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Peripheral oxygen availability within skeletal muscle in sepsis and septic shock: Comparison to limited infection and cardiogenic shock

Periphere Sauerstoffverfügbarkeit im Skelettmuskel bei Sepsis und septischem Schock: Vergleich mit begrenzter Infektion und kardiogenem Schock

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Summary

In 40 intensive care patients, tissue oxygen partial pressure distribution within skeletal muscle was measured in order to estimate peripheral oxygen availability. In septic patients with multiple organ failure (n=20) mean skeletal muscle pO2 was abnormally high (48.8 +/- 8.5 mmHg, p<0.001) in contrast to patients with limited infection without sepsis (28.3 +/- 5.9 mmHg, n=10). Mean muscle pO2 also discriminated between septic and cardiogenic shock (22.6 +/- 6.9 mmHg, p<0.001). The characteristic pattern of oxygen availability in septic patients — but not in patients with limited infection — was high skeletal muscle pO2, high whole body oxygen delivery and low whole body oxygen extraction, which was not influenced by the type of pathogenic agent of sepsis. In our patients in severe stage of sepsis, we did not observe local skeletal muscle hypoxia due to microcirculatory disorder. High mean skeletal muscle pO2 suggested reduced oxygen consumption within tissue rather than reduced oxygen transport to tissue in sepsis.

Zusammenfassung

Bei 40 Intensivpatienten wurde die Sauerstoffpartialdruck(pO2)-Verteilung im Skelettmuskelgewebe gemessen, um die periphere Sauerstoffverfügbarkeit abzuschätzen. Bei septischen Patienten mit Multiorganversagen (n=20) war der mittlere Muskel pO2 abnorm hoch (48,8 +/- 8,5 mmHg, p<0,001) im Gegensatz zu Patienten mit begrenzter Infektion (28,3 +/- 5,9 mmHg, n=10). Septischer und kardiogener Schock (22,6 +/- 6,9 mmHg) unterschieden sich ebenfalls deutlich in der Höhe des mittleren Muskel-pO2. Die für die Sepsis — nicht jedoch für die begrenzte Infektion ohne Sepsis — charakteristische Konstellation mit hohem peripherem Skelettmuskel-pO2, hohem Ganzkörper-O2-Angebot und niedriger Ganzkörper-O2-Extraktion war bei unterschiedlichen pathogenen Keimen in gleicher Weise vorhanden. Bei unseren Patienten mit schwerer Sepsis konnten wir keine lokale Hypoxie im Skelettmuskel als Hinweis für eine Mikrozirkulationsstörung beobachten. Der hohe mittlere Skelettmuskel-pO2 spricht eher für einen niedrigen zellulären O2-Verbrauch im Gewebe als für einen reduzierten O2-Transport zum Gewebe in der Sepsis.

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References

  1. Wolf, Y. G., Cotev, Sh., Perel, A., Manny, J. Dependence of oxygen consumption on cardiac output in sepsis. Crit. Care Med. 15 (1987) 198–203.

    Google Scholar 

  2. Gilbert, E. M., Haupt, M. T., Mandanas, R. Y., Huaringa, A. J., Carlson, R. W. The effects of fluid loading, blood transfusion, and catecholamine infusion on oxygen delivery and consumption in patients with sepsis. Am. Rev. Respir. Dis. 134 (1986) 873–878.

    Google Scholar 

  3. Bihari, D., Smithies, M., Gimson, A., Tinker, J. The effects of vasodilation with prostacyclin on oxygen delivery and uptake in critically ill patients. N. Engl. J. Med. 317 (1987) 397–403.

    Google Scholar 

  4. Kaufmann, B. S., Rackow, E. C., Falk, J. L. The relationship between oxygen delivery and consumption during fluid resuscitation of hypovolemic and septic shock. Chest 85 (1984) 336–340.

    Google Scholar 

  5. Gutierrez, G., Pohil, R. J. Oxygen consumption is linearily related to O2 supply in critically ill patients. J. Crit. Care 1 (1986) 45–63.

