The oxygen trail: the goal

changes in tissue perfusion and its prognostic implications. Has this translated into improved patient management? We review the clinical trials that have deliberately increased tissue oxygen delivery by increasing cardiac output. We have divided the studies into those that intervene early or those that intervene late in the course of a patient's illness. Although there are methodological problems limiting interpretation of the results, we show 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 rf it is initiated early, prior to the onset of organ failure. In the previous chapters the scientific basis and importance of tissue oxygenation and methods for its evaluation have been discussed. In this chapter, we discuss the clinical applications of the techniques, in terms of goals for treatment. It is not realistic to make the assumption that one goal is suitable for all patients. Patients present for treatment at different stages of their illness, have different conditions and co-morbidities and present with differing physiological states. We will consider the goal of therapy for patients with two general clinical presentations. The first is the patient about to undergo an operation who may have limited physiological reserve and underlying medical conditions but has not yet developed organ failure. The second, is the patient who has already developed organ failure and, while they may have limited physiological reserve and associated medical conditions, the focus of care is on support of the patient and treatment of their organ failure.