ABSTRACT
Resumen: El fenómeno de la deuda de oxígeno (dO2) descrito hace varias décadas en el contexto del ejercicio físico se ha incorporado progresivamente al terreno de la medicina. En particular se ha utilizado durante los cambios hemodinámicos producidos por la cirugía y la anestesia en los pacientes de alto riesgo. La dO2 se definió como el aumento en la cantidad de oxígeno consumida por el organismo inmediatamente después de realizar un ejercicio físico hasta que el consumo se normaliza nuevamente. En el perioperatorio se llega a producir cuando se presenta un desbalance entre la oferta (DO2) y la demanda de oxígeno (VO2) que lleva a hipoxia tisular. El grado de la dO2 tisular se ha relacionado directamente con la falla de órganos múltiples y morbimortalidad perioperatoria. A pesar de los avances en la medicina, aún no es posible prevenir o disminuir la dO2 con la administración de líquidos o con el uso de agentes vasoactivos. Por lo que un retardo o manejo inadecuado de la hemodinámica perioperatoria producirá hipoperfusión e hipoxia tisular afectando los resultados de la cirugía. El conocimiento y la valoración de la dO2 es esencial durante la anestesia del paciente de alto riesgo. Para lograr este objetivo se requiere del uso de índices adecuados que permitan detectar y cuantificar la hipoperfusión tisular y el desbalance entre la DO2 y la VO2. En esta revisión se presentan los conceptos fundamentales de la dO2, su mecanismo, detección y cuantificación; además de las intervenciones para evitarla o disminuirla y las recomendaciones para los anestesiólogos con el fin de asegurar mejores resultados en los pacientes quirúrgicos de alto riesgo.
Abstract: The phenomenon of oxygen debt (dO2) described several decades ago in the context of physical exercise has been incorporated into medicine, particularly during the hemodynamic changes produced by surgery and anesthesia in high-risk patients. dO2 is defined as the increase in the amount of oxygen consumed by the body immediately after physical exercise until O2 consumption returns to normal. In the perioperative period, an imbalance between oxygen supply (DO2) and demand (VO2) could generate dO2. The degree of tissue dO2 has been directly related to multiple organ failure and perioperative morbimortality. Despite advances in medicine, it is not yet possible to prevent or lower the dO2 with fluid administration or vasoactive agents. Delay or inadequate management of hemodynamics could produce tissue hypoperfusion and hypoxia, affecting surgery outcomes. Knowledge and assessing dO2 during perioperative are essential during anesthesia for high-risk patients. Adequate indices are required to detect and quantify tissue hypoperfusion and the imbalance between DO2 and VO2 during anesthesia. This review presents the mechanism, detection, and quantification of dO2. In addition to interventions to avoid or reduce dO2 and recommendations for anesthesiologists to ensure better results in high-risk surgical patients.
ABSTRACT
O objetivo do presente estudo foi analisar a validade, a reprodutibilidade e a objetividade do método de inspeção visual durante a identificação da fase rápida do excesso do consumo de oxigênio após o exercício (EPOC RÁPIDO). Dez homens fisicamente ativos (idade de 23,0 ± 4,0 anos, estatura de 176,4 ± 6,8cm, massa corporal de 72,4 ± 8,2kg, VòO2max 3,0 ± 0,5L ? min-1) realizaram um teste incremental máximo e um teste de carga constante até a exaustão a 110 por cento da carga máxima obtida no teste incremental. O consumo de oxigênio foi mensurado respiração a respiração durante dez minutos de recuperação passiva após o teste de carga constante. O EPOC RÁPIDO foi determinado matematicamente e visualmente por três avaliadores. O método visual foi aplicado duas vezes nos três avaliadores para verificar a sua reprodutibilidade. Não foram detectadas diferenças significativas entre os valores do EPOC RÁPIDO estabelecidos pelo método matemático (0,98 ± 0,45L) e pelo método visual identificado pelos três avaliadores (1,04 ± 0,45L, 1,02 ± 0,45L e1,02 ± 0,45L). Nenhuma diferença foi encontrada entre a primeira e a segunda identificação feita pelos avaliadores (avaliador 1: 1,04 ± 0,45L vs 1,04 ± 0,49L; avaliador 2: 1,02 ± 0,45L vs 1,01 ± 0,44L e avaliador 3: 1,02 ± 0,45L vs1,03 ± 0,47L). Além disso, o coeficiente de correlação intraclasse entre as duas identificações foi alto para todos os avaliadores (ICC entre 0,97 e0,99). Esses resultados sugerem que a inspeção visual é um método válido, objetivo e reprodutivo para a estimativa do EPOC RÁPIDO.
