[The value of systematic monitoring of oxygen consumption in the diagnosis and therapy of septic shock].

Abstract

In 31 patients with sepsis and multiple organic dysfunction, changes in the systemic oxygen consumption (VO2) during reanimation were observed in order to discover more objective indicators of the course and prognosis of the disease. In a prospective randomized study, 21 live (Group 1) and 11 dead patients (Group 2) were included. The investigation was based upon the application of the invasive tracing of oxygen hemodynamics and transport. The findings of the initially hypovolemic status were compared with those of the stabile normovolemic status obtained by the application of infusions and the blood volume substitute. In the early phase of the disease there were no significant differences in the clinical finding of the circulatory shock and the volume deficit of the circulated blood between these two groups of patients. Group 1 patients had lower values of the cardiac index (CI) and the systemic oxygen transport (DO2). In them there was a greater frequency of acute organic insufficiency, especially pulmonal, renal and hepatal. In the initial status VO2 decreased. In the normovolemic status of Group 1, a significant VO2 was found, while in Group 2 in spite of a DO2 increase and hemodynamics improvement, a more significant VO2 increase was not obtained. As VO2 is an objective indicator of oxidative metabolic reactions of the organism and the circulatory system, the authors maintain that by the VO2 tracing, a better insight into the seriousness and course of the disease is obtained, and that an inadequate VO2 finding during the therapeutic treatment requires a revision of the treatment.