The left shifted oxyhemoglobin curve in sepsis: a preventable defect

Area of Science:

• Physiology
• Critical Care Medicine
• Biochemistry

Background:

• Severe sepsis can lead to critical alterations in oxygen transport.
• Oxygen dissociation is influenced by factors such as 2,3-diphosphoglycerate (DPG) levels and blood pH.

Purpose of the Study:

• To investigate the causes of altered oxygen dissociation in patients with severe sepsis.
• To determine the impact of specific factors like hypophosphatemia and blood transfusions on oxygen transport.

Main Methods:

• Studied nine patients with severe sepsis, monitoring oxygen dissociation curves and DPG levels.
• Analyzed the influence of hypophosphatemia, acidosis, and blood transfusions (CPD preservative) on P(50T) and DPG levels.
• Observed outcomes in patients with and without these specific interventions/conditions.

Main Results:

• Seven out of nine patients exhibited left-shifted oxyhemoglobin curves and diminished DPG levels.
• Hypophosphatemia, acidosis, and transfusion of DPG-deficient blood were associated with decreased P(50T).
• Septic shock itself did not adversely affect oxygen dissociation, even in terminal stages.

Conclusions:

• Diminished DPG levels and left-shifted oxygen dissociation are common in severe sepsis.
• Hypophosphatemia, acidosis, and DPG-deficient blood transfusions are key contributors to impaired oxygen transport.
• Avoiding these factors and utilizing phosphate-rich blood transfusions can normalize oxygen dissociation.