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Oxygen consumption in septic shock: collective review
Circulatory Shock
|January 1, 1984
Summary
Declining oxygen consumption (VO2) does not reliably predict septic shock early. While elevated VO2 may indicate better survival, a significant drop is a grave sign, often following hemodynamic changes. VO2 may help assess resuscitation adequacy.
Area of Science:
- Critical Care Medicine
- Physiology
- Sepsis Research
Background:
- Previous observations suggested suppressed oxygen consumption (VO2) might precede septic shock.
- Supranormal VO2 levels have been linked to better survival rates in septic shock patients.
Purpose of the Study:
- To evaluate if VO2 serves as an early indicator of sepsis.
- To investigate the relationship between VO2, hemodynamics, and survival in sepsis.
Main Methods:
- Observed endotoxemia in 20 rhesus monkeys across different hemodynamic states.
- Monitored VO2 in seven preterminal septic humans using a novel gas analysis device.
- Reviewed existing literature on VO2 and sepsis.
Main Results:
- No flow-independent depression of VO2 was observed in primates or humans.
- VO2 was elevated in septic humans during their final day of life.
- Peripheral vascular resistance, blood flow, and oxygen extraction adapt to maintain VO2.
Conclusions:
- Systemic VO2 is not a specific early sepsis indicator or a definitive survival predictor.
- A significant decline in VO2 is a grave prognostic sign, usually preceded by hemodynamic changes.
- Elevated VO2 and cardiac output may enhance survival, but death can still occur rapidly.