The Effect of Fluid Loading, Blood Transfusion, and Catecholamine Infusion on Oxygen Delivery and Consumption in Patients with Sepsis1,2

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Abstract
Fifty-four patients with systemic sepsis and signs of circulatory shock were prospectively investigated immediately before and after 1 of 3 therapeutic interventions chosen to increase systemic oxygen delivery (ḊO2): colloidal fluid loading (Group I, n = 20), blood transfusion (Group II, n = 17), or catecholamine infusion (dopamine or dobutamine, Group III, n = 17). Patients in Groups I and II with normal blood lactate concentrations (< 2.2 mmol/L) exhibited no significant increases in systemic oxygen consumption ( ) in response to the increases in ḊO2. However, significant increases in were noted in patients in Groups I and II with elevated lactate concentrations (> 2.2 mmol/L). In contrast to patients in Groups I and II, patients in Group III with and without lactic acidosis exhibited significant increases in after catecholamine administration. Lactic acidosis, a clinical marker of anaerobic metabolism or oxygen debt, appears to predict increases in in response to increases in ḊO2 in septic patients receiving fluid and blood. Patients receiving catecholamines increase without regard for the presence or absence of anaerobic metabolism. The results of this clinical trial therefore suggest that catecholamines may exert a direct effect on oxidative metabolism.

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