    Google Scholar 

  6. Bredle, D. L., Samsel, R. W., Schumacker, P. T., Cain, S. M. Critical O2 delivery to skeletal muscle at high and low pO2 in endotoxemic dogs. J. Appl. Physiol. 66 (1989) 2553–2558.

    Google Scholar 

  7. Vincent, J. E., Roman, A., De Backer, D., Kahn, R. J. Oxygen uptake/supply dependency. Am. Rev. Respir. Dis. 142 (1990) 2–7.

    Google Scholar 

  8. Nelson, D. P., Samsel, R. W., Wood, L. D., Schumacker, P. T. Pathological supply dependency of systemic and intestinal O2 uptake during endotoxemia. J. Appl. Physiol. 64 (1988) 2410–2419.

    Google Scholar 

  9. Nelson, D. P., Beyer, C., Samsel, R. W., Wood, L. D. H., Schumacker, P. T. Pathological supply dependence of O2 uptake during bacteremia in dogs. J. Appl. Physiol. 63 (1987) 1487–1492.

    Google Scholar 

  10. Samsel, R. W., Nelson, D. P., Sanders, W. M., Wood, L. D. H., Schumacker, P. T. Effect of endotoxin on systemic and skeletal muscle O2 extraction. J. Appl. Physiol. 65 (1988) 1377–1382.

    Google Scholar 

  11. Villar, J., Slutsky, A. S., Hew, E., Aberman, A. Oxygen transport and oxygen consumption in critically ill patients. Chest 98 (1990) 687–692.

    Google Scholar 

  12. Bone, R. C., Slotman, G., Maunder, R., Silverman, H., Hyers, T. M., Kerstein, M. D. Randomized double blind, multicenter study of prostaglandin E1 in patients with adult respiratory distress syndrome. Chest 96 (1989) 114–119.

    Google Scholar 

  13. Shoemaker, W. C. Was a magic bullet aimed in the right direction? Chest 98 (1990) 257.

    Google Scholar 

  14. Vermej, C. G., Feenstra, B. W. A., Bruining, H. A. Oxygen delivery and oxygen uptake in postoperative and septic patients. Chest 98 (1990) 415–420.

    Google Scholar 

  15. Rackow, E. C., Astiz, M. E., Weil, M. H. Cellular oxygen metabolism during sepsis and shock. JAMA 259 (1988) 1989–1993.

    Google Scholar 

  16. Siegel, J. H. The metabolic basis of the septic multiple organ failure syndrome: abnormal energetic fuel control, pathophysiologic proteolysis and futile cycling of hepatically synthesized substrates. In:Schlag, G., Redl, H., Siegel, J. H. (eds.): Shock, sepsis and organ failure. Springer, Berlin-Heidelberg-New York 1990 pp. 92–150.

    Google Scholar 

  17. Silverman, H. J., Slotman, G., Bone, R. C., Maunder, R., Hyers, Th. M., Kerstein, M. D., Ursprung, J. J. andthe Prostaglandin E 1 Study Group Effects of prostaglandin E1 on oxygen delivery and consumption in patients with the adult respiratory distress syndrome. Chest 98 (1990) 405–410.

    Google Scholar 

  18. Cryer, H. M., Garrison, R. N., Kaebnick, H. W., Harris, P. D., Flint, L. M. Skeletal microcirculatory responses to hyperdynamicEscherichia coli sepsis in unanesthesized rats. Arch. Surg. 122 (1987) 86–92.

    Google Scholar 

  19. Demling, R. H., Wong, C., Wenger, H. Effect of endotoxin on the integrity of the peripheral (soft tissue) microcirculation. Circulatory Shock 12 (1984) 191–202.

    Google Scholar 

  20. Messmer, K. Microcirculatory changes in endotoxinemia and septic shock. In:Vincent, J. L., Thijs, L. G. (eds.): Septic Shock. Springer, Berlin-Heidelberg-New York 1987 pp. 35–45.

