Skip to main content
SpringerLink
Log in

Mechanism of Oxygen Extraction Defect in Septic Shock

  • Conference paper
Sepsis and Organ Dysfunction

  • 126 Accesses

Abstract

Critically ill patients suffering from septic shock most often present in a high output, low peripheral resistance cardiovascular status. In some patients cardiac output may increase to values above 15 lxmin-1 and mixed venous oxygen saturation may exceed normal values demonstrating decreased systemic oxygen extraction. Despite high systemic blood flow, progressive lactic acidosis and irreversible shock develops, suggesting progressive deterioration of oxygen supply to tissues. In these patients the major defect in organ oxygen supply is thought to be located within the microcirculation.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 39.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 54.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. Hotchkiss RS, Karl IE (1992) Reevaluation of the role of cellular hypoxia and bioenergetic failure in sepsis. JAMA 267:1503–1510

    Article  PubMed  CAS  Google Scholar 

  2. Sair M, Etherington PJ, Curzen NP et al (1996) Tissue oxygenation and pertusion in endotoxemia. Am J Physiol 271:H1620–H1625

    Google Scholar 

  3. Garrison RN, Spain DA, Wilson MA et al (1998) Microvascular changes explain the “twohit” theory of multiple organ failure. Ann Surg 227:851–860

    Article  PubMed  CAS  Google Scholar 

  4. Haisjackl M, Hasibeder W, Klaunzer S et al (1990) Diminished reactive hyperemia in the skin of criticallv ill patients. Crit Care Med 18:813–818

    Article  PubMed  CAS  Google Scholar 

  5. Nelson DP, Beyer C, Samsel RW et al (1987) Pathological supply dependence of 0>2 uptake during bacteremia in dogs. J Appl Physiol 63:1487–1492

    PubMed  CAS  Google Scholar 

  6. Samsel RW, Nelson DP, Sanders WM et al (1988) Effect of endotoxin on systemic and skeletal muscle O2 extraction. J Appl Physiol 65:1377–1382

    PubMed  CAS  Google Scholar 

  7. Nelson DP, Samsel RW, Wood LD et al (1988) Pathological supply dependence of systemic and intestinal O2 uptake during endotoxemia. J Appl Physiol 64:2410–2419

    PubMed  CAS  Google Scholar 

  8. Drazenovic R, Samsel RW, Wylam ME et al (1992) Regulation of perfused capillary density in canine intestinal mucosa during endotoxemia. J Appl Physiol 72:259–265

    Article  PubMed  CAS  Google Scholar 

  9. Hasibeder W, Germann R, Wolf HJ et al (1996) The effects of short-term endotoxemia and dopamine on mucosal oxygenation in the porcine jejunum. Am J Physiol 270:G667–G675

    Google Scholar 

  10. Archie JP (1977) Anatomic arterial-venous shunting in endotoxic and septic shock in dogs. Ann Surgg 186:171–176

    Article  Google Scholar 

  11. Unger LS, Cryer HM, Garrison RN (1989) Differential response of the microvasculature in the liver during bacteremia. Circ Shock 29:335–344

    PubMed  CAS  Google Scholar 

  12. Whitworth PW, Cryer HM, Garrison RN et al (1989) Hypoperfusion of the intestinal microcirculation without decreased cardiac output during live Escherichia coli sepsis in rats. Circ Shock 27:111–122

    PubMed  CAS  Google Scholar 

  13. Schmidt H, Secchi A, Wellmann R et al (1996) Effect of endotoxemia on intestinal villus microcirculation in rats. J Surg Res 61:521–526

    Article  PubMed  CAS  Google Scholar 

  14. Rai DK, Gupta LP, Singh RH et al (1974) A study of microcirculation in endotoxin shock. Surg Gynecol Obstet 139:11–16.

    PubMed  CAS  Google Scholar 

  15. Tepperman BL, Brown JF, Whittle BJ (1993) Nitric oxide synthetase induction and intestinal epithelial cell viability in rats. Am J Physiol 265:G214–G218

    Google Scholar 

  16. Baudry N, Rasetti C, Vicaut E (1996) Differences between cytokine effects in the microcirculation of the rat. Am J Physiol 271:H1186–H1192

    Google Scholar 

  17. Schutzer KM, Larsson A, Risberg B (1993) Lung protein leakage in feline septic shock. Am Rev Respir Dis 147:1380–1385

    PubMed  CAS  Google Scholar 

  18. Gotloib L, Shostak A, Galdi P et al (1992) Loss of microvascular negative charges accompanied by interstitial edema in septic rats’ heart. Circ Shock 36:45–56

    PubMed  CAS  Google Scholar 

  19. Hinshaw LB (1996) Sepsis/septic shock: participation of the microcirculation: an abbreviated review. Crit Care Med 24:1072–1078

    Article  PubMed  CAS  Google Scholar 

  20. Baker CH, Wilmoth FR, Sutton ET (1986) Reduced RBC versus plasma microvascular flow due to endotoxin. Circ Shock 20:127–139

    PubMed  CAS  Google Scholar 

  21. Bellary SS, Anderson KW, Arden WA (1995) Effect of lipopolysaccharide on the physical conformation of the erythrocyte cytoskeletal proteins. Life Sci 56:91–98.

