Oxygen delivery and consumption
- Ilene M Rosen, MD, MSCE
Ilene M Rosen, MD, MSCE
- Associate Professor of Clinical Medicine
- University of Pennsylvania School of Medicine
- Scott Manaker, MD, PhD
Scott Manaker, MD, PhD
- Section Editor — Critical Care
- Professor of Medicine
- University of Pennsylvania School of Medicine
Inspired oxygen from the environment moves across the alveolar-capillary membrane into the blood. Most of the oxygen binds to hemoglobin in red blood cells, although a small amount dissolves into the plasma. The oxygen is then transported from the lungs to the peripheral tissues, where it is removed from the blood and used to fuel aerobic cellular metabolism. This process can be conceptualized as three steps: oxygenation, oxygen delivery, and oxygen consumption. In this topic review, oxygen delivery and consumption are reviewed. Oxygenation is discussed separately. (See "Oxygenation and mechanisms of hypoxemia".)
Oxygen content — The arterial oxygen content (CaO2) is the amount of oxygen bound to hemoglobin plus the amount of oxygen dissolved in arterial blood:
CaO2 (mL O2/dL) = (1.34 x hemoglobin concentration x SaO2) + (0.0031 x PaO2)
where SaO2 is the arterial oxyhemoglobin saturation and PaO2 is the arterial oxygen tension. In dyshemoglobinemias, the oxygen content is calculated with the same equation, although the saturations (and therefore the oxygen content) will be different for a specific PaO2 . Normal CaO2 is approximately 20 mL O2/dL.
Similarly, the mixed venous blood oxygen content (CvO2) is the amount of oxygen bound to hemoglobin plus the amount of oxygen dissolved in mixed venous blood:
Subscribers log in hereLiterature review current through: Jul 2017. | This topic last updated: Jun 12, 2017.References
- Needleman JP, Setty BN, Varlotta L, et al. Measurement of hemoglobin saturation by oxygen in children and adolescents with sickle cell disease. Pediatr Pulmonol 1999; 28:423.
- Feenstra BW, Holland WP, van Lanschot JJ, Bruining HA. Design and validation of an automatic metabolic monitor. Intensive Care Med 1985; 11:95.
- Vermeij CG, Feenstra BW, Adrichem WJ, Bruining HA. Independent oxygen uptake and oxygen delivery in septic and postoperative patients. Chest 1991; 99:1438.
- Mira JP, Fabre JE, Baigorri F, et al. Lack of oxygen supply dependency in patients with severe sepsis. A study of oxygen delivery increased by military antishock trouser and dobutamine. Chest 1994; 106:1524.
- Shepherd AP, Granger HJ, Smith EE, Guyton AC. Local control of tissue oxygen delivery and its contribution to the regulation of cardiac output. Am J Physiol 1973; 225:747.
- Dantzker DR, Foresman B, Gutierrez G. Oxygen supply and utilization relationships. A reevaluation. Am Rev Respir Dis 1991; 143:675.
- Dantzker D. Oxygen delivery and utilization in sepsis. Crit Care Clin 1989; 5:81.
- Cain SM. Acute lung injury. Assessment of tissue oxygenation. Crit Care Clin 1986; 2:537.
- Kruse JA, Haupt MT, Puri VK, Carlson RW. Lactate levels as predictors of the relationship between oxygen delivery and consumption in ARDS. Chest 1990; 98:959.
- Chioléro R, Flatt JP, Revelly JP, Jéquier E. Effects of catecholamines on oxygen consumption and oxygen delivery in critically ill patients. Chest 1991; 100:1676.
- Dhakal BP, Malhotra R, Murphy RM, et al. Mechanisms of exercise intolerance in heart failure with preserved ejection fraction: the role of abnormal peripheral oxygen extraction. Circ Heart Fail 2015; 8:286.
