Do2 vo2
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Balance e interpretacion DO2/VO2
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Do2 vo2
- 1. Consumo/Entrega de O2Consumo/Entrega de O2 VO2/DO2VO2/DO2 M.C Rafael Herrera Enero 2016
- 2. Disponibilidad Oxigeno Centrales Gasto Cardiaco PaO2 Hemoglobina Periféricos Distribución de GC en tejidos ○ Regulación microcirculación (Humoral, Autonómico, Local) ○ Afinidad Hemoglobina Vincent Caille, Pierre Squara, Oxygen uptake-to-delivery relationship: a way to assess adequate flow, Critical Care 2011, 10(Suppl 3): S4 (doi:10.1186/cc4831)
- 3. Formulas Vincent Caille, Pierre Squara, Oxygen uptake-to-delivery relationship: a way to assess adequate flow, Critical Care 2011, 10(Suppl 3): S4 (doi:10.1186/cc4831)
- 9. 1. Fundamentos Hemodinamicos1. Fundamentos Hemodinamicos AporteAporte ConsumoConsumo Muerte Vida Aporte Crítico Consumo Mínimo
- 10. 1. Fundamentos Hemodinamicos1. Fundamentos Hemodinamicos VOVO22 DODO22 VO2 Minimo DO2 Critico AporteAporte ConsumoConsumo Dependencia Independencia de Aporte Aporte Critico Consumo Minimo Lactate
- 11. Un VO2 idéal no garantiza una adecuada circulacion a cada celula Pero es un requisito! La macrocirculación debe ser estabilizada antes de considerar la microcirculation. Considerar siempre el balanceConsiderar siempre el balance EntreEntre Vo2 actual y el requerido.Vo2 actual y el requerido. 1. Fundamentos Hemodinamico Gattinoni L et al, In: Pinsky & Payen ed. Functional hemodynamic monitoring. Springer 2005. p. 70-86.
- 12. 2. Debemos Monitorizar Vo2 Variable ClaveVariable Clave VO2 = plateau Variables DerivadasVariables Derivadas Descenso Lactato CO =« Ok » SvO2 =« Ok » Variables Derivadas de las DerivadasVariables Derivadas de las Derivadas Tension Arterial Adecuada Mejoria Clinica Valor Pronostico (AUC)Valor Pronostico (AUC) 0.72 0.70 0.54 (0.69) 0.55 (0,68) 0.66 0.66 Squara et al J Crit Care, 1994 VO2 = CO x 1.34 x Hb x (SaO2 – SvO2)
- 13. 2. Debemos Monitorizar Vo2 Variable ClaveVariable Clave VO2 = plateau Variables DerivadasVariables Derivadas Descenso Lactato CO = « Ok » SvO2 = « Ok » VariablesVariables Tension Arterial Adecuada Mejoria Clinica Interes FisiologicoInteres Fisiologico Interes del MonitoreoInteres del Monitoreo
- 14. 2. Debemos Monitorizar Vo2 Normal CO =2.3 – 3.2 L/min/m2 de acuerdo a edad CO Alto Hipermetabolismo Anemia Hipoxemia Mala Utilizacion/Difusion de Oxigeno CO Bajo Hipometabolismo, Anestesia Hipovolemia, Hipertension Falla Cardiaca Normal SvO2 = 68 – 74% SvO2 > 75% Hipometabolismo, Anestesia General Shunts Hiperdinamicos Bloqueo Mitocondrial (metabolico) SvO2 < 68% Hipermetabolismo Anemia Hipoxemia Bajo CO Vincent Caille, Pierre Squara, Oxygen uptake-to-delivery relationship: a way to assess adequate flow, Critical Care 2011, 10(Suppl 3): S4 (doi:10.1186/cc4831)
- 15. 2. Debemos Monitorizar Vo2 Vincent Caille, Pierre Squara, Oxygen uptake-to-delivery relationship: a way to assess adequate flow, Critical Care 2011, 10(Suppl 3): S4 (doi:10.1186/cc4831)
- 16. 4 tipos de falla circulatoria Vincent Caille, Pierre Squara, Oxygen uptake-to-delivery relationship: a way to assess adequate flow, Critical Care 2011, 10(Suppl 3): S4 (doi:10.1186/cc4831)
- 17. 2. Debemos Monitorizar Vo2 Vincent Caille, Pierre Squara, Oxygen uptake-to-delivery relationship: a way to assess adequate flow, Critical Care 2011, 10(Suppl 3): S4 (doi:10.1186/cc4831)
- 18. 22 33 44 0.820.82 0.760.76 0.70.7 SvOSvO22 COCO Si Hb y Sao2Si Hb y Sao2 EstableEstable Choque SepticoChoque Septico Choque CardiogenicoChoque Cardiogenico 5500 110000 115500 220000 Valor BasalValor Basal VOVO22 Disoxia (O2 aportado limita actDisoxia (O2 aportado limita act metabolica)metabolica) 2. Debemos Monitorizar Vo2 33 44 55 Ca-vOCa-vO22 Vincent Caille, Pierre Squara, Oxygen uptake-to-delivery relationship: a way to assess adequate flow, Critical Care 2011, 10(Suppl
- 19. 3. Extracción de Oxigeno Calculo: VO2/DO2 CaO2-CvO2/CaO2 Normal: 0.2 a 0.3 Bajo Aporte: 0.4 a 0.5 Fraccion de O2 liberada desde la microcirculación y consumino por tejidos Balance entre DO2/VO2 Vincent Caille, Pierre Squara, Oxygen uptake-to-delivery relationship: a way to assess adequate flow, Critical Care 2011, 10(Suppl 3): S4 (doi:10.1186/cc4831)
