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My paper 20 years later: effects of dobutamine on the VO2/DO2 relationship

Jean-Louis Vincent| Daniel De Backer
My Paper 20 Years Later
Volume 40, Issue 11 / November , 2014

Pages 1643 - 1648

Abstract

Introduction

Oxygen uptake (VO2) is independent of oxygen delivery (DO2) over a wide range of values, because O2 extraction can readily adapt to changes in DO2. However, VO2 can become DO2-dependent in acute circulatory failure.

Methods

Various methods of evaluating the presence of VO2/DO2 dependency were conducted, but criticized because of potential problems with mathematical coupling of data. Some 20 years ago, we proposed using a dobutamine test and showed similar relationships using direct and indirect measurements. Since these studies on the systemic VO2/DO2 relationship, investigators have also explored regional alterations.

Conclusion

The relationship between VO2 and DO2 remains an important concept. Abnormal global VO2/DO2 dependency does not exist in stable, critically ill patients, but can exist in circulatory shock of all etiologies. It can also occur regionally in septic patients, and microcirculatory alterations may contribute. Patient management should be titrated individually with careful assessment to identify those who will benefit from increased DO2.

Keywords

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