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The Case for Tissue Base Excess

  • Conference paper
Book cover Intensive Care Medicine

Abstract

Over many years a number of indices have enjoyed varying popularity as measures of ‘global’ tissue well-being in critical illness. These have ranged from the plasma lactate concentration to more invasive measurements such as oxygen delivery (DO2), oxygen consumption (VO2) and their relationships, mixed venous oxygen saturation (SvO2) and the veno-arterial PCO2 gradient. However, all such global indices have one major drawback. Since they are integrations derived from multiple inputs, their sensitivity to isolated regional dysoxia is poor. For example, the mixed venous oxygen tension (PvO2) is a flow-weighted average of post-capillary oxygen tensions in all organs contributing to venous return. At a PvO2 of 40 mmHg, the average intracellular PO2 is 11 mmHg [1]. At a PvO2 of 26 mmHg, average intracellular PO2 has fallen below the ‘Pasteur point’ to 0.8 mmHg. Consequently a PvO2 < 26 mmHg is a highly specific marker of tissue dysoxia. However, a normal PvO2 does not in any way rule out small pockets of significant dysoxia. To take an extreme example, a normal PvO2 can persist despite absolute ischemia in a major organ, as in brain death. Furthermore, an elevated PvO2 is far from a reassurance, since it can be a manifestation of tissue shunting [2], cytopathic hypoxia [3] or some combination of both [4].

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Authors
  1. T. J. Morgan
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  2. B. Venkatesh
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Editors and Affiliations

  1. Department of Intensive Care, Erasme Hospital, Free University of Brussels, Route de Lennik 808, B-1070, Brussels, Belgium

    Jean-Louis Vincent MD, PhD, FCCM, FCCP (Head) (Head)

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Morgan, T.J., Venkatesh, B. (2003). The Case for Tissue Base Excess. In: Vincent, JL. (eds) Intensive Care Medicine. Springer, New York, NY. https://doi.org/10.1007/978-1-4757-5548-0_53

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  • DOI: https://doi.org/10.1007/978-1-4757-5548-0_53

  • Publisher Name: Springer, New York, NY

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