Effect of Acute Respiratory Acidosis on the Limits of Oxygen Extraction during Hemorrhage

1996 ◽  
Vol 85 (4) ◽  
pp. 817-822 ◽  
Author(s):  
Michael E. Ward
Keyword(s):  
Blood Flow ◽  
Oxygen Consumption ◽  
Oxygen Content ◽  
Oxygen Delivery ◽  
Tissue Oxygenation ◽  
Respiratory Acidosis ◽  
Oxygen Availability ◽  
Oxygen Extraction ◽  
Oxygen Extraction Ratio ◽  
Critical Oxygen

Background Hypercapnia can impair cells' capacity to maintain energy status anerobically and enhances the risk of hypoxic injury when oxygen availability is reduced. The ability to maintain tissue oxygenation is determined by both bulk blood flow and the efficiency of oxygen extraction. Bulk blood flow is maintained during hypercapnia through increased sympathetic activity. The effect of hypercapnia on oxygen extraction, however, is unknown. This study evaluates the effect of hypercapnia on cells' capacity to adapt to reductions in oxygen availability by increasing oxygen extraction. Methods In three groups of paralyzed, mechanically ventilated dogs that were anesthetized with alpha-chloralose, the concentration of carbon dioxide in the inhaled gas mixture was adjusted to achieve normocapnia, moderate hypercapnia (Paco2 = 72 +/- 3 [SE] mmHg) or severe hypercapnia (Paco2 = 118 +/- 4 [SE] mmHg). Stepwise hemorrhage was induced until each dog's blood pressure was destabilized. At each stage in the hemorrhage protocol, the oxygen delivery, oxygen consumption, and oxygen extraction ratios (ratio of arteriovenous oxygen content difference to arterial oxygen content) were determined. Results At the point of onset of delivery dependence of oxygen consumption, the oxygen delivery rate (critical oxygen delivery) was 7.8 +/- 1.5 (SE) ml.kg-1.min-1 and the oxygen extraction ratio (critical oxygen extraction ratio) was 0.72 +/- 0.04 (SE) in the normocapnic dogs. Moderate hypercapnia had no effect on these parameters. In the severely hypercapnic dogs, the critical values for oxygen delivery and extraction ratios were 12.5 +/- 1.8 (SE) ml.kg-1.min-1 and 0.54 +/- 0.035 (SE), respectively (P < 0.05 for differences from the normocapnic dogs). Conclusions The results identify a previously unrecognized threat to tissue oxygenation and emphasize the importance of ensuring adequate oxygen delivery when adopting mechanical ventilatory strategies that permit respiratory acidosis to develop.

Is Calcium a Coronary Vasoconstrictor In Vivo? 

1998 ◽  
Vol 88 (3) ◽  
pp. 735-743 ◽  
Author(s):  
George J. Crystal ◽  
Xiping Zhou ◽  
Ramez M. Salem
Keyword(s):  
Blood Flow ◽  
Oxygen Consumption ◽  
Coronary Blood Flow ◽  
Myocardial Oxygen Consumption ◽  
Extraction Ratio ◽  
Oxygen Extraction ◽  
Oxygen Extraction Ratio ◽  
Myocardial Oxygen Extraction ◽  
Dose Dependent

Background Calcium produces constriction in isolated coronary vessels and in the coronary circulation of isolated hearts, but the importance of this mechanism in vivo remains controversial. Methods The left anterior descending coronary arteries of 20 anesthetized dogs whose chests had been opened were perfused at 80 mmHg. Myocardial segmental shortening was measured with ultrasonic crystals and coronary blood flow with a Doppler flow transducer. The coronary arteriovenous oxygen difference was determined and used to calculate myocardial oxygen consumption and the myocardial oxygen extraction ratio. The myocardial oxygen extraction ratio served as an index of effectiveness of metabolic vasodilation. Data were obtained during intracoronary infusions of CaCl2 (5, 10, and 15 mg/min) and compared with those during intracoronary infusions of dobutamine (2.5, 5.0, and 10.0 microg/min). Results CaCl2 caused dose-dependent increases in segmental shortening, accompanied by proportional increases in myocardial oxygen consumption. Although CaCl2 also increased coronary blood flow, these increases were less than proportional to those in myocardial oxygen consumption, and therefore the myocardial oxygen extraction ratio increased. Dobutamine caused dose-dependent increases in segmental shortening and myocardial oxygen consumption that were similar in magnitude to those caused by CaCl2. In contrast to CaCl2, however, the accompanying increases in coronary blood flow were proportional to the increases in myocardial oxygen consumption, with the result that the myocardial oxygen extraction ratio remained constant. Conclusions Calcium has a coronary vasoconstricting effect and a positive inotropic effect in vivo. This vasoconstricting effect impairs coupling of coronary blood flow to the augmented myocardial oxygen demand by metabolic vascular control mechanisms. Dobutamine is an inotropic agent with no apparent direct action on coronary resistance vessels in vivo.

