Intensive Care Medicine

, Volume 13, Issue 4, pp 223–229 | Cite as

The concept of a critical oxygen delivery

  • P. T. Schumacker
  • S. M. Cain
Review Articles


In healthy tissues, decreases in oxygen delivery (QOn) do not lower oxygen consumption (VO2) because tissue O2 extraction increases proportionately. When delivery is reduced below a critical threshold, VO2 falls because tissue extraction exceeds a critical threshold, and cannot compensate for the reduction in delivery. In the adult respiratory distress syndrome and perhaps in septicemia, tissue extraction capacity is impaired, leading to O2 supply dependency despite normal or increased overall delivery. This pathologic supply dependency could be caused by a loss in autoregulatory capacity, by disrupted blood flow distribution secondary to peripheral microembolization, or to other factors interfering with efficient tissue distribution of QO2 with respect to VO2. Alternatively, the increased VO2 may be consumed in biochemical pathways not associated with ATP production, or in the production of oxygen radicals or hydrogen peroxide. To the extent this abnormal dependence of VO2 on QO2 reflects tissue hypoxia, clinical interventions which decrease systemic delivery should be evaluated with regard to possible deleterious effects on organ system function.

Key words

ARDS Oxygen consumption Oxygen extraction ratio Respiratory failure Microcirculation Hypoxia 


