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Does oxygen delivery matter?
PiO2
130
PaO2
100
PmO2
2
PAO2
120
PcO2
45PvO2
40
Georg Ohm1789-1854
Die galvanische Kette, mathematisch bearbeitet: 1927
Q
P
Q
Georg Ohm1789-1854
Weil: Circulation 1970
Shoemaker: CHEST 1988
Shoemaker: CHEST 1988
Shoemaker: CHEST 1988
Cardiac failure
↑ Lactate (n=8)↓
Normal lactate (n=28)↓
Sepsis
↑ Lactate (n=16)↓
Normal lactate (n=21)↓
Vincent: ARRD 1990
“Oxygen supply dependency”
Hayes: New Engl J Med 1994
(n=50)
(n=50)
The end of the DO2 debate?
YESUnderstanding in haemodynamic physiologyLimitations of surrogate indicesPreference for non-synthetic catecholamines
NOIndustry-driven therapeutic imperativeIndustry-driven technological imperativeProtagonist-driven studies
Rivers: New Engl J Med 2001
EGDT in sepsis
Angus: Int Care Med 2015
Fifteen years of uncertainty and confusion between the first trial and eventual proof of
absence of benefit
Exposed the adverse influence of industry in investigator-initiated research focused on
surrogate outcomes.
MAP Volume
Stroke volume
ImpedanceCardiac
RAPNeurohormonal vasoregulation
Pressure = Stressing volume Compliance
The physiological fallacy
Cardiac failure
Spectrum of pathology
Compensated Decompensated
Acute
Chronic
Spectrum of treatment
Compensated Decompensated
Neurohormonal modulation Acute
Chronic
Pharmacologicalaugmentation
Cardiac failure
Spectrum of treatment
Compensated Decompensated
Acute
Chronic
ACE inhibitorsAT-II inhibitorsb Blockade
Diuretics
(Fluids)Catecholamines
Diuretics
Cardiac failure
We are happier in many ways when we are old than when we were young. The young sow wild oats. The old grow sage.
Does DO2 matter?