    Google Scholar 

  21. Gutierrez, G., Lund, N., Palizas, F., Acero, A. Skeletal muscle PO2 during hypodynamic sepsis. Adv. Exp. Med. Biol. 272 (1990) 559–567.

    Google Scholar 

  22. Kessler, M., Höper, J., Harrison, D. K., Skolasinka, K., Klövekorn, W. P., Sebening, F., Volkholz, H. J., Beier, I., Kernbach, C., Rettig, V., Richter, H. Tissue O2 supply under normal and pathological conditions. Adv. Exp. Med. Biol. 169 (1984) 69–81.

    Google Scholar 

  23. Beerthuizen, G. I. J. M., Goris, R. J. A., Bredel, J. J., Mashhour, Y. A., Kimmick, H. P., v.d. Kley, A. J., Kreuzer, F. Muscle oxygen tension, hemodynamics, and oxygen transport after extracorporal circulation. Crit. Care Med. 16 (1988) 748–750.

    Google Scholar 

  24. Beerthuizen, G. I. J. M., Goris, R. J. A., Kreuzer, F. J. A. Early detection of shock in critically ill patients by skeletal muscle pO2 assessment. Arch. Surgery 124 (1989) 853–855.

    Google Scholar 

  25. Vaupel, P., Kallinowski, F., Okunieff, P. Blood flow, oxygen and nutrient supply, and metabolic microenvironment of human tumors: a review. Cancer Research 49 (1989), 6449–6465.

    Google Scholar 

  26. Pilz, G., Gurniak, T., Bujdoso, O., Werdan, K. A basic program for calculation of APACHE II and Elebute scores and sepsis evaluation in intensive care medicine. Comput. Biol. Med. 21 (1991) 143–159.

    Google Scholar 

  27. Pilz, G., Werdan, K. Cardiovascular parameters and scoring systems in the evaluation of response to therapy in sepsis and septic shock. Infection 18 (1990) 253–262.

    Google Scholar 

  28. Montgomery, A. B., Stager, M. A., Carrico, C. J., Hudson, L. D. Causes of mortality in patients with the adult respiratory distress syndrome. Am. Rev. Respir. Dis. 132 (1985) 485–489.

    Google Scholar 

  29. Hinshaw, L., Peduzzi, P., Young, E., Sprung, C., Shatney, C., Sheagren, J., Wilson, M., Haakenson, C., andThe Veterans Administration Systemic Sepsis Cooperative Study Group Effect of high dose glucocorticoid therapy on mortality in patients with clinical signs of systemic sepsis. N. Engl. J. Med. 317 (1987) 659–665.

    Google Scholar 

  30. Pacher, R., Redl, H., Frass, M. Relationship between neopterin and granulocyte elastase plasma levels and the severity of multiple organ failure. Crit. Care Med. 17 (1989) 221–226.

    Google Scholar 

  31. Knaus, W. A., Draper, E. A., Wagner, D. P., Zimmermann, J. E. APACHE II: A severity of disease classification system. Crit. Care Med. 13 (1985) 818–829.

    Google Scholar 

  32. Elebute, E. A., Stoner, H. B. The grading of sepsis. Br. J. Surg. 70 (1983) 29–31.

    Google Scholar 

  33. Grundmann, R., Kipping, N., Wesoly, C. Der “Sepsisscore” von Elebute und Stoner zur Definition der postoperativen Sepsis auf der Intensivstation. Intensivmed. 25 (1988) 268–273.

    Google Scholar 

  34. Ganz, W., Swan, H. J. C. Measurement of blood flow by thermodilution. Am. J. Cardiol. 29 (1972) 241–245.

    Google Scholar 

  35. Berk, J. L., Sampliner, J. E. Handbook of Critical Care. Little, Brown and Company, Boston 1982.

    Google Scholar 

  36. Boekstegers, P., Riessen, R., Seyde, W. Oxygen partial pressure distribution within skeletal muscle: indicator of whole body oxygen delivery in patients? Adv. Exp. Med. Biol. 272 (1990) 507–514.

