TY - JOUR
T1 - Optimizing oxygen delivery in the critically Ill
T2 - The utility of lactate and central venous oxygen saturation (ScvO2) as a roadmap of resuscitation in shock
AU - Joshi, Raj
AU - De Witt, Benjamin
AU - Mosier, Jarrod M.
N1 - Publisher Copyright:
© 2014 Elsevier Inc.
PY - 2014/10/1
Y1 - 2014/10/1
N2 - Background Resuscitation of any critically ill patient is aimed at restoration of oxygen delivery to maintain aerobic metabolism. Thus, "endpoints" of resuscitation have been sought after as a measure of evaluating the adequacy of resuscitation. This review article describes the most commonly used endpoints, central venous oxygen saturation (ScvO2) and lactate, and provides a clinically useful paradigm for utilizing these endpoints during resuscitation of critically ill patients in the emergency department (ED). Objective This review article will summarize the pathophysiology of cellular shock, describe the available research regarding lactate and ScvO2, and provide an approach to utilizing these endpoints during resuscitation in the ED. Discussion ScvO2and lactate each have been shown to be useful for the assessment of shock, yet each has inherent limitations. When used together, ScvO2and lactate provide the emergency physician with a glimpse of the underlying pathophysiologic state, allowing targeted therapy to restore oxygen delivery. Conclusion ScvO2and lactate are useful endpoints of resuscitation, and when used together, provide a metabolic framework for guiding targeted therapy for critically ill patients in the ED with shock.
AB - Background Resuscitation of any critically ill patient is aimed at restoration of oxygen delivery to maintain aerobic metabolism. Thus, "endpoints" of resuscitation have been sought after as a measure of evaluating the adequacy of resuscitation. This review article describes the most commonly used endpoints, central venous oxygen saturation (ScvO2) and lactate, and provides a clinically useful paradigm for utilizing these endpoints during resuscitation of critically ill patients in the emergency department (ED). Objective This review article will summarize the pathophysiology of cellular shock, describe the available research regarding lactate and ScvO2, and provide an approach to utilizing these endpoints during resuscitation in the ED. Discussion ScvO2and lactate each have been shown to be useful for the assessment of shock, yet each has inherent limitations. When used together, ScvO2and lactate provide the emergency physician with a glimpse of the underlying pathophysiologic state, allowing targeted therapy to restore oxygen delivery. Conclusion ScvO2and lactate are useful endpoints of resuscitation, and when used together, provide a metabolic framework for guiding targeted therapy for critically ill patients in the ED with shock.
KW - central venous oxygen saturation
KW - lactate
KW - microcirculation shock
KW - oxygen delivery
UR - http://www.scopus.com/inward/record.url?scp=84907407300&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84907407300&partnerID=8YFLogxK
U2 - 10.1016/j.jemermed.2014.06.016
DO - 10.1016/j.jemermed.2014.06.016
M3 - Article
C2 - 25124137
AN - SCOPUS:84907407300
VL - 47
SP - 493
EP - 500
JO - Journal of Emergency Medicine
JF - Journal of Emergency Medicine
SN - 0736-4679
IS - 4
ER -