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Juan J. Ronco, MD; John C. Fenwick, MD; Martin G. Tweeddale, MD; Barry R. Wiggs, MSc; P. Terry Phang, MD; D. James Cooper, MD; Kenneth F. Cunningham, MD; James A. Russell, MD; Keith R. Walley, MD; Bart Chernow, MD; David Dantzker, MD; Jerrold Leiken, MD; Joseph E. Parrillo, MD; William J. Sibbald, MD; Jean-Louis Vincent, MD, PhD

JAMA. 1993;270(14):1724-1730.

Abstract
Objectives.
—To determine the critical oxygen delivery threshold for anaerobic metabolism and to compare its value between septic and nonseptic critically ill patients.

Design.
—Cohort analytic study, consecutive sample.

Setting.
—Two tertiary care medical and surgical intensive care units in university hospitals.

Patients.
—Nine septic and nine nonseptic critically ill humans. A diagnosis of sepsis was established by the presence of sepsis syndrome, positive cultures obtained within 48 hours of study, and autopsy evidence of a source of infection.

Methods and Interventions.
—The O₂ consumption (determined by indirect calorimetry), O₂ delivery (calculated from the Fick equation), and concentration of arterial plasma lactate were simultaneously determined at 5-to 20-minute intervals while life support was discontinued.

Main Outcome Measures.
—Critical O₂ delivery, critical O₂ extraction ratio, and maximal O₂ extraction ratio.

Results.
—In all septic and eight nonseptic patients, O₂ delivery and O₂ consumption displayed a biphasic relationship over the range of O₂ delivery studied. There were no differences in critical O₂ delivery threshold (3.8±1.5 vs 4.5±1.3 mL·min^-1·kg^-1; P>.28), critical O₂ extraction ratio (0.61 ±0.05 vs 0.59±0.16; P>.64), and maximal O₂ extraction ratio (0.74±0.08 vs 0.80±0.11; P>.29) between septic and nonseptic patients. These data have greater than 90% power to detect a difference of 2 mL·min^-1·kg^-1 in the critical O₂ delivery and 0.1 in the critical and maximal O₂ extraction ratios between the septic and nonseptic groups.

Conclusions.
—The critical O₂ delivery for anaerobic metabolism was identified from the biphasic relationship between O₂ delivery and O₂ consumption in individual humans. The critical O₂ delivery is considerably lower than previously reported in humans with the use of pooled group data. Sepsis does not alter the critical O₂ delivery for anaerobic metabolism or tissue O₂ extraction ability. Interventions to increase O₂ delivery to supranormal levels in critically ill humans in the hope of increasing O₂ consumption may be inappropriate.

(JAMA. 1993;270:1724-1730)

Author Affiliations
Baltimore, Md; New Hyde Park, NY; Chicago, III; Chicago, III; London, Ontario; Brussels, Belgium

From the Program of Critical Care Medicine, Vancouver General and St Pauls Hospitals, University of British Columbia, Vancouver.

Footnotes
Presented in part at the annual meeting of the American Thoracic Society, Anaheim, Calif, May 12, 1991.

Reprint requests to ICU Administration, LSP 2, Vancouver General Hospital, 855 W 12th Ave, Vancouver, British Columbia, Canada V5Z 1M9 (Dr Ronco).

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