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The impact of inspired oxygen concentration on tissue oxygenation during progressive haemorrhage

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Abstract

Purpose

Standard resuscitation practice for shock states mandates use of high flow, high concentration oxygen. However, this may induce microvascular constriction and potentially impair regional oxygen delivery. We thus investigated the impact of varying inspired oxygen concentrations in a rat model of progressive haemorrhage.

Methods

Tissue oxygen tension (the balance between local O2 supply and demand) was measured in four different organ beds (liver, renal cortex, muscle, bladder), with concurrent assessment of cardiorespiratory function and organ perfusion in a spontaneously breathing, anaesthetised rat model. 10% aliquots of circulating blood volume were removed at 15 min intervals until death. Different oxygen fractions in the gas mixture (0.15–1.0) were administered following 20% blood removal. A control group consisted of normovolaemic animals breathing varying oxygen fractions.

Results

Survival times following progressive haemorrhage were similar in animals breathing room air (98 ± 10 min), 60% O2 (102 ± 6 min) or 100% O2 (90 ± 4 min), but significantly worse in those breathing 15% O2 (52 ± 8 min, P < 0.01). Significant derangements of blood pressure, aortic blood flow and lactataemia were observed in both hypoxaemic and hyperoxaemic groups compared to normoxaemic animals. Breathing 100% O2 increased arterial PO2 sevenfold and tPO2 approximately threefold over baseline values during normovolaemia and mild haemorrhage (20% blood volume removal). However, with progressive haemorrhage, and despite maintained PaO2 values, tissue PO2 fell in line with the decrease in global oxygen delivery.

Conclusion

Hypoxaemia and hyperoxaemia both compromised haemodynamics and biochemical markers of organ perfusion during severe, progressive haemorrhage. This may carry implications for resuscitation practice.

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Acknowledgments

This work was funded by the UK Medical Research Council and Integrative Pharmacological Fund. This work was undertaken at UCLH/UCL who receive a proportion of funding from the UK Department of Health’s NIHR Biomedical Research Centre’s funding scheme. We thank Oxford Optronix for kindly providing the tPO2 probes.

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Authors and Affiliations

  1. Bloomsbury Institute of Intensive Care Medicine, Department of Medicine and Wolfson Institute for Biomedical Research, University College London, Gower Street, London, UK

    Alex Dyson, Ray Stidwill, Val Taylor & Mervyn Singer

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  1. Alex Dyson
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  2. Ray Stidwill
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  3. Val Taylor
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Correspondence to Mervyn Singer.

Additional information

This article is discussed in the editorial available at: doi:10.1007/s00134-009-1576-3.

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Dyson, A., Stidwill, R., Taylor, V. et al. The impact of inspired oxygen concentration on tissue oxygenation during progressive haemorrhage. Intensive Care Med 35, 1783–1791 (2009). https://doi.org/10.1007/s00134-009-1577-2

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