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April 20, 1994

Critical Oxygen Delivery in Patients With Sepsis

Author Affiliations

Northeastern Ohio Universities College of Medicine Rootstown
Free University of Berlin Berlin, Germany

JAMA. 1994;271(15):1158. doi:10.1001/jama.1994.03510390028015

To the Editor.  —Thanks to Dr Ronco and colleagues,1 their patients, and their patients' families, we have a glimpse into the world of oxygen extraction in severely limited conditions that was previously available only in animal models. However, we wish to comment on the authors' reasoning that because critical oxygen delivery (Do2) was surprisingly low as these patients neared death, it may be generally inappropriate to increase Do2 to high levels in an attempt to increase oxygen uptake (Vo2) and ultimately improve outcome in critically ill patients.First, these patients were considered beyond medical help; any direct application would closely fit only other "hopeless" patients. Normal body temperature of the end-stage septic shock patients illustrates that they were not representative of patients earlier in shock, perhaps the only period when therapeutic measures are effective. The authors only briefly mention this lack of generalizability.Second, the protocol

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