Chest
Oxygen Delivery in Critically III Patients: Relationship to Blood Lactate and Survival
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.
REFERENCES (38)
- et al.
Mechanical ventilation in respiratory failure
Med Clin N Am
(1983) - et al.
The influence of peep on survival of patients in respiratory failure—a retrospective analysis
Am J Med
(1979) - (1974)
- et al.
Swan HJC
Medical therapy of acute myocardial infarction by application of hemodynamic subsets. N Engl J Med
(1976) - et al.
Positive end-expiratory pressure therapy in adults with special reference to acute lung injury: a review of the literature and suggested clinical correlations
Crit Care Med
(1984) - et al.
The dependence of oxygen uptake on oxygen delivery in the adult respiratory distress syndrome
Am Rev Respir Dis
(1980) - et al.
Use of the balloon tipped pulmonary artery catheter in pulmonary disease
Ann Intern Med
(1983) - et al.
Correlation of tissue oxygen and mixed venous oxygen during hemorrhage
Clin Res
(1978) - et al.
Abnormalities in organ blood flow and its distribution during positive end expiratory pressure
Surgery
(1979) - et al.
Independently measured oxygen consumption and oxygen delivery in acute lung injury
Chest
(1982)
Collection and storage of serum lactic acid samples at room temperature without deproteinization
Clin Chem
Multiple organ system failure and infection in adult respiratory distress syndrome
Ann Intern Med
Mixed venous oxygen and hyperlactatemia survival in severe cardiopulmonary disease
JAMA
Treatment of severe hypoxemia due to the adult respiratory distress syndrome
Arch Intern Med
Continuous monitoring of mixed venous oxygen saturation in critically ill patients
Anesth Analg
Cardiovascular evaluation of patients treated with PEEP
Arch Intern Med
Comparison of mixed venous oxygen tension in endotoxin shock
Am Rev Respir Dis
Cited by (120)
Predictors of In-Hospital Mortality in Patients With ST-Segment Elevation Myocardial Infarction Complicated With Cardiogenic Shock
2019, Heart Lung and CirculationCitation Excerpt :In addition to haemodynamic derangements, CS patients should be analysed with metabolic and neurohumoral parameters. Regarding metabolic parameters, serum lactate level is considered to be a reliable indicator of tissue hypoperfusion [20]. Recently, lactate was found to be a prognostic indicator for early and late mortality after emergent coronary artery bypass grafting in myocardial infarction complicated with CS [21].
Cardiovascular compromise in the preterm infant during the first postnatal day
2018, Hemodynamics and Cardiology: Neonatology Questions and ControversiesThe Effects of red Blood Cell Transfusion on Tissue Oxygenation and the Microcirculation in the Intensive Care Unit: A Systematic Review
2017, Transfusion Medicine ReviewsCitation Excerpt :Lactic acid measurement is an essential method of assessing perfusion and tissue oxygenation in critically ill patients suffering from circulatory failure. Historically, lactic acidosis was interpreted as a sign of tissue hypoxia due to inadequate oxygen delivery [23,24], but more recently it has been established that oxygen delivery is only one of several elements affecting lactate production [25,26]. In septic shock, oxygen extraction can be gravely reduced, contributing to lactic acid production even when oxygen delivery is adequate.
Early Treatment of Severe Acute Respiratory Distress Syndrome
2016, Emergency Medicine Clinics of North AmericaRisk factors for requiring extracorporeal membrane oxygenation support after a Norwood operation
2014, Journal of Thoracic and Cardiovascular SurgeryCitation Excerpt :Although arterial po2 did not appear to be associated with risk of ECMO, both peak serum lactate and peak VIS appeared to have some predictive value. Serum lactate level is a marker for adequacy of systemic oxygen delivery,17,18 and both elevated lactate19,20 and rapid increase in lactate21 have been correlated with poor outcomes after congenital heart surgery. Recently, Murtuza and colleagues15 reported that the inability to clear blood lactate to less than 6.76 mmol/L within 24 hours of a Norwood operation was highly predictive of early mortality.
"Polarizing" microplegia improves cardiac cycle efficiency after CABG for unstable angina
2013, International Journal of Cardiology
Manuscript received September 10; revision accepted November 6.