- 20. 3. Extracción de Oxigeno En deportistas, Extracion de hasta 80% Ajustes en extracción mantienen VO2 aun cuando DO2 es variable DO2 Critico: Punto en el cual VO2 depende de DO2 ○ Disoxia (O2 limita Energia) Vincent Caille, Pierre Squara, Oxygen uptake-to-delivery relationship: a way to assess adequate flow, Critical Care 2011, 10(Suppl 3): S4 (doi:10.1186/cc4831)
- 21. Conclusion Considerar Equivales VO 2 medido con requerido VO2 equivale a O2 requerido: 1. Estado Clinico Mejora 2. Disminuye el Lactato 3. CO y SvO2 se encuentran en valores empiricamente esperados deacuerdo a las necesidades estimadas 4. VO 2 alcanza una mesetaVincent Caille, Pierre Squara, Oxygen uptake-to-delivery relationship: a way to assess adequate flow, Critical Care 2011, 10(Suppl 3): S4 (doi:10.1186/cc4831)
- 22. Guia resumen VO2 = Objetivo cuantitativo confiable OK, si lactato baja, tension Arterial mejor y presenta un Mejor estado clinico CO y SvO2 en rangos Cuantitativos estimados normales Ok Resucitado pero inestable Choque Persistente
Notas del editor
- Why we need flow monitoring ?
- The fundamental function of the circulatory system is to allow each cell to produce enough energy for metabolic activity that means to bring them enough nutrients and enough oxygen. Although circulation is necessary to bring both nutrients and oxygen to cells, in critical care situations, the limiting factor for life is most often oxygenation.
- The fundamental function of the circulatory system is to allow each cell to produce enough energy for metabolic activity that means to bring them enough nutrients and enough oxygen. Although circulation is necessary to bring both nutrients and oxygen to cells, in critical care situations, the limiting factor for life is most often oxygenation.
- The fundamental function of the circulatory system is to allow each cell to produce enough energy for metabolic activity that means to bring them enough nutrients and enough oxygen. Although circulation is necessary to bring both nutrients and oxygen to cells, in critical care situations, the limiting factor for life is most often oxygenation.
- The fundamental function of the circulatory system is to allow each cell to produce enough energy for metabolic activity that means to bring them enough nutrients and enough oxygen. Although circulation is necessary to bring both nutrients and oxygen to cells, in critical care situations, the limiting factor for life is most often oxygenation.
- The fundamental function of the circulatory system is to allow each cell to produce enough energy for metabolic activity that means to bring them enough nutrients and enough oxygen. Although circulation is necessary to bring both nutrients and oxygen to cells, in critical care situations, the limiting factor for life is most often oxygenation.
- The fundamental function of the circulatory system is to allow each cell to produce enough energy for metabolic activity that means to bring them enough nutrients and enough oxygen. Although circulation is necessary to bring both nutrients and oxygen to cells, in critical care situations, the limiting factor for life is most often oxygenation.
- The fundamental function of the circulatory system is to allow each cell to produce enough energy for metabolic activity that means to bring them enough nutrients and enough oxygen. Although circulation is necessary to bring both nutrients and oxygen to cells, in critical care situations, the limiting factor for life is most often oxygenation.
- Then, a whole body VO2 equal to needs is not a guarantee that circulation (or ventilation or oxydation) is adequate for each cell But it is a pre-requisite ! Macro circulation must be stabilized before looking at the micro circulation. This statement is at a theoretical level. This is not a call to always measure VO2 and needs. But clinicians must keep in mind the concept of balance between theoretical needs and actual performance.
- Assuming that Hb is normal and stable and that SaO2 is stable, exactly the same relationship can be found replacing Ca-vO2 by SvO2 Then the position of the patient in the nomogram can be now continuously monitored. For a diagnostic objective that enough. But for a therapeutic objective, this nomogram gives no idea of the needs.
- Is VO2 assessment always necessary ?