Manipulación del transporte y consumo de oxígeno en la sepsis

Abstract

Maintaining an adequate tissue oxygen delivery (DO2) and consumption (VO2) is crucial in the treatment of septic patients. A fall in VO2 is associated with a higher mortality. The early recognition of shock or tissue hypoperfusion impacts on patient prognosis. In occasions, hypovolemia or important regional oxygen debts are not recognized, since macro hemodynamic variables have been compensated. In this situation, the use of metabolic hypoperfusion markers such as lactate, central venous oxygen saturation and gastric tonometry, can be helpful. However, interpretation of these markers should be cautious and always considering the overall clinical status of the patient. In the initial stages of sepsis, the dependency of VO2 on DO2 predominates as physiopathological mechanism of multiple organic failure. In late stages, other factors predominate as determinants of multiple organic failure and mortality, such as hyper or hypo immune response, microcirculatory alterations and cytopathic hypoxia.