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ARTICLE |

Critical Oxygen Delivery in Patients With Sepsis FREE

Donald L. Bredle, PhD; Konrad Reinhart, MD
JAMA. 1994;271(15):1158-1158. doi:10.1001/jama.1994.03510390028015
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To the Editor.  —Thanks to Dr Ronco and colleagues,1 their patients, and their patients' families, we have a glimpse into the world of oxygen extraction in severely limited conditions that was previously available only in animal models. However, we wish to comment on the authors' reasoning that because critical oxygen delivery (Do2) was surprisingly low as these patients neared death, it may be generally inappropriate to increase Do2 to high levels in an attempt to increase oxygen uptake (Vo2) and ultimately improve outcome in critically ill patients.First, these patients were considered beyond medical help; any direct application would closely fit only other "hopeless" patients. Normal body temperature of the end-stage septic shock patients illustrates that they were not representative of patients earlier in shock, perhaps the only period when therapeutic measures are effective. The authors only briefly mention this lack of generalizability.Second, the protocol

REFERENCES

Ronco JJ, Fenwick JC, Tweeddale MG, et al.  Identification of the critical oxygen delivery for anaerobic metabolism in critically ill septic and nonseptic humans. JAMA . 1993;;270:1724-1730.
Hanneman LH, Reinhart K, Meier-Hellmann A, Murchner M, Bredle DL.  Prostacyclin in septic shock. Chest . In press.
Maynard N, Bihari D, Beale R, et al.  Assessment of splanchnic oxygenation by gastric tonometry in patients with acute circulatory failure. JAMA . 1993;;270:1203-1210.
Hanneman LH, Meier-Hellmann A, Specht M, Spies C, Reinhart K.  O2-Angebot, O2-Verbrauch und Mucosa pH-Wert des Magens. Anaesthesist . 1993;;42:11-14.
Tuchschmidt J, Fried J, Astiz M, Rackow E.  Elevation of cardiac output and oxygen delivery improves outcome in septic shock patients. Chest . 1992;;102:216-220.

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Ronco JJ, Fenwick JC, Tweeddale MG, et al.  Identification of the critical oxygen delivery for anaerobic metabolism in critically ill septic and nonseptic humans. JAMA . 1993;;270:1724-1730.
Hanneman LH, Reinhart K, Meier-Hellmann A, Murchner M, Bredle DL.  Prostacyclin in septic shock. Chest . In press.
Maynard N, Bihari D, Beale R, et al.  Assessment of splanchnic oxygenation by gastric tonometry in patients with acute circulatory failure. JAMA . 1993;;270:1203-1210.
Hanneman LH, Meier-Hellmann A, Specht M, Spies C, Reinhart K.  O2-Angebot, O2-Verbrauch und Mucosa pH-Wert des Magens. Anaesthesist . 1993;;42:11-14.
Tuchschmidt J, Fried J, Astiz M, Rackow E.  Elevation of cardiac output and oxygen delivery improves outcome in septic shock patients. Chest . 1992;;102:216-220.
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