Chest ACCP Member Benefits
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

Guest Access | Sign In via User Name/Password
This Article
Right arrow Full Text (PDF) Free
Right arrow Submit a response
Right arrow Alert me when this article is cited
Right arrow Alert me when eLetters are posted
Right arrow Alert me if a correction is posted
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to My Personal Article Archive
Right arrow Download to citation manager
Right arrow reprints & permissions
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Marik, P. E.
Right arrow Articles by Kaufman, D.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Marik, P. E.
Right arrow Articles by Kaufman, D.
(Chest. 1996;109:1038-1042.)
© 1996 American College of Chest Physicians

The Effects of Neuromuscular Paralysis on Systemic and Splanchnic Oxygen Utilization in Mechanically Ventilated Patients

Paul E. Marik MBBCh1 and David Kaufman MD, FCCP1

1 From the Department of Critical Care Medicine, St. Vincent Hospital, and University of Massachusetts, Worcester, Mass.

Objective: To evaluate the effect of neuromuscular paralysis on systemic and splanchnic oxygen utilization in patients in respiratory failure during controlled mechanical ventilation.

Setting: A university-affiliated teaching hospital.

Intervention: Mechanically ventilated patients, who were undergoing hemodynamic monitoring and who had a gastric intramucosal pH (pHi) of less than 7.35, were studied. Prior to paralysis, the patients were sedated with lorazepam and morphine to standard end points, and the cardiac output and oxygenation were optimized. The patients were then paralyzed with doxacurium and the ventilator rate adjusted to keep the PaCO2 at baseline value. The hemodynamic and oxygenation profile and pHi were determined prior to paralysis and repeated 2 to 2.5 h later.

Results: Eight patients were studied; their mean age was 63±8 years and acute physiology and chronic health evaluation II score was 22±4. The mean fraction of inspired oxygen, positive end-expiratory pressure, and venous admixture ratio prior to the study was 0.7±0.14, 11.8±2.4 cm H2O, and 26±9%, respectively. Prior to paralysis, the mean set assist controlled ventilation rate was 15±2 breaths/min and the patient rate was 23±5 breaths/min. With neuromuscular paralysis, the cardiac index fell from 4.6±2.2 to 4.3±2.4 L/min/m2 (p=0.1), the oxygen delivery fell from 537±129 to 471±95 mL/min/m2 (p=0.03), and the oxygen consumption and extraction ratio fell from 200±77 to 149±35 mL/min/m2 (p=0.03) and 36±5 to 31±10, respectively (p=0.2). The pHi increased from 7.21±0.16 to 7.29±0.1 (p=0.02).

Conclusion: In critically ill patients in respiratory failure, neuromuscular paralysis decreases whole body oxygen consumption and increases pHi. Presumably, by eliminating the work of breathing, there is a redistribution of blood flow from the respiratory muscles to the splanchnic and other nonvital vascular beds.

Key Words: neuromuscular paralysis • oxygen consumption • respiratory failure • splanchnic oxygenation

Submitted on June 1, 1995
Accepted on October 23, 2007




This article has been cited by other articles:


Home page
 Br J AnaesthHome page
T. S. Walsh
Recent advances in gas exchange measurement in intensive care patients
Br. J. Anaesth., July 1, 2003; 91(1): 120 - 131.
[Full Text] [PDF]


HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
Copyright © 1996 by the American College of Chest Physicians.