    Google Scholar 

  37. Boekstegers, P., Weiss, M. Tissue oxygen partial pressure distribution within the human skeletal muscle during hypercapnia. Adv. Exp. Med. Biol. 272 (1990) 525–531.

    Google Scholar 

  38. Boekstegers, P., Fleckenstein, W., Rosport, A., Ruchewsky, W., Braun, U. Überwachung der Sauerstoffversorgung des Skelettmuskels und der Gesamtsauerstoffaufnahme bei koronarchirurgischen Eingriffen. Anaesthesist 37 (1988) 287–296.

    Google Scholar 

  39. Pilz, G., Stäblein, A., Reuschel-Janetschek, E., Autenrieth, G., Werdan, K. The use of scoring systems in patients with cardiogenic and septic shock. In:Schlag, G., Redl, H. (eds.): Progress in clinical and biological research, Second Vienna Shock Forum. Alan R. Liss, New York 308 (1989) pp.625–631.

    Google Scholar 

  40. Parker, M. M., Parrillo, J. E. Septic shock: hemodynamics and pathogenesis. JAMA 250 (1983) 3324–3327.

    Google Scholar 

  41. Parillo, J. E. Septic shock in humans. Ann. Int. Med. 113 (1990) 227–242.

    Google Scholar 

  42. Reinhardt, K., Bloos, F., König, F., Hannemann, L., Kuss, B. Oxygen transport related variables and muscle tissue oxygenation in critically ill patients with and without sepsis. Adv. Exp. Med. Biol. 277 (1990) 861–864.

    Google Scholar 

  43. Harrison, D. K., Höper, J., Günther, H., Vogel, H., Frank, K. H., Brunner, M., Ellermann, R., Kessler, M. Microcirculation and PO2 in skeletal muscle during respiratory hypoxia and stimulation. Adv. Exp. Med. Biol. 169 (1984) 477–485.

    Google Scholar 

  44. Weiss, Ch., Fleckenstein, W. Local tissue pO2 measured with “thick” needle probes. Funktionsanalyse biologischer Systeme 15 (1986) 155–166.

    Google Scholar 

  45. Fleckenstein, W., Schäffler, A., Heinrich, R., Petersen, C., Günderoth-Palmowski, M., Nollert, G.: On the differences between muscle pO2 measurements obtained with hypodermic needle probes and with multiwire surface probes. In:Ehrly, A. M., Fleckenstein, W., Hauss, J., Huch, R. (eds.): Clinical Oxygen Pressure Measurement II. Blackwell Ueberreuter Berlin 1990 pp. 256–278.

  46. Vary, Th. C., Siegel, J. H., Nakatani, Th., Sato, T., Aoyama, H. Effect of sepsis on activity of pyruvate dehydrogenase complex in skeletal muscle and liver. Am. J. Physiol. 250 (1986) E634–640.

    Google Scholar 

  47. Vary, Th. C., Siegel, J. H., Tall, B., Morris, J. G. Role of anaerobic bacteria in intra-abdominal septic abscesses in mediating septic control of skeletal muscle glucose oxidation and lactic acidemia. J. Trauma 29 (1989) 1003–1114.

    Google Scholar 

  48. Boekstegers, P., Diebold, J., Weiss, Ch. Selective ECG synchronized suction and retroinfusion of coronary veins: first results of studies in acute myocardial ischaemia in dogs. Cardiovascular Research 24 (1990), 456–464.

    Google Scholar 

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  1. Medizinische Klinik I, Klinikum Grosshadern, Universität München, Marchioninistr. 15, W-8000, München 70, Germany

    P. Boekstegers,  St. Weidenhöfer,  G. Pilz &  K. Werdan

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Boekstegers, P., Weidenhöfer, S., Pilz, G. et al. Peripheral oxygen availability within skeletal muscle in sepsis and septic shock: Comparison to limited infection and cardiogenic shock. Infection 19, 317–323 (1991). https://doi.org/10.1007/BF01645355

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