation increasesV˙O2 during both hypovolemic and septic shock.

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MATERIALS AND METHODS

A summary of the individual patient data is given in Table 1. Thirteen consecutive patients with circulatory shock in whom volume loading increased oxygen delivery were investigated. The patients ranged in age from 66 to 97 years (median = 81 years). Five (38 percent) of the patients were in hypovolemic shock. Eight (62 percent) of the patients had septic shock. Sepsis was verified by positive blood culture or identification of an infected site.

Patients were entered into the study if

RESULTS

The time to peakD˙O2 during fluid challenge was 78 ± 18 min in the hypovolemic patients and 66 ± 11 min in the septic group (NS). Comparison of baseline values to values obtained at peakD˙O2 revealed significant increases in PAWP, CI, SVI, LVSWI and MAP in both the septic and hypovolemic group of patients. The A-VdO2 and the oxygen extraction ratio decreased in both groups, but not significantly. Fluid resuscitation resulted in a significant increase inD˙O2 in both groups. In the hypovolemic

DISCUSSION

Oxygen consumption is an overall index of total body metabolism.8 The optimal oxygen consumption is determined by the metabolic needs of the tissues.9 Wilson et al2 documented in critically ill patients that decreases in oxygen consumption were associated with increases in mortality. Duff et al3 noted that in patients with septic shock oxygen consumption was inversely related to arterial lactate level. Indeed, the development of anaerobic metabolism and consequent lactic acidosis serves as a

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Manuscript received May 20; revision accepted September 13.

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