Physiological measurements

In order to describe the time course of physiological events, hemodynamic and oxygen transport variables were monitored preoperatively, during surgery, and in the immediate postoperative period in 708 high-risk critically ill surgical patients. The temporal patterns of the survivors' values were compared with the patterns of those who died. The non-survivors were found to have relatively normal values for cardiac output, oxygen delivery Do2, and oxygen consumption Vo2, while survivors had markedly increased values for these variables.

The physiology of the shocked state after high-risk surgery can be summarized in terms of oxygen delivery and metabolism. Oxygen delivery is the most direct measurement of circulatory function and the capacity of the circulation to compensate. Oxygen consumption is a direct measure of metabolic activity. It measures what the patient is actually consuming at the time, but not necessarily what is needed. On the basis of these key variables which predict outcome, it is hypothesized that inadequate oxygen delivery in the face of increased metabolic demands due to trauma, surgical operations, blood loss, anesthesia, and infection produce tissue hypoxia, organ dysfunction, organ failure, and death (Sh9§.m§ke.Le.ta!: 19.92.a).

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