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- Role of Oxygen Debt in the Development of Organ Failure Sepsis, and Death in High-Risk Surgical Patients (8)

Patterns of Hemodynamics and Oxygen Transport
The patterns of selected hemodynamic and oxygen transport variables of surviving and nonsurviving high-risk surgical patients in the preoperative, intraoperative, and immediate postoperative periods are shown in Figure 2. Cardiac index, Do2, and Vo2 of survivors without organ failure were highest, those who survived with organ failure were intermediate, while the values of those who subsequently died were lowest but within the normal range. There were no other hemodynamic or oxygen metabolic changes that were appreciable or statistically significant in the early postoperative period. In general, the survivor-nonsurvivor patterns were consistent with previously reported series.’
Postoperative Tissue Oxygen Deficit
The temporal patterns of cumulative Vo2 deficit or excess in the intraoperative and immediate postoperative period for nonsurvivors, survivors with organ failure or complications, and survivors without organ failure or complications are graphically shown in Figure 3. Table 3 shows the mean (±SEM) of the intraoperative Vo2 deficit, the mean Vo2 deficit at its maximum, the time to reach the maximum Vo2 deficit, and the duration of the Vo2 deficit.

Figure-2

Figure 2. Serial measurements of mean arterial pressure (MAP), Cl, Do2, and Vo2 of surviving and nonsurviving patients during preoperative, intraoperative, and postoperative periods.

Figure-3

Figure 3. Net cumulative Vo2 deficit for nonsurvivors (dotted line\ survivors without organ failure (solid line\ and survivors with organ failure (dashed line) calculated for intraoperative period and each successive time period after surgery.

Table 3—Data on Tissue Oxygen Deficit

Data Nonsurvivors (n = 64) Survivors with Organ Failure (n = 31) Survivors with no Organ Failure (n = 158)
Vo2 deficit, L/m*
Intraoperative 12.0± 1.3 11.8 ± 1.6 5.7 ±0.9
Maximum 33.2±4.0 21.6±3.7 9.2± 1.3
Time to maximum
Vo2 deficit, h 17.8 ±2.2 10.1 ±2.7 4.1±0.6
Time to net cumulative positive Vo2, h 48.6±3.5 29.2±4.7 17.9± 1.6
August 16, 2013 Oxygen
Tags: anesthesia cardiac output organ failure oxygen