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Role of Oxygen Debt in the Development of Organ Failure Sepsis, and Death in High-Risk Surgical Patients
Section snippets
Clinical Series
A series of 253 high-risk surgical patients were studied in the preoperative, intraoperative, and early postoperative periods. Their average age was 59 ± 16 yrs (± SD); 134 (53 percent) were male patients, and 119 (47 percent) were female. Sixty-four patients (25 percent) died, all of whom had organ failure; 31 (12 percent) survived with organ failure or major complications; and 158 (62 percent) survived without organ failure. The clinical features and the high-risk criteria for each group are
Preoperative Baseline Hemodynamics and Oxygen Transport
Table 2 summarizes preoperative baseline hemodynamics, arterial oxygen tension (PaO2), , and values of those who died during their hospitalization, survivors with organ failure or complications, and survivors without organ failure or complications. There was considerable similarity among these baseline control values of the groups, but the nonsurvivors had slightly higher wedge pressures and lower than the other two groups, while survivors without either organ
DISCUSSION
Previous studies had demonstrated reduced during and immediately after surgical trauma from from maldistributed or inadequate tissue perfusion in the face of increased metabolic need is an early pathogenic mechanism that produces organ failure and death. Possible contributing influences of inadequate perfusion include (a) myocardial and metabolic depression from anesthetic agents; (b) delay or failure to keep up with fluid and blood losses; (c) uneven vasoconstriction by neural
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Manuscript received May 7; revision accepted December 23.