Low oxygen extraction despite high oxygen delivery causes low oxygen consumption in patients with burns recovering slowly from operative hypothermia

Shiozaki, T.; Ohnishi, M.; Tasaki, O.; Hiraide, A.; Shimazu, T.; Yoshioka, T.; Sugimoto, T.

Surgery 118(1): 44-48


ISSN/ISBN: 0039-6060
PMID: 7604378
DOI: 10.1016/s0039-6060(05)80008-x
Accession: 008976048

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Background. Patients with burns who eventually succumbed to their injuries tended to recover more slowly from operative hypothermia than those who survived. Slower recovery was associated with a lower postoperative oxygen consumption ( ovrhdot VO-2). We have now investigated whether this was due to impairment of oxygen delivery or extraction. Methods. This study was performed in 13 adult patients with severely burns. One hundred four measurements of ovrhdot VO-2 by indirect calorimetry were made during recovery from 23 episodes of operative hypothermia in 11 patients. Sixty-six measurements of oxygen transport variables by balloon-tipped pulmonary artery catheter were made after 17 episodes of operative hypothermia in six patients. Body temperature was monitored in the urinary bladder. Results. The rate of temperature rise (T) showed a strong positive correlation with ovrhdot VO-2 measured both by indirect calorimetry (r = 0.91, p lt 0.001) and by balloon-tipped pulmonary artery catheter (r = 0. 83, p lt 0.001). Oxygen delivery ( ovrhdot DO-2) was above normal in nearly all patients. Oxygen extraction was low in patients recovering slowly ( ovrhdot T lt 1.0 degree C/hr) and high in those recovering quickly ( ovrhdot T gtoreq 1.0 degree C/hr). During fast recovery ovrhdot VO-2 (373 +- 77 ml cntdot min-1 cntdot m-2; mean +- SD) was approximately three times normal and was independent of ovrhdot DO-2. In contrast, a strong linear relationship existed between ovrhdot O-2 and ovrhdot DO-2 during slow recovery (r = 0. 76, p lt 0.001). Conclusions. Patients with burns with slow recovery from operative hypothermia exhibited impaired oxygen extraction and dependence of ovrhdot VO-2 on ovrhdot DO-2 over a wide range. This picture resembles that in patients with critical illness.