If metabolic adaptations did not occur and aerobic metabolism was replaced by equivalent anaerobic metabolism, lactate levels would be overwhelming; however, supply-limited Vo2 does not necessarily translate to equivalent rates of ATP synthesis by anaerobic metabolism.
We believe that estimated Vo2 need represents a reasonable first approximation to the true need and that it is not possible under present conditions to obtain a better estimation of the true need. It is likely that errors from most of the influences listed previously would be randomly distributed between the various groups. The wide differences in the amount, time of appearance, and duration of the calculated oxygen deficits between the groups suggest that despite errors in the estimation, reduced tissue oxygenation is directly related to subsequent organ failure and death (Fig 4).
Many studies on multiple organ failure have described the number and sequence of organ failures and the interactions of one organ failure with the subsequent organ failure. The basic question to be addressed is the identification of underlying pathogenic mechanisms and possible mediators of specific organ system failures so that therapy may be appropriately directed at the primary problem.
Figure 4. Temporal patterns of the magnitude and duration of oxygen debts in survivors with and without organ failure and nonsurvivors (below the horizontal line) and the times of the clinical appearance of various organ failures (above the horizontal line). Time is shown on the x-axis.