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2023, Number 1

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Rev Mex Anest 2023; 46 (1)

The importance of oxygen debt determination in the perioperative period

Luna-Ortiz P, Bernal-Ríos N, Vázquez-Hernández DB, Romero-López R, Martínez-Rosas M

Language: Spanish
References: 57
Page: 46-55
PDF size: 349.04 Kb.


ABSTRACT

The phenomenon of oxygen debt (dO2) described several decades ago in the context of physical exercise has been incorporated into medicine, particularly during the hemodynamic changes produced by surgery and anesthesia in high-risk patients. dO2 is defined as the increase in the amount of oxygen consumed by the body immediately after physical exercise until O2 consumption returns to normal. In the perioperative period, an imbalance between oxygen supply (DO2) and demand (VO2) could generate dO2. The degree of tissue dO2 has been directly related to multiple organ failure and perioperative morbimortality. Despite advances in medicine, it is not yet possible to prevent or lower the dO2 with fluid administration or vasoactive agents. Delay or inadequate management of hemodynamics could produce tissue hypoperfusion and hypoxia, affecting surgery outcomes. Knowledge and assessing dO2 during perioperative are essential during anesthesia for high-risk patients. Adequate indices are required to detect and quantify tissue hypoperfusion and the imbalance between DO2 and VO2 during anesthesia. This review presents the mechanism, detection, and quantification of dO2. In addition to interventions to avoid or reduce dO2 and recommendations for anesthesiologists to ensure better results in high-risk surgical patients.


REFERENCES

  1. Krogh A, Lindhard J. The regulation of respiration and circulation during the initial stages of muscular work. J Physiol. 1913;47:112-136. doi: 10.1113/jphysiol.1913.sp001616.

  2. Bearden SE, Moffatt RJV. VO2 kinetics and the O2 deficit in heavy exercise. J Appl Physiol. 2000;88:1407-1412.

  3. Shoemaker WC, Appel PL, Kram HB. Tissue oxygen debt as a determinant of lethal and nonlethal postoperative organ failure. Crit Care Med. 1988;16:1117-1120.

  4. Dunham CM, Siegel JH, Weireter L, Fabian M, Goodarzi S, Guadalupi P, et al. Oxygen debt and metabolic acidemia as quantitative predictors of mortality and the severity of the ischemic insult in hemorrhagic shock. Crit Care Med. 1991;19:231-243.

  5. Siegel JH. Posttrauma oxygen debt and its metabolic consequences. In: Gullo A. Anaesthesia, pain, intensive care and emergency medicine. Berlin: Springer-Verlag; 1995. Vol. 10. pp. 225-236.

  6. Shoemaker WC, Appel PL, Kram HB. Role of oxygen debt in the development of organ failure sepsis, and death in high-risk surgical patients. Chest. 1992;102:208-215.

  7. Vallet B, Tavernier B, Lund N. Assessment of tissue oxygenation in the critically ill. Eur J Anaesthesiol. 2000;17:221-229.

  8. August Krogh (1874-1949) the physiologist's physiologist. JAMA. 1967;199:496-497.

  9. Hill AV, Long CNH, Lupton H. Muscular exercise, lactic acid and the supply and utilization of oxygen. Proc Roy Soc Series B. Parts I-VIII. 1924. xcvi, 438; xcii, 84; xcvii, 155.

  10. Shoemaker WC, Appel PL, Kram HB, et al. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest. 1988;94:1176-1186.

  11. Vincent JL. The relationship between oxygen demand, oxygen uptake, and oxygen supply. Intensive Care Med. 1990;16:145-148.

  12. Molnar Z, Szabo Z, Nemeth M. Multimodal individualized concept of hemodynamic monitoring. Curr Opin Anesthesiol. 2017;30:171-177.

  13. Crowell JW, Smith EE. Oxygen deficit and irreversible hemorrhagic shock. Am J Physiol. 1964;206:313-316.

  14. Conte B, L'hermite J, Ripart J, Lefrant JY. Perioperative optimization of oxygen delivery. Transfusion Altern Transfus Med. 2010;11:22-29.

