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Oxygen Transport Assessment

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Monitoring Tissue Perfusion in Shock

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Abstract

In critical conditions, oxygen transport (i.e., the product of cardiac output by arterial oxygen content) is the main determinant of tissue oxygenation. Its assessment, therefore, is a crucial task in the intensive care unit. Although the value of oxygen transport is easily determined in this setting, such measurement might be insufficient to characterize the global state of tissue oxygenation. Since oxygen demands are varied and changing, isolated values of oxygen transport might be misleading. Attempts to characterize the relationship between oxygen transport and consumption are also futile. The assessment of oxygen transport should not only include measurements of its actual value or some surrogate but also a comprehensive evaluation of tissue oxygenation. Thus, the main goal of the assessment of oxygen transport is to show its adequacy to satisfy metabolic oxygen needs. In the absence of a gold standard of tissue oxygenation, the approach should include clinical evaluation (blood pressure, mental status, diuresis, and peripheral perfusion), laboratory variables (arterial blood gases and lactate), and markers of microvascular perfusion. Despite a large body of evidence favoring the usefulness of tissue capnometry, this technique is not used anymore. In the last years, the direct visualization of sublingual microcirculation has been introduced for bedside evaluation. It provides relevant information, not available when monitoring systemic cardiovascular and oxygen transport. Nevertheless, its actual role in the assessment of oxygen transport in critically ill patients remains controversial.

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Authors and Affiliations

  1. La Plata, Argentina

    Arnaldo Dubin

  2. Cátedra de Farmacología Aplicada, Facultad de Ciencias Médicas, Universidad Nacional de La Plata, Buenos Aires, Argentina

    Arnaldo Dubin

  3. Servicio de Terapia Intensiva, Sanatorio Otamendi y Miroli, Buenos Aires, Argentina

    Arnaldo Dubin

  4. Medical School Hospital of the Albert Einstein, Sao Paulo, Brazil

    Eliézer Silva

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  1. Department of Intensive Care, Erasmus MC University Hospital Rotterdam, Rotterdam, The Netherlands

    Alexandre Augusto Pinto Lima

  2. Medical School Hospital of the Albert Einstein, Sao Paulo, Brazil

    Eliézer Silva

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Dubin, A., Silva, E. (2018). Oxygen Transport Assessment. In: Pinto Lima, A., Silva, E. (eds) Monitoring Tissue Perfusion in Shock. Springer, Cham. https://doi.org/10.1007/978-3-319-43130-7_6

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