• J P Mira, J E Fabre, F Baigorri, J Coste, G Annat, A Artigas, G Nitenberg, and J F Dhainaut.
• Intensive Care Unit, Cochin Port-Royal University Hospital, Paris, France.
• Chest. 1994 Nov 1;106(5):1524-31.

BackgroundDuring severe sepsis, the existence of a pathologic oxygen supply dependency remains controversial.Study ObjectiveTo evaluate the relationship between oxygen delivery (DO2) and oxygen consumption (VO2) during severe sepsis and to compare, in this respect, survivors and nonsurvivors and patients with normal or increased concentration of plasma lactate.Study DesignCohort analytic study.SettingThree European ICUs in university hospitals.PatientsSeventeen mechanically ventilated patients with severe sepsis (six with high blood lactate levels) studied within the first day of diagnosis.Interventions And MeasurementsPulmonary elimination of carbon dioxide, or carbon dioxide production (VCO2) and VO2 were measured by indirect calorimetry before and after two interventions designed to increase DO2 (calculated from the Fick equation): inflation of a military antishock trouser (MAST) and infusion of dobutamine.ResultsDuring MAST inflation, DO2 increased by 19% in patients with a normal concentration of plasma lactate (p < 0.01), but remained unchanged in patients with high lactate levels. During dobutamine infusion, DO2 increased in both groups by 16% (p < 0.01) and 20% (p < 0.05), respectively. In both groups, we found that the VO2 and VCO2 were not affected by either the MAST or the dobutamine-induced increase in DO2. There was no difference between survivors and nonsurvivors.ConclusionThere was no evidence of a pathologic oxygen supply dependency in patients with severe sepsis, even in those who had an elevated concentration of plasma lactate and in those who ultimately died. These results do not favor the conclusion that maximizing DO2 is a primary therapeutic objective in such patients.

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