Lack of Oxygen Supply Dependency in Patients With Severe Sepsis

A Study of Oxygen Delivery Increased by Military Antishock Trouser and Dobutamine

¹ From the Intensive Care Unit, Cochin Port-Royal University Hospital, Paris, France
² From the Intensive Care Unit, Gustave Roussy Institute, Villejuif, France
³ From the Intensive Care Unit, Sabadell University Hospital, Sabadell, Spain
⁴ From the Department of Biostatistics, Cochin Port-Royal University Hospital, Paris, France
⁵ From the Department of Physiology, Lyon Grange Blanche University, Lyon, France

Background: During severe sepsis, the existence of a pathologic oxygen supply dependency remains controversial.

Study objective: To evaluate the relationship between oxygen delivery (DO₂) and oxygen consumption (VO₂) during severe sepsis and to compare, in this respect, survivors and nonsurvivors and patients with normal or increased concentration of plasma lactate.

Study design: Cohort analytic study.

Setting: Three European ICUs in university hospitals.

Patients: Seventeen mechanically ventilated patients with severe sepsis (six with high blood lactate levels) studied within the first day of diagnosis.

Interventions and measurements: Pulmonary elimination of carbon dioxide, or carbon dioxide production (VCO₂) and VO₂ were measured by indirect calorimetry before and after two interventions designed to increase DO₂ (calculated from the Fick equation): inflation of a military antishock trouser (MAST) and infusion of dobutamine.

Results: During MAST inflation, DO₂ increased by 19% in patients with a normal concentration of plasma lactate (p <0.01), but remained unchanged in patients with high lactate levels. During dobutamine infusion, DO₂ increased in both groups by 16% (p <0.01) and 20% (p <0.05), respectively. In both groups, we found that the VO₂ and VCO₂ were not affected by either the MAST or the dobutamine-induced increase in DO₂. There was no difference between survivors and nonsurvivors.

Conclusion: There was no evidence of a pathologic oxygen supply dependency in patients with severe sepsis, even in those who had an elevated concentration of plasma lactate and in those who ultimately died. These results do not favor the conclusion that maximizing DO₂ is a primary therapeutic objective in such patients.

Key Words: dobutamine • indirect calorimetry • military antishock trouser • oxygen consumption • oxygen delivery • sepsis

Submitted on February 14, 1994
Accepted on April 19, 2007

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