Objective: To evaluate the effects of increased oxygen
delivery on mortality and morbidity.
Randomized, controlled trial.
Medical-surgical ICU of a tertiary care hospital.
Patients: Sixty-three patients classified according to
predetermined criteria as having severe sepsis or septic shock.
Interventions: The patients were randomly assigned to one
of two groups: the control group (n = 32) received conventional
therapy with a normal targeted value of oxygen delivery, and the
treatment group (n = 31) received therapy with a targeted oxygen
delivery index (Do2i) value of>
600 mL/min/m2. The therapeutic approach to
maintain BP, arterial saturation, hemoglobin concentration, and
pulmonary artery occlusion pressure was similar in both groups.
Measurements and main results: The hemodynamic, oxygen
transport, and gastric intramucosal pH measurements were recorded at
the time of admission to the study and every 6 h for the next
96 h. The outcome measures were the rate of patient mortality and
the number of organ dysfunctions occurring during the ICU stay. The
study groups were similar with respect to demographics and admission
hemodynamic variables, but the percentage of patients with positive
blood cultures was significantly higher in the control group than in
the treatment group, respectively: 34 vs 13% (p = 0.04). The average
cardiac index was significantly higher in the treatment group than in
the control group, respectively: 3.96 vs 3.05 L/min/m2
(p = 0.01). This factor did not significantly affect the
Do2i. Nine of the 31
treatment group patients reached an average
Do2i value of > 600
mL/min/m2. The rate of mortality in the control group
patients up to the time of ICU discharge (66%) was similar to that
seen in the treatment group (74%), respectively: 21 of 32 vs 23 of 31
(p = 0.46). The number of dysfunctional organs per patient was also
similar in the control and treatment groups, respectively: 2.1 ± 1.1
vs 2.6 ± 1.2 (p = 0.12).
aimed at maximizing oxygen delivery in patients with severe sepsis or
septic shock does not reduce mortality or
CI = cardiac index;
Do2i = oxygen delivery index;
Fio2 = fraction of inspired oxygen;
Hb = hemoglobin; PAOP = pulmonary artery occlusion pressure;
pHi = gastric intramucosal pH; RR = relative risk;
Sao2 = arterial oxygen saturation;
Svo2 = mixed venous saturation;
V̇o2i = oxygen consumption