  15. Rixen D, Siegel JH. Bench-to-bedside review: oxygen debt and its metabolic correlates as quantifiers of the severity of hemorrhagic and posttraumatic shock. Crit Care. 2005;9:441-453.

  16. Dueñas Castell C, Mendoza Franco R, Álvarez Gaviria M, et al. Perfusión tisular en el paciente crítico. Acta Colombiana de Cuidado Intensivo. 2012;2:111-127.

  17. Shibutani K, Komatsu, Kubal K, et al. Critical level of oxygen delivery in anesthetized man. Crit Care Med. 1983;11:640-643.

  18. Lugo G, Arizpe D, Dominguez G, et al Relationship between oxygen consumption and oxygen delivery during anesthesia in high-risk surgical patients. Crit Care Med. 1993;21:64-69.

  19. Kern JW, Shoemaker WC. Meta-analysis of hemodynamic optimization in high-risk patients. Crit Care Med. 2002;30:1686-1692.

  20. Walley K. Use of central venous oxygen saturation to guide therapy. Am J Respir Crit Care Med. 2011;184:514-520.

  21. Carrillo-Esper R, Núñez-Bacarreza JJ, Carrillo-Córdova JR. Saturación venosa central: conceptos actuales. Rev Mex Anest. 2007;30:165-171.

  22. Nebout S, Pirracchio R. Should we monitor ScVO(2) in critically ill patients? Cardiol Res Pract. 2012;2012:370697.

  23. Dellinger P, Okorie ON. Lactate: biomarker and potential therapeutic target. Crit Care Clin. 2011;27:299-326.

  24. Vernon C, Letourneau JL. Lactic acidosis: recognition, kinetics, and associated prognosis. Crit Care Clin. 2010;26:255-283.

  25. Huckabee WE. Relationship of piruvate and lactate during anaerobic metabolism. Exercise and formation of oxygen debt. J Clin Invest. 1958;37:255-263.

  26. Hernández LA, López PHR, Etulain GJE, et al. Delta de dióxido de carbono para valorar perfusión tisular como predictor de mortalidad en choque séptico. Med Crit. 2011;25:66-70.

  27. López PHR, Sandoval AJ, Salinas MC, Poblano MM, Sánchez CC, Aguirre SJ, et al. Tercer Lugar: Premio "Dr. Mario Shapiro" Delta arterial-venoso de la presión de CO2 (ΔPCO2) como indicador de reanimación y mortalidad en cuidados postquirúrgicos cardiovasculares. Med Crit. 2010;24:13-17.

  28. Grundler W, Weil MH, Rackow EC. Arteriovenous carbon dioxide and pH gradients during cardiac arrest. Circulation. 1986;74:1071-1074.

  29. Weil MH, Rackow EC, Trevino R, et al. Arteriovenous carbon dioxide and pH gradients during cardiac arrest. Circulation. 1986;74:1071-1074.

  30. Bakker J, Vincent JL, Gris P, et al. Veno-arterial carbon dioxide gradient in human septic shock. Chest. 1992;101:509-515.

  31. Cuschieri J, Rivers EP, Donnino MW, et al. Central venous-arterial carbon dioxide difference as an indicator of cardiac index. Intensive Care Med. 2005;31:818-822.

  32. Weil MH. Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. N Engl J Med. 1986;315:1616-1618.

  33. Vallet B, Teboul JL, Cain S, et al. Venoarterial CO(2) difference during regional ischemic or hypoxic hypoxia. J Appl Physiol. 2000;89:1317-1321.

  34. De Backer D, Creteur J, Preiser JC, et al. Microvascular blood flow is altered in patients with sepsis. Am J Respir Crit Care Med. 2002;166:98-104.

  35. Siggaard-Andersen O, Fogh-Andersen N. Base excess or buffer base (strong ion difference) as measure of a non-respiratory acid–base disturbance. Acta Anaesthesiol Scand Suppl. 1995;107:123-128.

  36. Pareznik R, Knezevic R, Voga G, et al. Changes in muscle tissue oxygenation during stagnant ischemia in septic patients. Intensive Care Med. 2006;32:87-92.

  37. Marechal X, Favory R, Joulin O, et al. Endothelial glycocalyx damage during endotoxemia coincides with microcirculatory dysfunction and vascular oxidative stress. Shock. 2008;29:572-576.

