Rodrigues Roseny Dos Reis, Brunetta Denise Menezes, Costa Lorena, Benites Bruno Deltreggia, Magnus Mariana Munari, Alves Susankerle de Oliveira Costa, De Santis Gil Cunha, Rizzo Silvia Renata Cornélio Parolin, Rabello Guilherme, Junior Dante Mario Langhi
Hospital Israelita Albert Einstein são Paulo, São Paulo, SP, Brazil; Faculdade de Medicina da Universidade de São Paulo (FM USP), São Paulo, SP, Brazil.
Centro de Hematologia e Hemoterapia do Ceará (HEMOCE), Fortaleza, CE, Brazil; Complexo Hospitalar da Universidade Federal do Ceará (EBSERH - UFC), Fortaleza, CE, Brazil; Faculdade de Medicina da Universidade Federal do Ceará (FM UFC), Fortaleza, CE, Brazil.
Hematol Transfus Cell Ther. 2024 Apr;46 Suppl 1(Suppl 1):S77-S82. doi: 10.1016/j.htct.2024.02.010. Epub 2024 Mar 19.
Understanding the physiological concepts of oxygen delivery is essential to discern the mechanisms that influence its increase, reduction or maintenance in the body. This text explores the different mechanisms that help maintain oxygen delivery even in the face of reduced hemoglobin levels. Adequate oxygen delivery ensures tissue and metabolic balance, which is crucial to avoid harmful consequences such as metabolic acidosis and cellular dysoxia. The complex interaction between variables such as cardiac output, hemoglobin and heart rate (HR) plays a fundamental role in maintaining oxygen delivery, allowing the body to temporarily adjust to situations of anemia or high metabolic demand. It is important to emphasize that blood transfusions should not be based on fixed values, but rather on individual metabolic needs. Strategies to reduce myocardial consumption and monitor macro and micro hemodynamics help in making rational decisions. Individualizing treatment and considering factors such as blood viscosity in relation to the benefits of transfusion are increasingly relevant to optimize therapy and minimize risks, especially in complex clinical scenarios, such as neurocritical patients and trauma victims.
理解氧输送的生理概念对于识别影响其在体内增加、减少或维持的机制至关重要。本文探讨了即使在血红蛋白水平降低的情况下仍有助于维持氧输送的不同机制。充足的氧输送可确保组织和代谢平衡，这对于避免诸如代谢性酸中毒和细胞缺氧等有害后果至关重要。心输出量、血红蛋白和心率（HR）等变量之间的复杂相互作用在维持氧输送方面起着基本作用，使身体能够暂时适应贫血或高代谢需求的情况。必须强调的是，输血不应基于固定值，而应基于个体的代谢需求。降低心肌消耗和监测宏观及微观血流动力学的策略有助于做出合理决策。个性化治疗并考虑诸如与输血益处相关的血液粘度等因素，对于优化治疗和将风险降至最低越来越重要，尤其是在复杂的临床场景中，如神经重症患者和创伤受害者。
