DIFFERENT OXYGEN-TRANSPORT PATTERNS IN PATIENTS WITH ADULT RESPIRATORY-DISTRESS SYNDROME TREATED WITH POSITIVE END-EXPIRATORY PRESSURE

被引:3
作者
DUBIN, A [1 ]
ESTENSSORO, E [1 ]
SILVA, C [1 ]
TOLEDO, P [1 ]
ARN, HG [1 ]
MODAY, M [1 ]
ESPERANZA, M [1 ]
PAZ, T [1 ]
MAFFEI, R [1 ]
LAPORTE, M [1 ]
机构
[1] HOSP INTERZONAL AGUDOS,SERV TERAPIA INTENS,LA PLATA,BUENOS AIRES,ARGENTINA
关键词
D O I
10.1016/0883-9441(90)90055-E
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
To test the hypothesis that different oxygen transport patterns reported in adult respiratory distress syndrome (ARDS) could be due to the presence of sepsis, we prospectively studied 28 mechanically ventilated patients with ARDS who received positive end-expiratory pressure (PEEP) at 0, 5, 10, and 15 cm H2O. Nonseptic patients showed a strong correlation between oxygen delivery index (DO2I) and mixed venous oxygen saturation (SvO2) (r = .77, P < .001) and DO2I and oxygen extraction ratio (O2ER) (r = -.87, P < .001), and a correlation between DO2I and oxygen consumption index (VO2I) best described by third-degree polynomial fit (r = .86) which allowed the description of a critical DO2 point of 293 mL/min/m2. Septic patients showed no consistent relationship between DO2I and SvO2 (r = .21, P = NS), and DO2I and O2ER (r = -.21, P = NS), but DO2I and VO2I correlated linearly (r = .72, P < .001) in what has been described as pathologic dependence of VO2 on DO2. We suggest that sepsis seems to be the determinant of this abnormal relationship between supply and utilization of oxygen in our ARDS patients treated with PEEP. © 1990.
引用
收藏
页码:101 / 107
页数:7
相关论文
共 56 条
[1]  
Montgomery, Stager, Carrico, Et al., Causes of mortality in patients with adult respiratory distress syndrome, Am Rev Respir Dis, 132, pp. 485-489, (1985)
[2]  
Bell, Coalson, Smith, Et al., Multiple organ system failure and infection in adult respiratory distress syndrome, Ann Intern Med, 99, pp. 293-298, (1983)
[3]  
Kariman, Burns, Regulation of tissue oxygenation extraction is disturbed in adult respiratory distress syndrome, Am Rev Respir Dis, 132, pp. 109-114, (1985)
[4]  
Danek, Lynch, Weg, Et al., The dependence of oxygen uptake on oxygen delivery in the adult respiratory distress syndrome, Am Rev Respir Dis, 122, pp. 387-395, (1980)
[5]  
Powers, Mannal, Neclerio, Et al., Physiologic consequences of positive end-expiratory pressure (PEEP) ventilation, Annals of Surgery, 178, pp. 265-272, (1973)
[6]  
King, Jones, Patakas, Et al., Evaluation of positive end-expiratory pressure therapy in the adult respiratory distress syndrome, Canad Anaesth Soc J, 20, pp. 546-558, (1973)
[7]  
Rhodes, Newell, Shah, Et al., Increased oxygen consumption accompanying increase oxygen delivery with hypertonic mannitol in adult respiratory distress syndrome, Surgery, 84, pp. 490-497, (1978)
[8]  
Mohsenifar, Goldbach, Tashking, Et al., Relationship between O<sub>2</sub> delivery and O<sub>2</sub> consumption in the adult respiratory distress syndrome, Chest, 84, pp. 267-271, (1983)
[9]  
Gutierrez, Pohil, Oxygen consumption is linearly related to O<sub>2</sub> supply in critically ill patients, Journal of Critical Care, 1, pp. 45-53, (1986)
[10]  
Lutch, Murray, Continuous positive-pressure ventilation: Effects on systemic oxygen transport and tissue oxygenation, Ann Intern Med, 76, pp. 193-202, (1972)