The cerebral critical oxygen threshold of ventilated preterm lambs and the influence of antenatal inflammation

2011 ◽  
Vol 111 (3) ◽  
pp. 775-781 ◽  
Author(s):  
C. C. Andersen ◽  
J. J. Pillow ◽  
A. W. Gill ◽  
B. J. Allison ◽  
T. J. M. Moss ◽  
...  
Keyword(s):  
Blood Flow ◽  
Oxygen Consumption ◽  
Oxygen Delivery ◽  
In Utero ◽  
Recruitment Strategy ◽  
Critical Threshold ◽  
Cerebral Oxygen ◽  
Neurodevelopmental Outcomes ◽  
Cerebral Oxygen Consumption ◽  
Critical Oxygen

Perinatal inflammation is associated with adverse neurodevelopmental outcomes, which may be partly due to changes in the cerebral oxygen delivery/consumption relationship. We aimed to determine the critical oxygen delivery threshold of the brain of preterm, ventilated lambs and to determine whether the critical threshold is affected by exposure to inflammation in utero. Pregnant ewes received intra-amniotic injection of lipopolysaccharide or saline at 125 or 127 days of gestation. Pulmonary and systemic flow probes and catheters were surgically positioned in the fetus immediately before delivery at 129 days of gestation. After delivery, lambs were ventilated for 90 min using a positive end-expiratory pressure recruitment strategy. Cardio-respiratory variables and blood gases were measured regularly. Systemic and cerebral oxygen delivery, consumption (Fick), and extraction were calculated, and the relationship between cerebral delivery and consumption analyzed. Linear regression was used to define the transition or “critical” oxygen threshold as the point at which the slope of the oxygen delivery/consumption curve changed to be >10°. Four subgroups were defined according to the calculated critical threshold. A total of 150 measurements were recorded in 18 lambs. Fetal cerebral oxygen consumption was increased by antenatal lipopolysaccharide ( P < 0.05). The postnatal critical oxygen threshold was 3.6 ml·kg−1·min−1, corresponding to cerebral oxygen consumption of 0.73 ml·kg−1·min−1. High oxygen delivery and consumption were associated with increased pulmonary and carotid blood flow and systemic extraction compared with low oxygen delivery and consumption. No postnatal effect of antenatal inflammation was observed. Inflammation in utero increases fetal, but not postnatal, cerebral oxygen consumption. Adverse alterations to pulmonary blood flow can result in reduced cerebral blood flow, oxygen delivery, and consumption. Regardless of exposure to inflammation, there is a consistent postnatal relationship between cerebral oxygen delivery and consumption.

Effects of afferent neural stimulation on critical oxygen delivery: a hemodynamic explanation

1995 ◽  
Vol 269 (6) ◽  
pp. R1448-R1454 ◽  
Author(s):  
E. Kirkman ◽  
H. Zhang ◽  
H. Spapen ◽  
R. A. Little ◽  
J. L. Vincent
Keyword(s):  
Blood Flow ◽  
Oxygen Delivery ◽  
Nerve Fibers ◽  
Afferent Nerve ◽  
Oxygen Extraction ◽  
Whole Body ◽  
Afferent Nerve Fibers ◽  
Femoral Blood Flow ◽  
Critical Oxygen ◽  
Renal Flow