  38. Croner RS, Hoerer E, Kulu Y, et al. Hepatic platelet and leukocyte adherence during endotoxemia. Crit Care. 2006;10:R15.

  39. Kanoore Edul VS, Ince C, Dubin A. What is microcirculatory shock? Curr Opin Crit Care. 2015;21:245-252.

  40. De Backer D, Creteur J, Dubois MJ, Sakr Y, Koch M, Verdant C, et al. The effects of dobutamine on microcirculatory alterations in patients with septic shock are independent of its systemic effects. Crit Care Med. 2006;34:403-408

  41. Schultz RJ, Whitfield GF, LaMura JJ, et al. The role of physiologic monitoring in patients with fractures of the hip. J Trauma. 1985;25:309-316.

  42. Ince C. Hemodynamic coherence and the rationale for monitoring the microcirculation. Crit Care. 2015;19:S8.

  43. He H, Long Y, Liu D, Wang X, Zhou X. Clinical classification of tissue perfusion based on the central venous oxygen saturation and the peripheral perfusion index. Crit Care. 2015;19:330. doi: 10.1186/s13054-015-1057-8.

  44. Grocott MP, Dushianthan A, Hamilton MA, et al. Perioperative increase in global blood flow to explicit defined goals and outcomes following surgery. Cochrane Database Syst Rev. 2012;11:CD004082.

  45. Benes J, Chytra I, Altmann P, et al. Intraoperative fluid optimization using stroke volume variation in high-risk surgical patients: results of prospective randomized study. Crit Care. 2010;14:R118.

  46. Leiner T, Tanczos K, Molnar Z. Avoiding perioperative oxygen debt. J Emerg Crit Care Med. 2020;4:1-7.

  47. Salzwedel C, Puig J, Carstens A, et al. Perioperative goal-directed hemodynamic therapy based on radial arterial pulse pressure variation and continuous cardiac index trending reduces postoperative complications after major abdominal surgery: a multicenter, prospective, randomized study. Crit Care. 2013;17:R191.

  48. Karimova AK, Pinsky DJ. The endothelial response to oxygen deprivation: biology and clinical implications. Intensive Care Med. 2001;27:19-31.

  49. Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED. Changes in central venous saturation after major surgery, and association with outcome. Crit Care. 2005;9:R694-R699.

  50. Shoemaker WC, Appel PL, Bland R. Use of physiologic monitoring to predict outcome and to assist in clinical decisions in critically ill postoperative patients. Am J Surg. 1983;146:43-50.

  51. Donati A, Loggi S, Preiser JC, Orsetti G, Munch C, Gabbanelli V, et al. Goal-directed intraoperative therapy reduces morbidity and length of hospital stay in high-risk surgical patients. Chest. 2007;132:1817-1824.

  52. Kapoor PM, Kakani M, Chowdhury U, Choudhury M, Lakshmy R, Kiran U. Early goal-directed therapy in moderate to high-risk cardiac surgery patients. Ann Card Anaesth. 2008;11:27-34.

  53. Pearse R, Dawson D, Fawcett J, Rhodes A, Grounds RM, Bennett ED. Early goal-directed therapy after major surgery reduces complications and duration of hospital stay. A randomised, controlled trial [ISRCTN38797445]. Crit Care. 2005;9:R687-R693.

  54. Hamilton MA, Cecconi M, Rhodes A. A systematic review and meta-analysis on the use of preemptive hemodynamic intervention to improve postoperative outcomes in moderate and high-risk surgical patients. Anesth Analg. 2011;112:1392-1402.

  55. Saugel B, Kouz K, Scheeren TWL. The '5 Ts' of perioperative goal-directed haemodynamic therapy. Br J Anaesth. 2019;123:103-107. doi: 10.1016/j.bja.2019.04.048.

  56. Saugel B, Michard F, Scheeren TWL. Goal-directed therapy: hit early and personalized! J Clin Monit Comput. 2018;32:375e7.

  57. Boyd O, Jackson N. Clinical review: How is risk defined in high-risk surgical patient management? Crit Care. 2005;9:390-396.




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