In which of the following conditions does the arterial-mixed venous O2 content difference (a–O2 difference) become misleading when it is used to assess tissue O2 extraction?
A. cardiogenic shock
B. septic shock
C. neurogenic shock
D. anaphylactic shock
?ANS: B
A. Incorrect response: The a–O2 difference is useful in managing patients with primary cardiovascular compromise. An a–O2 difference of less than 5 volumes% (i.e., 5 ml O2/dl) in a patient with cardiogenic shock suggests adequate O2 extraction from the blood.
B. Correct response: In septic shock, the capability to increase O2 extraction from the blood is lost because of systemic shunting. Therefore, using the a–O2 difference as an index of the tissue O2 extraction during septic shock is misleading. An a–O2 difference value of 5 ml O2/dl may be present in a patient with septic shock; however, this patient may have poor extraction capabilities from the systemic disease.
C. Incorrect response: See explanation B.
D. Incorrect response: See explanation B.
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