Injury and activation of somatic afferent nerve fibers may alter critical oxygen delivery (DO2C), the point at which oxygen consumption becomes dependent upon delivery, and hence reduce tolerance to hypovolemia. The present study investigated the mechanism of this. Anesthetized mongrel dogs were divided into two groups: control (n = 6) and those subject to brachial nerve stimulation (BNS; n = 5). Whole body oxygen delivery (DO2I) and consumption were initially similar in both groups. DO2I was reduced by cardiac tamponade to determine DO2C. DO2C was significantly higher in BNS compared with control (11.5: 11.0-16.7 vs. 7.5: 6.9-9.5 ml.min-1.kg-1; median: Q1 - Q3), whereas critical oxygen extraction ratios were lower (54.8: 39.7-61.2 vs. 78.3: 53.5-92.4%). At approximately DO2C, normalized femoral blood flow was lower than renal flow in control (renal-femoral difference 17.4: 8.7-40.0%) but not in BNS (-7.8: -14.8 to +11.8%). These results indicate that activation of somatic afferent nerve fibers elevates DO2C. This could be due to an impairment in peripheral oxygen extraction as a consequence of a redistribution of blood flow away from metabolically active vital organs toward relatively inactive skeletal muscle.

scholarly journals Cerebral Fractional Oxygen Extraction is Inversely Correlated with Oxygen Delivery in the Sick, Newborn, Preterm Infant

2005 ◽  
Vol 25 (5) ◽  
pp. 545-553 ◽  
Author(s):  
Christopher M Kissack ◽  
Rosaline Garr ◽  
Stephen P Wardle ◽  
A Michael Weindling
Keyword(s):  
Blood Flow ◽  
Oxygen Consumption ◽  
Preterm Infants ◽  
Metabolic Activity ◽  
Negative Correlation ◽  
Oxygen Delivery ◽  
Near Infrared ◽  
Extremely Low Birth Weight ◽  
Oxygen Extraction ◽  
Cerebral Oxygen

Cerebral blood flow (CBF) is known to be low in newborn infants, but this has not been shown to be damaging. The purpose of this study was to investigate the relationships between cerebral haemoglobin flow, blood flow, oxygen delivery, oxygen consumption, venous saturation, and fractional oxygen extraction (OEF) in newborn, preterm infants. Measurements were made by near-infrared spectroscopy in 13 very preterm, extremely low birth weight infants (median gestation 25 weeks) during the first 3 days after birth. There was a negative correlation between cerebral oxygen delivery and OEF ( n=13, r=−0.5, P=0.03), which implies that when there is a reduction in cerebral oxygen delivery in sick preterm infants, increased cerebral oxygen extraction may be responsible for maintaining oxygen availability to the brain. During the first 3 days after birth CBF ( n=13, r=0.7, P=0.01), oxygen delivery ( n=13, r=0.5, P=0.03), and oxygen consumption ( n=13, r=0.7, P=0.004) all increased. This increase in oxygen consumption indicates increased cerebral metabolic activity after birth, which is likely to be a normal adaptation to extrauterine life. The increases in blood flow and oxygen delivery may also be normal adaptations that facilitate this increase in metabolic activity. There was a decrease ( P=0.04) in mean (±s.d.) cerebral OEF between day 1 (0.37±0.10) and day 2 (0.29±0.09), with no change between day 2 and day 3. Taking into account the negative correlation between OEF and oxygen delivery, this decrease in OEF may be because of increased oxygen delivery during this time.

scholarly journals Delaying Blood Transfusion in Experimental Acute Anemia with a Perfluorocarbon Emulsion

2011 ◽  
Vol 114 (4) ◽  
pp. 901-911 ◽  
Author(s):  
Pedro Cabrales ◽  
Juan Carlos Briceño
Keyword(s):  
Oxygen Consumption ◽  
Oxygen Delivery ◽  
Tissue Oxygenation ◽  
Oxygen Carrier ◽  
Capillary Density ◽  
Functional Capillary Density ◽  
Peripheral Tissue ◽  
Control Group ◽  
Oxygen Extraction Ratio ◽  
Perfluorocarbon Emulsion