- Cain SM. Oxygen delivery and uptake in dogs during anemic and hypoxic hypoxia. J Appl Physiol Respir Environ Exerc Physiol 1977; 42:228.
- Shibutani K, Komatsu T, Kubal K, et al. Critical level of oxygen delivery in anesthetized man. Crit Care Med 1983; 11:640.
- Wysocki M, Besbes M, Roupie E, Brun-Buisson C. Modification of oxygen extraction ratio by change in oxygen transport in septic shock. Chest 1992; 102:221.
- Silverman HJ. Lack of a relationship between induced changes in oxygen consumption and changes in lactate levels. Chest 1991; 100:1012.
- Annat G, Viale JP, Percival C, et al. Oxygen delivery and uptake in the adult respiratory distress syndrome. Lack of relationship when measured independently in patients with normal blood lactate concentrations. Am Rev Respir Dis 1986; 133:999.
- Shoemaker WC, Appel PL, Kram HB. Role of oxygen debt in the development of organ failure sepsis, and death in high-risk surgical patients. Chest 1992; 102:208.
- Vermeij CG, Feenstra BW, Bruining HA. Oxygen delivery and oxygen uptake in postoperative and septic patients. Chest 1990; 98:415.
- Russell JA, Ronco JJ, Lockhat D, et al. Oxygen delivery and consumption and ventricular preload are greater in survivors than in nonsurvivors of the adult respiratory distress syndrome. Am Rev Respir Dis 1990; 141:659.
- Danek SJ, Lynch JP, Weg JG, Dantzker DR. The dependence of oxygen uptake on oxygen delivery in the adult respiratory distress syndrome. Am Rev Respir Dis 1980; 122:387.
- Mohsenifar Z, Goldbach P, Tashkin DP, Campisi DJ. Relationship between O2 delivery and O2 consumption in the adult respiratory distress syndrome. Chest 1983; 84:267.
- Kariman K, Burns SR. Regulation of tissue oxygen extraction is disturbed in adult respiratory distress syndrome. Am Rev Respir Dis 1985; 132:109.
- Ronco JJ, Montaner JS, Fenwick JC, et al. Pathologic dependence of oxygen consumption on oxygen delivery in acute respiratory failure secondary to AIDS-related Pneumocystis carinii pneumonia. Chest 1990; 98:1463.
- Russell JA, Phang PT. The oxygen delivery/consumption controversy. Approaches to management of the critically ill. Am J Respir Crit Care Med 1994; 149:533.
- Ronco JJ, Phang PT, Walley KR, et al. Oxygen consumption is independent of changes in oxygen delivery in severe adult respiratory distress syndrome. Am Rev Respir Dis 1991; 143:1267.
- Villar J, Slutsky AS, Hew E, Aberman A. Oxygen transport and oxygen consumption in critically ill patients. Chest 1990; 98:687.
- Weissman C, Kemper M. The oxygen uptake-oxygen delivery relationship during ICU interventions. Chest 1991; 99:430.
- Boyd O, Grounds M, Bennett D. The dependency of oxygen consumption on oxygen delivery in critically ill postoperative patients is mimicked by variations in sedation. Chest 1992; 101:1619.
- Majerus TC, Chodoff P, Borel CO. Dopamine and dobutamine in septic shock. A comparison. Arch Int Physiol Biochim 1984; 92:S65.
- Gilbert EM, Haupt MT, Mandanas RY, et al. The effect of fluid loading, blood transfusion, and catecholamine infusion on oxygen delivery and consumption in patients with sepsis. Am Rev Respir Dis 1986; 134:873.
- Shoemaker WC, Appel PL, Kram HB. Hemodynamic and oxygen transport effects of dobutamine in critically ill general surgical patients. Crit Care Med 1986; 14:1032.
- Shoemaker WC, Appel PL, Kram HB, et al. Comparison of hemodynamic and oxygen transport effects of dopamine and dobutamine in critically ill surgical patients. Chest 1989; 96:120.
