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Abstract
Inadequate tissue oxygenation may occur in critically ill patients with sepsis despite
an apparently adequate O2 transport (QO2), and this may contribute to the development
of an O2 debt and also to multiple organ failure. It has been shown that increasing
QO2 by infusing a vasodilator may reveal this O2 debt in septic patients. To investigate
whether the site of action of vasodilators may be of importance in unmasking such
an O2 debt, we administered prostacyclin, a prostaglandin with a preferential effect
on the microcirculation, and phentolamine, an arteriolar vasodilator, in 11 patients
studied during the first 48 hours after the onset of sepsis, and compared their effect
on whole body oxygen consumption (VO2) and skin microvascular blood flow. The results
demonstrated that increasing QO2 by prostacyclin but not by phentolamine significantly
increases VO2 in critically ill patients with sepsis. The site of action of vasodilators
may therefore play an important role in their ability to unmask an O2 debt.