Relation between oxygen consumption and oxygen delivery in patients after cardiac surgery.

The relative contributions of oxygen delivery (DO2) and oxygen extraction (O2ER) to the increase in cellular oxygen uptake (VO2) after cardiopulmonary bypass were studied prospectively in 36 patients after coronary artery bypass grafting (n = 18), valve replacement (n = 17), and removal of a left atrial tumor (n = 1). VO2 was calculated from the Fick equation and DO2 from thermodilution cardiac output and arterial oxygen content. During the first 24 h after cardiac surgery, there was a strong relation between VO2 and DO2 (VO2 = 28 + 0.27 x DO2, r = 0.79, P < 0.0001) but not between VO2 and oxygen extraction. Mixed venous oxygen saturation (SVO2) was usually reduced when cardiac index was below 2.0 L.min-1.m-2. Patients with a prolonged intensive care unit course (> 24 h) had lower cardiac index and lower SVO2 than the other patients. Therefore, the progressive increase in VO2 after cardiac surgery is accomplished primarily by an increase in cardiac output and DO2. It is usually when cardiac function is compromised that O2ER increases and SVO2 decreases.

[1]  Matthew Gelmini,et al.  Oxygen consumption, energy expenditure, and substrate utilization after cardiac surgery in children , 1992, Critical care medicine.

[2]  J. Vincent,et al.  Effects of anesthetic agents on systemic critical O2 delivery. , 1991, Journal of applied physiology.

[3]  T. Iwasaka,et al.  Oxygen utilization, carbon dioxide elimination and ventilation during recovery from supine bicycle exercise 6 to 8 weeks after acute myocardial infarction. , 1991, The American journal of cardiology.

[4]  J. Takala,et al.  Hypermetabolism after coronary artery bypass. , 1991, The Journal of thoracic and cardiovascular surgery.

[5]  O. Stenqvist,et al.  Metabolic gas exchange during aortocoronary bypass surgery using a double pump systemand mechanical ventilation , 1991 .

[6]  J. Vincent,et al.  Oxygen uptake/supply dependency. Effects of short-term dobutamine infusion. , 1990, The American review of respiratory disease.

[7]  M. Sanchez,et al.  Quality control of perfusion: monitoring venous blood oxygen tension to prevent hypoxic acidosis. , 1990, The Journal of thoracic and cardiovascular surgery.

[8]  C. Wolfe,et al.  Acute myocardial dysfunction and recovery: a common occurrence after coronary bypass surgery. , 1990, Journal of the American College of Cardiology.

[9]  E. Fiaccadori,et al.  Cell metabolism in patients undergoing major valvular heart surgery: Relationship with intra and postoperative hemodynamics, oxygen transport, and oxygen utilization patterns , 1989, Critical care medicine.

[10]  R. Alston,et al.  Systemic oxygen uptake during hypothermic cardiopulmonary bypass. Effects of flow rate, flow character, and arterial pH. , 1989, The Journal of thoracic and cardiovascular surgery.

[11]  J. Vincent,et al.  Automated cardiovascular analysis and treatment (ACAT) , 1989, International journal of clinical monitoring and computing.

[12]  J. Ramsay,et al.  The effects of shivering on oxygen consumption and carbon dioxide production in patients rewarming from hypothermic cardiopulmonary bypass , 1988, Canadian journal of anaesthesia = Journal canadien d'anesthesie.

[13]  J. S. Janicki,et al.  Concepts and applications of cardiopulmonary exercise testing. , 1988, Chest.

[14]  B. Groves,et al.  Operation Everest II: oxygen transport during exercise at extreme simulated altitude. , 1988, Journal of applied physiology.

[15]  O. Chiara,et al.  Hypermetabolic response after hypothermic cardiopulmonary bypass. , 1987, Critical care medicine.

[16]  R. Teasdall,et al.  Mixed venous oxygen saturation as a predictor of cardiac output in the postoperative cardiac surgical patient. , 1987, The Annals of thoracic surgery.

[17]  J. Askanazi,et al.  Do oxygen consumption and carbon dioxide production affect cardiac output after cardiopulmonary bypass? , 1987, Archives of surgery.

[18]  J Tinker,et al.  The effects of vasodilation with prostacyclin on oxygen delivery and uptake in critically ill patients. , 1987, The New England journal of medicine.

[19]  R. Dechert,et al.  Suppression of shivering decreases oxygen consumption and improves hemodynamic stability during postoperative rewarming. , 1987, The Annals of thoracic surgery.

[20]  J. Kaplan,et al.  Shivering following cardiac surgery: hemodynamic changes and reversal. , 1987, Journal of cardiothoracic anesthesia.

[21]  R. F. Davis,et al.  Continuous venous oximetry in surgical patients. , 1987, Annals of surgery.

[22]  M. Haupt,et al.  Fluid loading increases oxygen consumption in septic patients with lactic acidosis. , 1986, The American review of respiratory disease.

[23]  R. Sladen.  Temperature and Ventilation after Hypothermic Cardiopulmonary Bypass , 1985, Anesthesia and analgesia.

[24]  F. Estafanous,et al.  Continuous SVO2 measurement and oxygen transport patterns in cardiac surgery patients , 1984 .

[25]  K. Kubal,et al.  Critical level of oxygen delivery in anesthetized man , 1983, Critical care medicine.

[26]  T. Bateman,et al.  Transient hemodynamic dysfunction after myocardial revascularization. Temperature dependence. , 1983, The Journal of thoracic and cardiovascular surgery.

[27]  P. Macklem,et al.  The oxygen cost of breathing in patients with cardiorespiratory disease. , 2015, The American review of respiratory disease.

[28]  J. Kirklin,et al.  Management of the cardiovascular subsystem after cardiac surgery. , 1981, The Annals of thoracic surgery.

[29]  C. Wilkinson,et al.  Serial assessment of left ventricular performance following coronary artery bypass grafting. Early postoperative results with myocardial protection afforded by multidose hypothermic potassium crystalloid cardioplegia. , 1981, The Journal of thoracic and cardiovascular surgery.

[30]  T. H. Stanley,et al.  Anesthetic Requirements and Cardiovascular Effects of Fentanyl‐Oxygen and Fentanyl‐Diazepam‐Oxygen Anesthesia in Man , 1978, Anesthesia and analgesia.

[31]  P. Hugenholtz,et al.  On-line monitoring of mixed venous oxygen saturation after cardiothoracic surgery. , 1975, Thorax.

[32]  J. Buckler,et al.  Growth hormone and blood-glucose concentrations during cardiopulmonary bypass. , 1975, British journal of anaesthesia.

[33]  E. Blackstone,et al.  Cardiac performance and mortality early after intracardiac surgery in infants and young children. , 1975, Circulation.

[34]  J. Kirklin,et al.  Cardiac Performance after Open Intracardiac Surgery , 1963, Circulation.

[35]  F. Spencer,et al.  Estimation of Cardiac Output Soon After Intracardiac Surgery with Cardiopulmonary Bypass , 1959, Annals of surgery.