Background To avoid unnecessary blood transfusions, physiologic transfusion triggers, rather than exclusively hemoglobin-based transfusion triggers, have been suggested. The objective of this study was to determine systemic and microvascular effects of using a perfluorocarbon-based oxygen carrier (PFCOC) to maintain perfusion and oxygenation during extreme anemia. Methods The hamster (weight, 55-65 g) window chamber model was used. Two isovolemic hemodilution steps were performed using hydroxyethyl starch, 10%, at normoxic conditions to a hematocrit of 19% (hemoglobin, 5.5 g/dl), the point at which the transfusion trigger was reached. Two additional hemodilution exchanges using the PFCOC (Oxycyte) and increasing the fraction of inspired oxygen to 1.0 were performed to reduce the hematocrit to 11% (hemoglobin, 3.8 g/dl) and 6% (hemoglobin, 2.0 g/dl), respectively. No control group was used in the study because this concentration of hemodilution is lethal with conventional plasma expanders. Systemic parameters, microvascular perfusion, functional capillary density, and oxygen tensions across the microvascular network were measured. Results At 6% hematocrit, the PFCOC maintained mean arterial pressure, cardiac output, systemic oxygen delivery, and oxygen consumption. As hematocrit was decreased from 11% to 6%, functional capillary density, calculated microvascular oxygen delivery, and oxygen consumption decreased; and the oxygen extraction ratio was close to 100%. Peripheral tissue oxygenation was not predicted by systemic oxygenation. Conclusions The PFCOC, in conjunction with hyperoxia, was able to sustain organ function and partially provide systemic oxygenation during extreme anemia during the observation period. The PFCOC can work as a bridge until erythrocytes are available for transfusion or when additional oxygen is required, despite the possible limitations in peripheral tissue oxygenation.

alpha-Adrenergic control of oxygen delivery to myocardium during exercise in conscious dogs

1982 ◽  
Vol 242 (5) ◽  
pp. H805-H809 ◽  
Author(s):  
G. R. Heyndrickx ◽  
P. Muylaert ◽  
J. L. Pannier
Keyword(s):  
Heart Rate ◽  
Blood Flow ◽  
Oxygen Consumption ◽  
Coronary Blood Flow ◽  
Coronary Sinus ◽  
Oxygen Delivery ◽  
Left Ventricular ◽  
Conscious Dogs ◽  
Adrenergic Blockade ◽  
Adrenergic Control

alpha-Adrenergic control of the oxygen delivery to the myocardium during exercise was investigated in eight conscious dogs instrumented for chronic measurements of coronary blood flow, left ventricular (LV) pressure, aortic blood pressure, and heart rate and sampling of arterial and coronary sinus blood. After alpha-adrenergic receptor blockade a standard exercise load elicited a significantly greater increase in heart rate, rate of change of LV pressure (LV dP/dt), LV dP/dt/P, and coronary blood flow than was elicited in the unblocked state. In contrast to the response pattern during control exercise, there was no significant change in coronary sinus oxygen tension (PO2), myocardial arteriovenous oxygen difference, and myocardial oxygen delivery-to-oxygen consumption ratio. It is concluded that the normal relationship between myocardial oxygen supply and oxygen demand is modified during exercise after alpha-adrenergic blockade, whereby oxygen delivery is better matched to oxygen consumption. These results indicate that the increase in coronary blood flow and oxygen delivery to the myocardium during normal exercise is limited by alpha-adrenergic vasoconstriction.

Whole body oxygen consumption and critical oxygen delivery in response to prolonged and severe carbon monoxide poisoning

Resuscitation ◽  
2003 ◽  
Vol 56 (1) ◽  
pp. 97-104 ◽  
Author(s):  
Howard A Smithline ◽  
Kevin R Ward ◽  
Donald A Chiulli ◽  
Heidi C Blake ◽  
Emanuel P Rivers
Keyword(s):  
Carbon Monoxide ◽  
Oxygen Consumption ◽  
Oxygen Delivery ◽  
Carbon Monoxide Poisoning ◽  
Whole Body ◽  
Critical Oxygen

Heterogeneity of gut capillary transit times and impaired gut oxygen extraction in endotoxemic pigs

1996 ◽  
Vol 81 (2) ◽  
pp. 895-904 ◽  
Author(s):  
M. F. Humer ◽  
P. T. Phang ◽  
B. P. Friesen ◽  
M. F. Allard ◽  
C. M. Goddard ◽  
...  
Keyword(s):  
Blood Volume ◽  
Transit Time ◽  
Volume Flow ◽  
Oxygen Extraction ◽  
Control Group ◽  
Total Blood Volume ◽  
Oxygen Extraction Ratio ◽  
Total Blood ◽  
Transit Times ◽  
Critical Oxygen

