My paper 20 years later: effects of dobutamine on the VO.sub.2/DO.sub.2 relationship

Introduction Oxygen uptake (VO.sub.2) is independent of oxygen delivery (DO.sub.2) over a wide range of values, because O.sub.2 extraction can readily adapt to changes in DO.sub.2. However, VO.sub.2 can become DO.sub.2-dependent in acute circulatory failure. Methods Various methods of evaluating the presence of VO.sub.2/DO.sub.2 dependency were conducted, but criticized because of potential problems with mathematical coupling of data. Some 20 years ago, we proposed using a dobutamine test and showed similar relationships using direct and indirect measurements. Since these studies on the systemic VO.sub.2/DO.sub.2 relationship, investigators have also explored regional alterations. Conclusion The relationship between VO.sub.2 and DO.sub.2 remains an important concept. Abnormal global VO.sub.2/DO.sub.2 dependency does not exist in stable, critically ill patients, but can exist in circulatory shock of all etiologies. It can also occur regionally in septic patients, and microcirculatory alterations may contribute. Patient management should be titrated individually with careful assessment to identify those who will benefit from increased DO.sub.2.
Author(s): Jean-Louis Vincent [sup.1], Daniel De Backer [sup.1] Author Affiliations: (1) grid.4989.c, 0000000123480746, Department of Intensive Care, Erasme Hospital, Université libre de Bruxelles, , Route de Lennik 808, 1070, Brussels, [...]