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  1. 1.
    Rowell LB (1974) Human cardiovascular adjustments to exercise and thermal stress. Physiol Rev 54:75Google Scholar
  2. 2.
    Cain SM (1977) Oxygen delivery and uptake in dogs during anemic and hypoxic hypoxia. J Appl Physiol 42:228Google Scholar
  3. 3.
    Cain SM (1965) Appearance of excess lactate in anesthetized dogs during anemic and hypoxic hypoxia. Am J Physiol 209:604Google Scholar
  4. 4.
    Cain SM (1983) Peripheral oxygen uptake and delivery in health and disease. Clin Chest Med 4:139Google Scholar
  5. 5.
    Cain SM, Bradley WE (1983) Critical O2 transport values at lowered body temperatures in rats. J Appl Physiol 55:1713Google Scholar
  6. 6.
    Powers SR, Mannal R, Neclerio M, English M, Marr C, Leather R, Ueda H, Williams G, Custead W, Dutton R (1973) Physiologic consequences of positive end-expiratory pressure (PEEP) ventilation. Ann Surg 178:265Google Scholar
  7. 7.
    Rhodes GR, Newell JC, Shah D, Scovill W, Tauber J, Dutton RE, Powers SR (1978) Increased oxygen consumption accompanying increased oxygen delivery with hypertonic mannitol in adult respiratory distress syndrome. Surgery 84:490Google Scholar
  8. 8.
    Danek SJ, Lynch JP, Weg JG, Dantzker DR (1980) The dependence of oxygen uptake on oxygen delivery in the adult respiratory distress syndrome. Am Rev Respir Dis 122:387Google Scholar
  9. 9.
    Varela JB, Calvo ML, Fernandez RG, Perez-San-Jose MJ, Castaneda-Casado J (1982) Relacion entre consumo y transporte ed O2 en el sindrome del distress respiratorio del adulto (ARDS) inducido por la ingestion de aceite toxico. Rev Esp Anesthesiol Reanin 29:79Google Scholar
  10. 10.
    Mohsenifar Z, Goldbach P, Tashkin DP, Campisi DJ (1983) Relationship between O2 delivery and O2 consumption in the adult respiratory distress syndrome. Chest 84:267Google Scholar
  11. 11.
    Shibutani K, Komatsu T, Kubal K (1983) Critical level of oxygen delivery in anesthetized man. Crit Care Med 11:640Google Scholar
  12. 12.
    Krasney JA (1971) Regional circulatory responses to arterial hypoxia in the anesthetized dog. Am J Physiol 220:699Google Scholar
  13. 13.
    Granger HJ, Goodman AH, Granger DN (1976) Role of resistance and exchange vessels in local microvascular control of skeletal muscle oxygenation in the dog. Circ Res 38:379Google Scholar
  14. 14.
    Cain SM, Chapler CK (1980) O2 extraction by canine hindlimb during alpha-adrenergic blockade and hypoxic hypoxia. J Appl Physiol 48:630Google Scholar
  15. 15.
    Lindbom L, Tuma RF, Arfors KE (1980) Influence of oxygen on perfused capillary density and capillary red cell velocity in rabbit skeletal muscle. Microvasc Res 19:197Google Scholar
  16. 16.
    Honig CR, Odoroff CL (1981) Calculated dispersion of capillary transit times: significance for oxygen exchange. Am J Physiol 240:H199Google Scholar
  17. 17.
    Tenney SM (1974) A theoretical analysis of the relationship between venous blood and mean tissue oxygen pressures. Respir Physiol 20:283Google Scholar
  18. 18.
    Delaney JP (1969) Arteriovenous anastomotic blood flow in the mesenteric organs. Am J Physiol 216:1556Google Scholar
  19. 19.
    Hammerson F (1970) The terminal vascular bed in skeletal muscle with special regard to the problem of shunts. In: Crone C, Lassen N (eds) Capillary permeability. Munkagaard, Copenhagen, pp 351–371Google Scholar
  20. 20.
    Piiper J, Meyer M, Scheid P (1984) Dual role of diffusion in tissue gas exchange: blood-tissue equilibration and diffusion shunt. Respir Physiol 56:131Google Scholar
  21. 21.
    Duling BR, Berne RM (1970) Longitudinal gradients in periarteriolar oxygen tension. A possible mechanism for the participation of oxygen in local regulation of blood flow. Cir. Res 27:669Google Scholar
  22. 22.
    Rose CP, Goresky CA (1985) Limitations of tracer oxygen uptake in the canine coronary circulation. Circ Res 56:57Google Scholar
  23. 23.
    Andreadis N, Petty TL (1985) Adult respiratory distress syndrome: problems and progress. Am Rev Respir Dis 132:1344Google Scholar
  24. 24.
    Bachofen A, Weibel ER (1977) Alterations of the gas exchange apparatus in adult respiratory insufficiency associated with septicemia. Am Rev Respir Dis 116:589Google Scholar
  25. 25.
    Said SI (1982) Metabolic functions of the pulmonary circulation. Circ Res 50:325Google Scholar
  26. 26.
    Casey L, Krieger B, Kohler J, Rice C, Oparil S, Azidon P (1981) Decreased serum angiotensin converting enzyme in adult respiratory distress syndrome associated with sepsis: a preliminary report. Crit Care Med 9:651Google Scholar
  27. 27.
    Wilberg-Jorgensen F, Klausen NO, Hald A, Qvist J, Giese J, Damkjare Nielsen M (1983) Pulmonary angiotensin II production in respiratory failure. Clin Physiol 3:59Google Scholar
  28. 28.
