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Does hepato-splanchnic VO2/DO2 dependency exist in critically ill septic patients?
D De Backer1, J Creteur, O Noordally
1Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium.
Summary
Septic patients with increased hepatic vein oxygen saturation gradient show increased splanchnic oxygen consumption. This indicates splanchnic dysoxia, an imbalance in oxygen supply and demand in the gut region during sepsis.
Area of Science:
- Critical Care Medicine
- Hepatology
- Sepsis Pathophysiology
Background:
- Sepsis often presents with an elevated gradient between mixed venous and hepatic vein oxygen saturation (DSO2).
- This suggests a potential oxygen supply-demand imbalance in the hepato-splanchnic area during sepsis.
Purpose of the Study:
- To investigate the relationship between hepato-splanchnic oxygen delivery (DO2spla) and consumption (VO2spla) in septic patients.
- To determine if increased DSO2 is associated with splanchnic dysoxia.
Main Methods:
- Studied 42 septic patients, measuring hepato-splanchnic blood flow using indocyanine green clearance and hepatic vein catheterization.
- Analyzed DO2spla and VO2spla during dobutamine infusion and, in some, increased positive end-expiratory pressure (PEEP).
- Patients were grouped based on DSO2 (<10% vs. >10%).
Main Results:
- VO2spla increased significantly only in patients with DSO2 > 10% (Group II), indicating increased oxygen consumption.
- The VO2spla/DO2spla relationship slope was significantly higher in Group II compared to Group I (DSO2 < 10%).
- The slope was similar when using dobutamine or PEEP, suggesting a lack of thermogenic effect.
Conclusions:
- Increased DSO2 in septic patients is linked to increased VO2spla, signifying splanchnic dysoxia.
- The findings support the hypothesis of an oxygen supply-demand imbalance in the hepato-splanchnic area in sepsis.
- Dobutamine and PEEP similarly affected VO2spla/DO2spla relationship, ruling out a significant thermogenic contribution.