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Oxygen transport goals in the resuscitation of critically ill patients
1Department of Pharmacy Practice, College of Pharmacy, University of Arizona, Tucson 85721.
Objective:
To discuss the limitations of conventional monitoring techniques of shock and examine more recent monitoring techniques that are used to titrate therapies to attain supranormal oxygen transport goals.
Data Sources:
Review articles and investigations published since 1973.
Study Selection:
Articles were selected if they examined the monitoring or treatment of shock. Emphasis was placed on finding investigations involving humans that used innovative methods to assess and treat inadequate tissue perfusion.
Data Extraction:
Data were extracted primarily from original investigations and review articles published in or translated into English.
Data Synthesis:
The conventional monitoring of shock often fails to detect inadequate tissue perfusion, which may lead to inadequate resuscitation of patients, resulting in increased morbidity and mortality. Attainment of supranormal values for oxygen transport variables has been associated with improved outcomes, especially in patients with hypovolemic shock or septic shock. Additionally, interventions used to increase these variables to supranormal values have resulted in improved survival in high-risk preoperative patients with hypovolemic or septic shock, but not in severely ill postoperative patients with multiple complications.
Conclusions:
Efforts to increase oxygen transport variables to supranormal values cannot be recommended routinely for all critically ill patients. Preoperative patients in early stages of hypovolemic or septic shock may benefit from therapies titrated to achieve supranormal goals, but patients in later stages of illnesses may be harmed by such attempts. Questions remain regarding how quickly and how long the oxygen transport variables should be elevated. The most effective and least toxic therapeutic interventions for increasing the variables need to be determined.
Insights
Conventional shock monitoring is limited. Newer techniques to achieve supranormal oxygen transport goals show improved outcomes in early hypovolemic or septic shock, but routine use in all critically ill patients is not recommended.
Area of Science:
- Critical care medicine
- Hemodynamics
- Shock management
Background:
- Conventional shock monitoring often fails to detect inadequate tissue perfusion.
- This can lead to suboptimal resuscitation, increasing patient morbidity and mortality.
Purpose of the Study:
- To evaluate limitations of conventional shock monitoring.
- To examine newer techniques for titrating therapies to supranormal oxygen transport goals.
Main Methods:
- Systematic review of articles published since 1973.
- Emphasis on human investigations using innovative methods for assessing and treating inadequate tissue perfusion.
Main Results:
- Supranormal oxygen transport variables correlate with improved outcomes in hypovolemic and septic shock.
- Interventions to achieve supranormal values improved survival in high-risk preoperative patients but not in severely ill postoperative patients.
Conclusions:
- Routine supranormal oxygen transport goals are not recommended for all critically ill patients.
- Early-stage hypovolemic or septic shock patients may benefit, but later stages could be harmed.
- Further research is needed on optimal timing, duration, and methods for increasing oxygen transport variables.