Vein graft disease:avoiding problems.
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Graft Occlusion, Vascular↗
Biomedical subjects
C Gottschall
Publications and source records attributed to C Gottschall.
Oxygen consumption and resting metabolic rate in sepsis, sepsis syndrome, and septic shock.
OBJECTIVE: To test the hypothesis that variations in oxygen consumption (VO2) and resting metabolic rate reflect the severity of bacterial infections and reflect the development of sepsis syndrome and septic shock. DESIGN: Observational study with sequential measurements of VO2 and resting metabolic rate by expiratory gas analysis. SETTING: Medical intensive care unit. PATIENTS: Thirty patients, treated primarily for presumed bacterial infection, were examined on 118 treatment days. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: VO2 and resting metabolic rate were measured by expiratory gas analysis. For mechanically ventilated patients, a measurement system was developed, based on a paramagnetic oxygen sensor, an infrared CO2 sensor, and digital signal averaging. Measurements in spontaneously breathing patients were performed with a metabolic monitor. Patients were assigned by clinical criteria to the following groups: sepsis, sepsis syndrome, and septic shock. The lowest VO2 value of each patient in each stage was evaluated. Mean VO2 in 15 patients with sepsis was 180 +/- 19 (SD) mL/min/m2, in 11 patients with sepsis syndrome 156 +/- 22 mL/min/m2, and in eight patients with septic shock 120 +/- 27 mL/min/m2 (p < .001). Mean resting metabolic rate in sepsis was +55 +/- 14%, in sepsis syndrome +24 +/- 12%, and in septic shock +2 +/- 24% (p < .001). Mean oxygen delivery (DO2) was 501 +/- 116 mL/min/m2 in sepsis, 515 +/- 186 mL/min/m2 in sepsis syndrome, and 404 +/- 96 mL/min/m2 in septic shock. Oxygen extraction (VO2/DO2) was highest in sepsis (0.39 vs. 0.33 in sepsis syndrome and 0.29 in septic shock). During recovery from sepsis syndrome or septic shock, a significant increase in resting metabolic rate to +61 +/- 22% was measured in nine patients. CONCLUSIONS: In sepsis syndrome, VO2 and resting metabolic rate are enhanced by 30% compared with normal basal metabolism, but they are markedly reduced compared with uncomplicated sepsis. The higher VO2 in uncomplicated sepsis is flow independent. The noninvasive measurement of VO2 and resting metabolic rate by expiratory gas analysis therefore can be used as a quantitative staging and monitoring parameter for the development of sepsis syndrome and septic shock.
Adult↗
[Comparative measurement of oxygen uptake and cardiac output at rest and during stress--evaluation of a new monitor for continuous determination of oxygen uptake and carbon dioxide release].
A new device for the continuous monitoring of oxygen uptake and carbon dioxide delivery is presented, which is based on a continuous expired gas analysis using a paramagnetic oxygen and an infrared-absorption carbon dioxide sensor. To validate the results, data of measured oxygen uptake and cardiac output calculated by the Fick principle were compared to synchronous thermodilution measurements at rest and during exercise. Measurements were performed at rest on 18 patients, additionally 13 of the patients were exercised with either 25 W or 50 W workload. The results indicate, for both measurement series, a significant correlation (r greater than 0.95, p less than 0.001) and exemplify that the measurement of oxygen uptake by expired gas analysis permits a precise analysis of the cardiovascular transport function during exercise.
Adult↗
[Noninvasive monitoring of gas exchange: methodologic prerequisites and clinical use].
The noninvasive determination of the respiratory gas exchange (measurement of oxygen uptake and carbon dioxide delivery) permits the calculation of cardiac output by Fick principle and of the actual energy requirement of the patient (indirect calorimetry). A system is presented for the continuous measurement of oxygen uptake and carbon dioxide delivery, that bases on simple components, which are available on most intensive care units. The methodical problems are discussed and the improvement of the signal of the oxygen sensor by digital signal processing is described. Clinical measurements on 16 patients are presented, whose metabolic rate early after extracorporal circulation was measured. The results reveal, that 4.4 hours after ECC the metabolic rate is close to the calculated basic metabolic rate. They demonstrate the importance of indirect calorimetry as a future bedside monitoring routine.
Anesthesia, General↗