The objective of this study was to analyze the validity, reproducibility and objectivity of the visual inspection method during the identification of the fast component of excess post-exercise oxygen consumption (EPOC FAST). Ten healthy physically active men (age = 23.0 + 4.0 years; height = 176.4 + 6.8 cm; body mass = 72.4 + 8.2 kg; VO2MAX = 3.0 + 0.5 L.min-1) performed a maximal incremental exercise and a constant workload test until exhaustion corresponding to 110 percent of maximal workload reached during the maximal incremental exercise. Oxygen consumption was measured breath-by-breath for 10 minutes during the passive recovery after the constant workload test. EPOC FAST was mathematically and visually determined by three evaluators. Double visual determination of EPOC FAST was carried out by each evaluator for reproducibility determination. There were no significant differences between EPOCFAST values obtained by mathematical (0.98 ± 0.45 L) or visual method (1.04 ± 0.45 L; 1.02 ± 0.45 L and 1.02 ± 0.45 L). None significant difference was found between the first and second visual assessment carried out by the evaluators (evaluator 1: 1.04 ± 0.45 L vs 1.04 ± 0.49 L; evaluator 2: 1.02 ± 0.45 L vs 1.01 ± 0.44 L and evaluator 3: 1.02 ± 0.45 L vs 1.03 ± 0.47 L). Finally, coefficient of intra-class correlation between determinations was high for all evaluators (ICC from 0.97 to 0.99). These results suggest that the visual method is valid, objective and reproducible for determination of the EPOC FAST.
Subject(s)
Humans , Male , Adult , Anaerobic Threshold , Oxygen Consumption , Physical Exertion , Resistance TrainingABSTRACT
A study was conducted to examine the efficacy of indicators of anaerobic work capacity or estimations of anaerobic energy expenditure by measuring Δ blood lactate and O<SUB>2</SUB> debt after short-term maximal exercise. Eight male subjects performed cycle ergometer pedaling against 5.5-7.0 kp resistance with maximal effort for 45 s. After pedaling, venous blood samples were drawn serially at 1 min intervals from 1 to 10 min, for measurement of peak blood lactate. Anaerobic energy expenditure was determined in terms of both alactacid and lactacid energy expenditure, on the basis of Δ blood lactate (L-method) and O2 uptake kinetics (D-method) during recovery.<BR>The following results were obtained:<BR>1) The correlation coefficient between lactate and performance was higher (about 0.3-0.5) when lactate was expressed as the estimated value of lactate production rather than Δ blood lactate. A significant relationship (r=0.740, p<0.05) was found between lactate production and peak power.<BR>2) When O<SUB>2</SUB> uptake after recovery for 60 min did not recover to the baseline of O<SUB>2</SUB> uptake at rest, O<SUB>2</SUB> debt was calculated using a baseline of O<SUB>2</SUB> uptake just before the end of recovery. This O<SUB>2</SUB> debt was significantly correlated with work at any time of recovery.<BR>3) There was a significant relationship between lactate production and lactic O<SUB>2</SUB> debt, which was significantly correlated with work.<BR>4) When lactacid energy was calculated using a formula of 1.7×Δ blood lactate and 0.3 kcal/g lactate, there was no significant difference between anaerobic energy expenditure calculated by the L- and D-methods for up to 30 min during recovery.<BR>It was concluded that a) the estimated value of lactate production and O<SUB>2</SUB> debt calculated using a baseline of O<SUB>2</SUB> uptake just before the end of recovery could be employed as an indicator of anaerobic work capacity, and b) Δ La multiplied by a coefficient of 1.7 and 0.3 kcal/g lactate was more appropriate for estimating anaerobic expenditure in short-term maximal cycle ergometer pedaling.