AUGMENTATION OF OXYGEN DELIVERY - RISKS VERSUS BENEFITS

Within these next few pages, an attempt will be made to clarify the ba sis for the polarity of opinion on hemodynamic strategies in ARDS, and to explore the prospects for consensus formation in 1995. The specifi c studies of augmented O-2 delivery (DO2) are discussed in detail in t his issue by Russell and by Boye and co-workers. Herein we will examin e the premise that a rational approach to this dilemma may be develope d through a consideration of the basic mechanisms that link the lung i njury of ARDS to the devastating events of multiple organ dysfunction (MODS). The application of such a mechanism-based perspective will lea d to a clearer analysis of the risks and benefits attendant to the cli nician's choices of hemodynamic strategy in our patients with ARDS. Re cognizing the concerns expressed in this monograph as to the precise r elationship of O-2 uptake (VO2) and delivery in ARDS (Fig. 1), it is a pparent that respiratory gas exchange is compromised in these patients . These findings can be incorporated into a consideration of disease m echanisms in order to yield a logical framework from which to discuss hemodynamic intervention. Finally, this analysis will illustrate the b asis for the central premise that the lung injury occupies a central r ole in the reciprocating pathophysiology linking ARDS to multiple orga n failure.