OXYGEN DELIVERY IS AN IMPORTANT PREDICTOR OF OUTCOME IN PATIENTS WITHRUPTURED ABDOMINAL AORTIC-ANEURYSMS

Objective The purpose of this study was to evaluate the relation of ox ygen delivery (DO,) to the occurrence of multiple organ dysfunction (M OD) in patients with ruptured abdominal aortic aneurysms (AAA). Summar y Background Data Patients with ruptured AAA are at high risk for the development of MOD and death. Previous reports of high-risk general su rgical patients have shown improved survival when higher levels of DO, are achieved. Methods Hemodynamic data were collected at 4-hour inter vals on 57 consecutive patients (mean age, 70.5 years) who survived 24 hours after repair of infrarenal ruptured AAA. Patients were resuscit ated to standard parameters of perfusion (pulse, blood pressure, urine output, normal base deficit). MOD was determined based on six organ s ystems. Standard parametric (analysis of variance, t tests) and nonpar ametric (chi square, Wilcoxon) tests were used to compare hemodynamic data, red blood cell requirements, colon ischemia, and organ failure f or patients with and without MOD. Results Patients who developed MOD h ad a significantly lower cardiac index and DO2 for the first 12 hours; the difference was most significant at 8 hours. Logistic regression a nalysis demonstrated that the strongest predictors of MOD were DO2, ea rly onset of renal failure, and total number of red blood cells transf used. Conclusions DO2 is an earlier and better predictor of MOD after ruptured AAA than previously identified risk factors. Failure to achie ve a normal DO2 in the first 8 hours after repair is strongly associat ed with the development of MOD and a high mortality. Strategies to res tore normal DO2 may be useful to improve outcome in these high-risk pa tients.