| Abstract: | Oxygen delivery and utilization were studied in a rapidly fatal model of rat peritonitis. Cecal ligation and perforation induced peritonitis and septic shock in five animals. Five animals served as sham-operated controls. Arterial pressure, central venous pressure, cardiac index, hemoglobin, plasma colloid osmotic pressure, arterial blood lactate concentration, and arterial and central venous oxygen saturation were sequentially measured over 5 hr. In septic animals, decreases in mean central venous pressure were associated with hemoconcentration and decreases in plasma colloid osmotic pressure from 16.3 +/- 0.8 to 12.2 +/- 0.1 mmHg (P less than 0.05). The cardiac index decreased from 359 +/- 35 to 166 +/- 25 ml/kg/min (P less than 0.001), and arterial lactate increased from 0.2 +/- 0.1 to 2.1 +/- 0.4 mmol (P less than 0.001). However, oxygen consumption was maintained secondary to increases in systemic oxygen extraction. Arterial lactate concentration was inversely correlated with systemic oxygen delivery and central venous oxygen saturation (r = -0.68, P less than 0.05 and r = -0.71, P less than 0.001, respectively). These observations during lethal peritonitis suggest that hypovolemia is associated with increases in microvascular permeability, although the concomitant influence of intravascular pooling cannot be excluded. Decreases in systemic perfusion appear to account for critical oxygen deficits and lactic acidosis. The increases in systemic oxygen extraction imply that cellular oxygen utilization is maintained during lethal septic shock. |
