Oxygen uptake and increased metabolic requirements are characteristic
of the acute state resulting from septic shock, One therapeutic approa
ch to improving hemodynamics is to increase oxygen delivery in an atte
mpt to overcome tissue oxygen debt. Recent randomized trials have sugg
ested that systematically increasing oxygen supply is not necessarily
the ideal strategy. It might be better, for each patient, to reach an
optimal oxygen supply. This requires identification of parameters capa
ble of indicating the optimal level, a rather difficult task. Currentl
y, focus has been placed on the importance of the splanchnic circulati
on in severe septic shock. Hypoxia resulting from hypoperfusion of the
intestinal mucosa occurs early in sepsis and could, via intermediary
bacterial and/or endotoxinic translocation, maintain the septic syndro
me and favor development of multiple organ failure, Since the drugs us
ed to restore hemodynamics have vasoactive properties, measuring their
effect on revelant indicators of splanchnic perfusion and oxygenation
such as PCO2 or pH within the gastric mucosa using tonometric gastric
probes might be a means of determining optimal oxygen level. With thi
s approach, it would be possible to avoid sacrifying the perfusion of
the gastrointestinal mucosa by using drugs which appear to favor the m
icrocirculation in this territory.