Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK.
Bloomsbury Institute of Intensive Care Medicine, Division of Medicine, University College London, London, UK.
Br J Anaesth. 2019 Aug;123(2):170-176. doi: 10.1016/j.bja.2019.03.027. Epub 2019 May 2.
Maintenance or prompt restoration of an oxygen supply sufficient to facilitate adequate cellular metabolism is fundamental in maintaining organ function. This is particularly relevant when metabolic needs change markedly, for example in response to major surgery or critical illness. The consequences of inadequate tissue oxygenation include wound and anastomotic breakdown, organ dysfunction, and death. However, our ability to identify those at risk and to promptly recognise and correct tissue hypoperfusion is limited. Reliance is placed upon surrogate markers of tissue oxygenation such as arterial blood pressure and serum lactate that are insensitive to early organ compromise. Advances in oxygen sensing technology will facilitate monitoring in various organ beds and allow more precise titration of therapies to physiologically relevant endpoints. Clinical trials will be needed to evaluate any impact on outcomes, however accurate on-line monitoring of the adequacy of tissue oxygenation offers the promise of a paradigm shift in resuscitation and perioperative practice. This narrative review examines current evidence for goal-directed therapy in the optimisation of organ perfusion in high-risk surgical and critically ill patients, and offers arguments to support the potential utility of tissue oxygen monitoring.
维持或迅速恢复充足的氧气供应以促进细胞代谢是维持器官功能的基础。当代谢需求发生显著变化时，例如在接受大手术或重症疾病时，这一点尤为重要。组织氧合不足的后果包括伤口和吻合口破裂、器官功能障碍和死亡。然而，我们识别风险并及时发现和纠正组织灌注不足的能力有限。我们依赖于组织氧合的替代标志物，如动脉血压和血清乳酸，这些标志物对早期器官损伤不敏感。氧传感技术的进步将有助于在各种器官床上进行监测，并允许更精确地根据生理相关终点滴定治疗。需要进行临床试验来评估任何对结果的影响，然而，准确的在线监测组织氧合的充分性为复苏和围手术期实践带来了范式转变的希望。本叙述性综述检查了在高危手术和重症患者中优化器官灌注的目标导向治疗的现有证据，并提出了支持组织氧监测潜在效用的论据。