We tested the hypothesis that endotoxin increases the heterogeneity of gut capillary transit times and impairs oxygen extraction. The gut critical oxygen extraction ratio was determined by measuring multiple oxygen delivery-consumption points during progressive phlebotomy in eight control and eight endotoxin-infused anesthetized pigs. In multiple 1- to 2-g samples of small bowel, we measured blood volume (radiolabeled red blood cells) and flow (radiolabeled 15-microns microspheres) before and after critical oxygen extraction. Red blood cell transit time (= volume/flow) multiplied by morphologically determined capillary/total blood volume gave capillary transit time. During hemorrhage, capillary/total blood volume did not change in the endotoxin group (0.5 +/- 4.5%) but increased in the control group (17.6 +/- 2.5%; P < 0.05) due to a decrease in total gut blood volume. Flow decreased significantly in the endotoxin group (36 +/- 10%; P < 0.05) but not in the control group (12 +/- 10%). Capillary transit-time heterogeneity increased in the endotoxin group (12.3 +/- 4.9%) compared with the control group (-5.8 +/- 7.4%; P < 0.05), predicting a critical oxygen extraction ratio 0.14 lower in the endotoxin group than in the control group (K. R. Walley. J. Appl. Physiol. 81: 885–894, 1996). This matches the measured difference (endotoxin group, 0.60 +/- 0.04; control group, 0.74 +/- 0.03; P < 0.05). Increased heterogeneity of capillary transit times may be an important cause of impaired oxygen extraction.

Development of dependence on oxygen in embryo salamanders

1979 ◽  
Vol 236 (5) ◽  
pp. R282-R291
Author(s):  
E. F. Adolph
Keyword(s):  
Blood Flow ◽  
Oxygen Uptake ◽  
Oxygen Pressure ◽  
Oxygen Delivery ◽  
Survival Times ◽  
Stages Of Development ◽  
Heart Rates ◽  
Species Survival ◽  
Critical Oxygen

Survival times in anoxia and hypoxia were measured at various stages of development in Ambystoma embryos and larvae of two species. Survival times in anoxia at 20 degrees C shifted from more than 30 h at 2 days after fertilization to 20 h at 10 days of age, to only 4--2 h at 14 days of age. In hypoxia (oxygen pressure equivalent to 3.8% oxygen) similar shifts of survival times appeared about 7 days of age later. During anoxia heart rates decreased, less at younger stages than at older. At older stages the heart stopped beating, sometimes irreversibly. In hypoxia also, hearts at all stages whether in situ or isolated decreased their rates of beat. Oxygen uptakes of larvae diminished in oxygen pressures even as high as 11% oxygen. This critical oxygen pressure did not change between early stages without blood flow and later stages with blood flow. Oxygen uptake was probably not limited by oxygen delivery but presumably by properties of cellular masses. No oxygen debts were paid off. Some parallel changes of tolerances to anoxia in embryo birds and mammals are noted.

Effects of varying hematocrit on intestinal oxygen uptake in neonatal lambs

1985 ◽  
Vol 248 (4) ◽  
pp. G432-G436 ◽  
Author(s):  
I. R. Holzman ◽  
B. Tabata ◽  
D. I. Edelstone
Keyword(s):  
Blood Flow ◽  
Anaerobic Metabolism ◽  
Lactate Production ◽  
Oxygen Availability ◽  
Intestinal Blood Flow ◽  
Oxygen Extraction ◽  
Base Line ◽  
Wide Range ◽  
O2 Extraction ◽  
Neonatal Lambs

We chronically catheterized 15 newborn lambs (9.5 +/- 2.8 days) and measured intestinal blood flow (Qi) by the radionuclide microsphere technique at hematocrit levels ranging from 10 to 55%. Seven animals were made progressively anemic and eight polycythemic by means of exchange transfusions. Using the Fick principle, we calculated intestinal oxygen delivery (Di o2), oxygen consumption (Vi o2), and oxygen extraction. Initial base-line values were Qi = 195.5 ml . min-1 . 100 g intestine-1, Di o2 = 22.1 ml . min-1 . 100 g-1, Vi o2 = 4.8 ml . min-1 . 100 g-1, and O2 extraction = 22.5%. As the hematocrit was lowered, Di o2 decreased and O2 extraction increased and vice versa when the hematocrit was raised. Vi o2 remained constant, but Qi did not correlate with changes in hematocrit. However, intestinal blood flow, as a percent distribution of total blood flow, decreased with lower hematocrit levels. At no time was there any evidence of anaerobic metabolism as measured by excess lactate production. Our data indicate that the intestines of neonatal lambs are capable of maintaining their metabolic needs over a wide range of oxygen availability induced by a changing hematocrit. The primary mechanism is through alteration of oxygen extraction. Within the range of our experiments, no critically low oxygen availability was attained at which anaerobic metabolism became significant.

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