• Kamal Maheshwari.
• Department of General Anesthesiology, Cleveland Clinic, Cleveland, OH, USA; Department of Outcomes Research, Cleveland Clinic, Cleveland, OH, USA. Electronic address: http://www.OR.org.
• Best Pract Res Clin Anaesthesiol. 2021 Dec 1; 35 (4): 543-549.

AbstractOxygen delivery is dependent on pulmonary gas exchange, cardiac output, blood oxygen-carrying capacity, and tissue oxygen extraction. Reduction in oxygen delivery or higher oxygen consumption can initiate complex protective cellular processes precipitating oxygen debt. In critically ill and potentially surgical patients, stress and consequent hormonal or metabolic changes can trigger oxygen debt which is associated with worse morbidity and mortality. Increase in oxygen delivery by augmenting cardiac output or by increasing fraction of inspired oxygen (FiO2) can help reduce oxygen debt. However, the extent of oxygen debt in an individual patient is poorly defined and difficult to measure. Furthermore, large heterogeneity in clinical trials assessing outcomes benefit of increasing oxygen delivery limits our ability to recommend goal directed fluid therapy aimed at increasing cardiac ouput or higher FiO2. To understand and prevent oxygen debt in critically ill and surgical patients, we need to develop continuous monitoring techniques to assess the balance of oxygen delivery and consumption. Furthermore, methods of increasing oxygen delivery like goal-directed fluid therapy, higher FiO2 and anemia prevention should be rigorously evaluated with focus on establishing outcomes benefit.Copyright © 2020 Elsevier Ltd. All rights reserved.

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