Publications

Reuse, Charles; Vincent, Jean-Louis; Lejeune, Philippe; Kahn, Robert J. Author Information

SCOPUS: le.j

Reduced cardiac output is a crucial determinant in hypovolemic, cardiogenic and obstructive types of acute circulatory failure, but cardiac output is considered less meaningful in septic shock where the primary defect is thought to be peripheral. In septic states, oxygen transport values are typically elevated, and the altered oxygen extraction (ratio of oxygen uptake over oxygen supply) limits the ability of the tissues to increase their oxygen uptake in relation to high oxygen needs. To correct tissue hypoxia, oxygen consumption should be increased to a level where oxygen uptake equals oxygen demand and lactic acidosis resolves. For a given level of oxygen demand, the best option is to improve oxygen extraction so that oxygen consumption will be higher for the same level of oxygen transport. This, however, is very difficult. Another approach can consist of further increasing oxygen transport to meet the elevated oxygen demand. Whenever possible, the metabolic needs of the tissues should be restrained.

Recent years have seen the place of the pulmonary artery catheter in intensive care increasingly challenged, with one recent study reporting no difference in outcome in patients treated with or without a pulmonary artery catheter. However, this study has several methodological flaws and, although pulmonary artery catheterization should not be performed routinely on all patients, when used correctly by trained personnel in selected patients the pulmonary artery catheter continues to provide valuable information.

Risk-standardized septic shock mortality rates varied considerably between hospitals, suggesting that septic shock is an important performance target. However, efforts to profile hospital performance were sensitive to septic shock case definitions, suggesting that septic shock mortality is not currently ready for widespread use as a hospital quality measure.