Premium
Oxygen delivery:demand ratio is a predictor of survival in hemorrhaged swine with hypotensive resuscitation
Author(s) -
Wade Charles E,
Dubick Michael A,
Holcomb John B,
Sondeen Jill L
Publication year - 2006
Publication title -
the faseb journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.709
H-Index - 277
eISSN - 1530-6860
pISSN - 0892-6638
DOI - 10.1096/fasebj.20.5.a1384-b
Subject(s) - resuscitation , medicine , oxygen , oxygen delivery , anesthesia , blood pressure , cardiology , chemistry , organic chemistry
In the care of the severely injured trauma victim, estimation of stability is paramount to timely intervention. Plasma lactate levels and base excess, representative of oxygen debt, have been used as indices of subsequent outcome, but the timing of death can not be derived. We postulated that the relationship of oxygen delivery to oxygen demand (the sum of consumption and debt) could provide information as to outcome and time of death. Data was obtained from 80 sedated swine following severe hemorrhage mimicking injury to a major blood vessel. Immediately following completion of the hemorrhage animals were assigned to no resuscitation, hypotensive resuscitation to systolic blood pressure (SBP) of 80 mmHg with conventional fluids, or full resuscitation (dotted). In response to hemorrhage SBP decreased to 33 ± 1 mmHg. There were significant increases in oxygen consumption and plasma lactate, thus demand increased. The cumulative area under the curve (AUC) of the ratio of delivery to demand was < 1 at 15 min. Animals that did not attain a value greater than 1 (n= 30) within 6 h died (dashed) while those > 1 lived (solid). The time of death was correlated (r=0.77, p < 0.01) with the rate at which the ratio decreased. The interaction of oxygen delivery, consumption and debt provide information to enhance the prediction of mortality and the duration of survival. Supported by US Army Medical Research & Materiel Command.