Chest
Volume 87, Issue 5, May 1985, Pages 580-584
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Oxygen Delivery in Critically III Patients: Relationship to Blood Lactate and Survival

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Forty-four critically ill patients with or without adult respiratory distress syndrome (ARDS) were studied in an attempt to define critical levels of oxygen delivery. Blood lactate was used as the indicator of tissue hypoxia independent of cardiac output. Survival was good (55 percent) and blood lactate near normal for those with oxygen delivery more than 8 ml/kg/min. Below this level, survival was poor (14 percent) and blood lactate markedly increased. There were significant nonlinear correlations of lactate with O2 delivery (r = – .735, p<.001) and cardiac output (r = — .602, p<.001). Mixed venous oxygen was not a reliable indicator of blood lactate, survival, oxygen delivery, or oxygen consumption.

Section snippets

METHODS

This study is a retrospective analysis of all patients admitted to the intensive care units of the University of Cincinnati and Veterans Administration Hospitals of Cincinnati from June 1981 through January 1983. Patients were eligible if they required cardiovascular monitoring with a triple lumen right heart catheter, and they had at least one set of simultaneously measured values for the following parameters: pulmonary artery systolic, diastolic, and mean pressures, pulmonary artery wedge

RESULTS

Table 2 provides a summary of the clinical diagnosis for all 44 patients who were identified as having adequate information to be included in the analysis. Twenty-one patients had ARDS, defined as respiratory distress associated with diffuse alveolar infiltrates on x-ray film, PaO2 of less than 50 mm Hg while receiving an inspired oxygen fraction (FIo2) of 50 percent or more, and an initial PAW of 15 mm Hg or less.13 Twenty-three patients did not have ARDS. Four patients had combined disease.

DISCUSSION

Our selection criteria enabled us to look at patients with a broad spectrum of hemodynamic measurements. Patients being monitored prospectively for fluid balance were normal, whereas several patients were studied just hours prior to death. We found that patients who always had an O2D of more than 8 ml/kg/min had a good survival even if they were diagnosed as having ARDS. In addition, these patients with O2D greater than 8 ml/kg/min had lactic acid levels in or near the normal range.

Mixed venous

ACKNOWLEDGMENT

The authors thank Dr. Robert C. Loudon for reviewing this manuscript.

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    Manuscript received September 10; revision accepted November 6.

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