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1 Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA; Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA; Department of Physiology, Virginia Commonwealth University, Richmond, VA, USA
2 Department of Anesthesiology, Virginia Commonwealth University, Richmond, VA, USA; Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA
3 Department of Emergency Medicine, Virginia Commonwealth University, Richmond, VA, USA; Department of Physiology, Virginia Commonwealth University, Richmond, VA, USA
* To whom correspondence should be addressed. E-mail: itorres{at}vcu.edu.
Systemic variables were evaluated with respect to oxygen delivery to test the hypothesis that critical oxygen delivery and critical hemoglobin can be estimated by multiple variables collected simultaneously. Rats were subjected to transfusion with either fresh or stored blood and then subjected to stepwise isovolemic hemodilution. Critical levels were measured by the dual-regression method from plots of systemic variables against oxygen delivery and hemoglobin. Delivery was calculated from cardiac index and arterial oxygen content. We found that (1) following hemodilution, oxygen delivery changed in a non-linear relationship with hemoglobin, (2) critical delivery calculated using thirty different systemic variables were not statistically different from each other, (3) critical delivery and critical hemoglobin were correlated but were not different between animals receiving fresh or stored blood, (4) similar critical levels were found using a single variable from several animals and using several variables from the same subject. The best variables to estimate critical delivery were lactate, bicarbonate, base excess, oxygen extraction ratio, expired CO2, pulse pressure, cardiac index and systolic pressure. The data suggest that a multi-variable analysis of critical delivery may help determining the physiological oxygenation boundary at whole-body level. This may assist in finding therapeutic triggers on an individual basis using systemic markers of the transition from aerobic to anaerobic metabolism.
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