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- Role of Oxygen Debt in the Development of Organ Failure Sepsis, and Death in High-Risk Surgical Patients (10)

Specific Organ Failures and Times of Onset
Table 5 details the number of types of organ failure in nonsurvivors and survivors. There were 1.72 organ failures per nonsurvivor and 1.42 organ failures per survivor with organ failure, or 0.28 organ failures for all survivors. Table 6 lists the complications in the survivors and nonsurvivors. In nonsurvivors the organ failures in decreasing order of frequency were as follows: pulmonary, sepsis, cardiac, renal, DIC, and CNS failure. There were similar distributions of organ failures, except for somewhat greater numbers of pulmonary failures and fewer cardiac problems, in the survivors.
The average time of appearance of each organ failure is listed in Table 5. Although there were wide ranges in the times of appearance of each organ failure, pulmonary failure often occurred first, followed by cardiac failure, renal failure, DIC, sepsis, and coma; however, the order of appearance varied widely. The average organ failure occurred 5.5 ±4.3 days after surgery; this was later than the oxygen debt, which began during surgery and reached maximum values 10.1 h after surgery for survivors and 17.8 h after surgery for nonsurvivors (Table 4).

Table 5—Incidence of Organ Failure, Sepsis, and DIC

Organ: Criteria Nonsurvivors (n = 64)t Survivors with Organ Failure (n = 31)t Total with Organ Failure (n = 95)f Time of Appearance, days after surgery*
Lung: PSiOj/FIOj <250; Qsp >20 percent 30 (27) 19 (43) 49 (32) 3.6±3.1
Kidney: BUN >50 mg/dl; creatinine >3 mg/dl 18 (16) 7 (26) 25 (16) 5.9±4.1
Heart: Cl <2.5; WP >20 mm Hg§ 26 (24) 3 (7) 29 (19) 4.3±4.8
CNS: coma 1 (1) 1 (2) 2 (1) 11
Sepsis: positive cultures; WBC>13,00Q/cu mm; temperature >102°F 28 (25) 11 (25) 39 (25) 7.4±4.9
DIC: platelets <75,000; PT >18/12 sec; PTT >2X normal; fibrin split products 7 (6) 3 (7) 10 (6) 6.2 ±5.6
Total 110 (100) 44 (100) 154 (100)

Table 6—Major Complications in Survivors and Nonsurvivors

Complication Survivors Nonsurvivors
Aspiration 3 1
Delirium tremens 1 2
Encephalopathy 1 1
GI bleeding 1 3
Gastric outlet obstruction 3 0
Postoperative hemorrhage 2 5
Pancreatitis 1 1
Pulmonary edema 6 6
Pleural effusion 5 1
Terminal carcinomatosis 0 2
Urinary tract infection 8 3
Wound dehiscence 7 2
Wound infection 9 1
Other 8 4
Total number 58 33
No./group (percent) 58/260 (22) 33/79 (42)
August 21, 2013 Oxygen
Tags: anesthesia cardiac output organ failure oxygen