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- Role of Oxygen Debt in the Development of Organ Failure Sepsis, and Death in High-Risk Surgical Patients (3)

Figure-2The second aim was to study the capacity of supranormal cardiac index (Cl), Do2, and Vo2 to reduce tissue oxygen debt and subsequent organ failures as part of a prospective randomized clinical trial of high-risk surgical patients. In this study, a control group was maintained at normal circulatory values, while a protocol group was maintained at supranormal values that were empirically observed in critically ill survivors.
Materials and Methods
Clinical Series
A series of 253 high-risk surgical patients were studied in the preoperative, intraoperative, and early postoperative periods. Their average age was 59 ±16 yrs (±SD); 134 (53 percent) were male patients, and 119 (47 percent) were female. Sixty-four patients (25 percent) died, all of whom had organ failure; 31 (12 percent) survived with organ failure or major complications; and 158 (62 percent) survived without organ failure. The clinical features and the high-risk criteria for each group are shown in Table 1; previously, we had defined high-risk criteria that were shown to have mortalities over 30 percent.
In a second series that was part of an ongoing study, 56 high-risk surgical patients were randomized before surgery using opaque sealed envelopes prepared by an outside person from a random number table.

Table 1—Preoperative Clinical High-Risk Criteria

Data Survivors without Organ Failure orComplications Survivors with Organ Failure orComplications Nonsurvivors
No. of patients 158 31 64
Age, yrHigh-Risk Criteria 57 ±17 60 ± 17 62± 15
Previous severe cardiorespiratory illness (acute MI, COPD, stroke, etc.) Extensive ablative surgery planned for carcinoma, eg, esophagectomy and 31 (18) 7 (16) 6 (6)
total astrectomy, prolonged surgery (>8 h)Severe multiple trauma, eg> >3 organs or >2 systems or opening 2 body 37 (21) 5 (11) 9 (10)
cavities 0 1 (2) 2 (2)
Massive acute blood loss (>8 units); BV<1.5 L/m2; Hct<20 percent Age >70 yr and evidence of limited physiologic reserve of 1 or more 2 (1) 1 (2) 3 (3)
vital organsSepticemia, positive blood culture or septic focus, WBC >13,000 cu mm, spiking fever to 101° for 48 h, and 34 (20) 10 (23) 24 (26)
spiking fever to 101° F for 48 h, and hemodynamic instability Respiratory failure, eg, Pa02 <60 mm Hg on FIo2 >0.4, Qsp/Qt >30 5 (3) 2 (5) 10 (11)
percent, mechanical ventilation needed >48 h 1 (1) 1 (2) 3 (3)
Acute renal failure; creatinine >3 mg/dl; BUN >50 mg/dl and rising Acute abdominal catastrophe with hemodynamic instability, eg, pancreatitis, gangrenous bowel, peritonitis, perforated viscus, 1 (1) 1 (2) 3 (3)
Cl bleeding 42 (24) 13 (30) 24 (26)
Last-stage vascular disease involving aortic disease 19 (11) 2 (5) 7 (8)
Severe nutritional problems 1 (1) 1 (2) 1 (1)
Hepatic failure, eg, bilirubin >5 mg/dl, elevated hepatic enzymes 0 0
Total high-risk criteria 173 (100) 44 (100) 93 (100)
Criteria/patient 1.09 1.42 1.45
August 3, 2013 Oxygen
Tags: anesthesia cardiac output organ failure oxygen