- Vincent JL, Roman A, Kahn RJ. Dobutamine administration in septic shock: addition to a standard protocol. Crit Care Med 1990; 18:689.
- Vincent JL, Roman A, De Backer D, Kahn RJ. Oxygen uptake/supply dependency. Effects of short-term dobutamine infusion. Am Rev Respir Dis 1990; 142:2.
- Lobo SM, Salgado PF, Castillo VG, et al. Effects of maximizing oxygen delivery on morbidity and mortality in high-risk surgical patients. Crit Care Med 2000; 28:3396.
- Ronco JJ, Fenwick JC, Wiggs BR, et al. Oxygen consumption is independent of increases in oxygen delivery by dobutamine in septic patients who have normal or increased plasma lactate. Am Rev Respir Dis 1993; 147:25.
- Hayes MA, Timmins AC, Yau EH, et al. Elevation of systemic oxygen delivery in the treatment of critically ill patients. N Engl J Med 1994; 330:1717.
- Alía I, Esteban A, Gordo F, et al. A randomized and controlled trial of the effect of treatment aimed at maximizing oxygen delivery in patients with severe sepsis or septic shock. Chest 1999; 115:453.
- Tuchschmidt J, Fried J, Astiz M, Rackow E. Elevation of cardiac output and oxygen delivery improves outcome in septic shock. Chest 1992; 102:216.
- Bollaert PE, Bauer P, Audibert G, et al. Effects of epinephrine on hemodynamics and oxygen metabolism in dopamine-resistant septic shock. Chest 1990; 98:949.
- Kaufman BS, Rackow EC, Falk JL. The relationship between oxygen delivery and consumption during fluid resuscitation of hypovolemic and septic shock. Chest 1984; 85:336.
- Bihari D, Smithies M, Gimson A, Tinker J. The effects of vasodilation with prostacyclin on oxygen delivery and uptake in critically ill patients. N Engl J Med 1987; 317:397.
- Pittet JF, Lacroix JS, Gunning K, et al. Prostacyclin but not phentolamine increases oxygen consumption and skin microvascular blood flow in patients with sepsis and respiratory failure. Chest 1990; 98:1467.
- Silverman HJ, Slotman G, Bone RC, et al. Effects of prostaglandin E1 on oxygen delivery and consumption in patients with the adult respiratory distress syndrome. Results from the prostaglandin E1 multicenter trial. The Prostaglandin E1 Study Group. Chest 1990; 98:405.
- Shoemaker WC, Appel PL, Kram HB, et al. Prospective trial of supranormal values of survivors as therapeutic goals in high-risk surgical patients. Chest 1988; 94:1176.
- Edwards JD, Brown GC, Nightingale P, et al. Use of survivors' cardiorespiratory values as therapeutic goals in septic shock. Crit Care Med 1989; 17:1098.
- Yu M, Levy MM, Smith P, et al. Effect of maximizing oxygen delivery on morbidity and mortality rates in critically ill patients: a prospective, randomized, controlled study. Crit Care Med 1993; 21:830.
- Bishop MH, Shoemaker WC, Appel PL, et al. Prospective, randomized trial of survivor values of cardiac index, oxygen delivery, and oxygen consumption as resuscitation endpoints in severe trauma. J Trauma 1995; 38:780.
- Hinds C, Watson D. Manipulating hemodynamics and oxygen transport in critically ill patients. N Engl J Med 1995; 333:1074.
- Gattinoni L, Brazzi L, Pelosi P, et al. A trial of goal-oriented hemodynamic therapy in critically ill patients. SvO2 Collaborative Group. N Engl J Med 1995; 333:1025.
- Hébert PC, Wells G, Blajchman MA, et al. A multicenter, randomized, controlled clinical trial of transfusion requirements in critical care. Transfusion Requirements in Critical Care Investigators, Canadian Critical Care Trials Group. N Engl J Med 1999; 340:409.