Impaired Oxygen Extraction In Septic Patients Is Related To Decreased Effective Hepatic Blood Flow
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Background: Studies have suggested that tissue hypoxia in septic patients despite increased cardiac output is attributable to impaired oxygen extraction, and sepsis is known to alter blood flow or metabolic demand, especially in the splanchnic area. Effective hepatic blood flow (EHBF) is thought to reflect splanchnic perfusion and metabolic changes in the liver, but the relationship between impaired systemic oxygen extraction and decreased EHBF in septic patients remains unknown. Objective: To test the hypothesis that impaired systemic oxygen extraction in septic patients is associated with decreased EHBF. Materials and Methods: Twenty-two critically ill patients were examined in this study, and 12 met the criteria for sepsis. A 20mg dose of indocyanine green was administered to each patients, and cardiac output (CO) and EHBF were determined by pulse dye-densitometry. The systemic O2 extraction rate (O2ER) was determined with a pulmonary artery catheter. Results: The EHBF/CO ratio of septic patients was significantly lower than in non-septic patients (sepsis vs. non-sepsis, 0.08±0.03 vs. 0.21±0.06, p<0.001). There was no significant correlation between EHBF/CO and O2ER in non-septic patients, but a significant correlation was found between EHBF/CO and O2ER in septic patients (r=0.73, p<0.01). Conclusions: The decreased O2 extraction in septic patients is associated with decreased EHBF/CO, suggesting that inadequate splanchnic perfusion or metabolic alternation reflects O2 extraction in septic patients.
- 一般社団法人 日本救急医学会の論文
一般社団法人 日本救急医学会 | 論文
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