    Caldwell PRB, Seegal BC, Hsu KC, Das M, SofferRI (1976) Angiotensinconverting enzyme: vascular endothelial localization. Science 191:1050Google Scholar
  29. 29.
    Pepe PE, Culver BH (1985) Independently measured oxygen consumption during reduction of oxygen delivery by positive end-expiratory pressure. Am Rev Respir Dis 132:788Google Scholar
  30. 30.
    Repine JE (1985) Neutrophils, oxygen radicals and acute pulmonary edema. In: Zapol WM, Falke KJ (eds) Acute respiratory failure. Lenfant C (ed) Lung biology in health and disease series. Marcel Dekker, New York, p 347Google Scholar
  31. 31.
    Newman JH (1985) Sepsis and pulmonary edema. Clin Chest Med 6:371Google Scholar
  32. 32.
    Cain SM (1984) Supply dependency of oxygen uptake in ARDS: myth or reality? Am J Med Sci 288:119Google Scholar
  33. 33.
    Gaehtgens P, Benner KU, Schickendantz S (1976) Nutritive and non-nutritive blood flow in canine skeletal muscle after partial microembolization. Pflugers Arch 361:183Google Scholar
  34. 34.
    Ellsworth ML, Goldfarb RD, Alexander RS (1981) Microembolization induced oxygen utilization impairment in the canine gracilis muscle. Adv Shock Res 5:89Google Scholar
  35. 35.
    Saldeen T (1976) Trends in microvasular research. The microembolism syndrome. Microvasc Res 11:227Google Scholar
  36. 36.
    Jones R, Zapol WM, Tomashefski JF Jr, Kirton OC, Kobayashi K, Reid L (1985) Pulmonary vascular pathology: Human and experimental studies. In: Zapol WM, Falke KJ (eds) Acute respiratory failure. Lung biology in health and disease series. Marcel Dekker, New York, p 23Google Scholar
  37. 37.
    Tucker HJ, Murray JF (1973) Effects of end-expiratory pressure on organ blood flow in normal and diseased dogs. J Appl Physiol 34:573Google Scholar
  38. 38.
    Kariman K, Burns SR (1985) Regulation of tissue oxygen extraction in disturbed in adult respiratory distress syndrome. Am Rev Respir Dis 132:109Google Scholar
  39. 39.
    Archie JP (1981) Mathematical coupling of data may produce invalid results and unjustified conclusions. Ann Surg 193:296Google Scholar
  40. 40.
    Chappell TR, Rubin LJ, Markham RV Jr, Firth BG (1983) Independence of oxygen consumption and systemic oxygen transport in patients with either stable pulmonary hypertension or refractory left ventricular failure. Am Rev Respir Dis 128:30Google Scholar
  41. 41.
    Moreno LF, Stratton HH, Newell JC, Feustel PJ (1986) Mathematical coupling of data: correction of a common error for linear calculations. J Appl Physiol 60:335Google Scholar
  42. 42.
    McCord JM (1985) Oxygen-derived free radicals in postischemic tissue injury. N Engl J Med 312:159Google Scholar
  43. 43.
    Bradley SG (1979) Cellular and molecular mechanisms of action of bacterial endotoxins. Ann Microbiol 33:67Google Scholar
  44. 44.
    Brigham K, Bowers R, Haynes J (1979) Increased sheep lung vascular permeability caused by Escherichia coli endotoxin. Circ Res 45:292Google Scholar
  45. 45.
    Snapper JR, Hinson JM Jr, Hutchinson AA, Lefferts PL, Ogletree MJ, Brigham KL (1984) Effects of platelet depletion on the unanesthetized sheep's pulmonary response to endotoxemia. J Clin Invest 74:1782Google Scholar
  46. 46.
    Said SI (1985) Peptides and lipids as mediators of acute lung injury. In: Zapol WA, Falke KJ (eds) Acute respiratory failure. Lung biology in health and disease series. Marcel Dekker, New York, p 435Google Scholar
  47. 47.
    Snapper J, Bernard GR, Hinson JM, Hutchinson AA, Loyd JE, Ogletree ML, Brigham KL (1983) Endotoxemia-induced leukopenia in sheep: correlation with lung vascular permeability and hypoxemia but not with pulmonary hypertension. Am Rev Respir Dis 127:306Google Scholar
  48. 48.
    Heflin AC, Brigham KL (1981) Prevention by granulocyte depletion of increased vascular permeability of sheep lung following endotoxemia. J Clin Invest 68:1253Google Scholar
  49. 49.
    Zwiefach BW, Thomas L (1957) The relationship between the vascular manifestations of shock produced by endotoxin, trauma and hemorrhage. I Certain similarities between the reactions in normal and endotoxin-tolerant rats. J Exp Med 106:385Google Scholar
  50. 50.
    Ghosh S, Liu MS (1983) Changes in alpha-adrenergic receptors in dog livers during endotoxic shock. J Surg Res 34:239Google Scholar
  51. 51.
    Baker CH, Wilmoth FR (1984) Microvascular responses to E Coli endotoxin with altered adrenergic activity. Cric Shock 12:165Google Scholar
  52. 52.
    Wood LDH, Prewitt RM (1981) Cardiovascular management in acute hypoxemic respiratory failure. Am J Cardiol 47:963Google Scholar

Copyright information

© Springer-Verlag 1987

Authors and Affiliations

  • P. T. Schumacker
    • 1
  • S. M. Cain
    • 2
  1. 1.Department of Pulmonary and Critical Care MedicineThe University of ChicagoChicagoUSA
  2. 2.Department of Physiology and BiophysicsUniversity of Alabama at BirminghamBirminghamUSA

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