    Article  PubMed  CAS  Google Scholar 

  22. Betticher DC, Keller H, Maly FE (1993) The effect of endotoxin and tumour necrosis tactor on erythrocyte and leucocyte deformability in vitro. Br J Haematol 83:130–137

    Article  PubMed  CAS  Google Scholar 

  23. Bienvenu K, Granger DN (1993) Molecular determinants of shear rate-dependent leukocyte adhesion in postcapillary venules. Am J Physiol 264:H1504–H1508.

    Google Scholar 

  24. Harris AG, Skalak TC (1993) Effects of leukocyte activation on capillary hemodynamics in skeletal muscle. Am J Physiol 264:H909–H916

    Google Scholar 

  25. Mammen EF (1998) The haematological manifestations of sepsis. J Antimicrob Chemother 41:17–24

    Article  PubMed  CAS  Google Scholar 

  26. Shoemaker WC, Appel PL, Kram HB et al (1988) Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 94:1176–1186

    Article  PubMed  CAS  Google Scholar 

  27. Tuchschmidt J, Fried J, Astiz M et al (1992) Elevation of cardiac output and oxygen delivery improves outcome in septic shock. Chest 102:216–220

    Article  PubMed  CAS  Google Scholar 

  28. Gattinoni L, Brazzi L, Pelosi P et al (1995) A trial of goal-oriented hemodynamic therapy in critically ill patients. N Engl J Med 333:1025–1032

    Article  PubMed  CAS  Google Scholar 

  29. Hayes MA, Timmins AC, Yau EHS et al (1994) Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 330:1717–1722

    Article  PubMed  CAS  Google Scholar 

  30. Germann R, Haisjackl M, Schwarz B et al (1997) Inotropic treatment and intestinal mucosal tissue oxygenation in a model of porcine endotoxemia. Crit Care Med 25:1191–1197

    Article  PubMed  CAS  Google Scholar 

  31. Silva E, Debacker D, Creteur J et al (1998) Effects of vasoactive drugs on gastric intramucosal pH. Crit Care Med 26:1749–1758

    Article  PubMed  CAS  Google Scholar 

  32. Fortenberry JD, Huber AR, Owens ML (1997) Inotropes inhibit endothelial cell surface adhesion molecules induced by interleukin-1 beta. Crit Care Med 25:303–308

    Article  PubMed  CAS  Google Scholar 

  33. Tighe D, Moss R, Haywood G et al (1993) Dopexamine hydrochloride maintains portal blood flow and attenuates hepatic ultrastructural changes in a porcine peritonitis model of multiple system organ failure. Circ Shock 39:199–206

    PubMed  CAS  Google Scholar 

  34. Schmidt H, Schmidt W, Muller T et al (1997) Effect of the 21-aminosteroid tirilazad mesylate on leukocyte adhesion and macromolecular leakage during endotoxemia. Surgery 121: 328–334

    Article  PubMed  CAS  Google Scholar 

  35. Ward A, Clissold SP (1987) Pentoxifylline. A review of its pharmacodynamic and pharmacokinetic properties, and its therapeutic efficacy. Drugs 34:50–97.

    Article  PubMed  CAS  Google Scholar 

  36. Dackiw AP, Mcgilvray ID, Woodside M (1996) Prevention of endotoxin-induced mortality by antitissue factor immunization. Arch Surg 131:1273–1278

    Article  PubMed  CAS  Google Scholar 

Download references

Authors
  1. W. Pajk
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Knotzer
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. W. Hasibeder
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Department of Surgery, Health Sciences Center, Saint Louis University, St. Louis, USA

    A. E. Baue M.D.

  2. Department of Anaesthesia, Intensive Care and Pain Therapy, Cattinara Hospital, University of Trieste, Trieste, Italy

    G. Berlot M.D.  & A. Gullo M.D.  & 

  3. Department of Intensive Care, Erasme University Hospital, Free University of Brussels, Belgium

    J.-L. Vincent M.D.

Rights and permissions

Reprints and permissions

Copyright information

© 2000 Springer-Verlag Italia

About this paper

Cite this paper

Pajk, W., Knotzer, H., Hasibeder, W. (2000). Mechanism of Oxygen Extraction Defect in Septic Shock. In: Baue, A.E., Berlot, G., Gullo, A., Vincent, JL. (eds) Sepsis and Organ Dysfunction. Springer, Milano. https://doi.org/10.1007/978-88-470-2284-3_6

Download citation

  • DOI: https://doi.org/10.1007/978-88-470-2284-3_6

  • Publisher Name: Springer, Milano

  • Print ISBN: 978-88-470-0096-4

  • Online ISBN: 978-88-470-2284-3

  • eBook Packages: Springer Book Archive

Publish with us

Policies and ethics

Search

Navigation