The oxygen trail: the goal

Over the last 10 years, there have been great advances in knowledge concern ing changes in tissue perfusion and its prognostic implications. Has this t ranslated into improved patient management:, We review the clinical trials that have deliberately increased tissue oxygen delivery by increasing cardi ac output. We have divided the studies into those that intervene early or t hose that intervene late in the course of a patient's illness. Although the re are methodological problems limiting interpretation of the results, we s how a combined odds ratio of a reduction in mortality for the early studies but not for the late studies. We conclude that a treatment policy whereby oxygen delivery is deliberately increased improves patient outcome if it is initiated early, prior to the onset of organ failure.