Supranormal oxygen delivery in critical illness.

Objective: To review the literature addressing use of the pulmonary artery catheter (PAC) to augment oxygen delivery to supranormal levels in critical illness.

Data source: All pertinent English language articles dealing with use of the PAC to augment oxygen delivery to supranormal levels in critical illness were retrieved from 1988 through 1996.

Study selection: Articles were chosen if material relevant to supranormal oxygen delivery in critically ill patients was studied or reviewed.

Data extraction: Methodology of the available studies was analyzed. From the articles selected, information was obtained regarding changes in outcome associated with prospective goal-oriented hemodynamic intervention using a PAC to augment systemic oxygen delivery to supranormal levels prior to high-risk surgery. Patient outcome information was also obtained regarding use of the PAC to augment oxygen delivery to supranormal values begun after the onset of the systemic inflammatory response syndrome (SIRS) following sepsis or trauma.

Data synthesis: Inadequate evidence exists to accurately determine if PAC use to augment systemic oxygen delivery improves outcome in either of these circumstances.

Conclusion: Further research must be performed before a recommendation can be made about goal-oriented hemodynamic intervention utilizing the PAC to augment oxygen delivery to supranormal levels prior to high-risk surgery. PAC-guided hemodynamic intervention to augment oxygen delivery to supranormal values in patients with SIRS-related organ dysfunction from sepsis, trauma, or postoperative complications is not recommended at this time. Carefully designed, multicenter, randomized, controlled trials are needed to establish whether augmenting oxygen delivery improves organ-specific outcomes and survival under each of these circumstances.