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. 2024 Aug 5;12(8):1754.
doi: 10.3390/biomedicines12081754.

Transitions from Aerobic to Anaerobic Metabolism and Oxygen Debt during Elective Major and Emergency Non-Cardiac Surgery

Nikolaos Papagiannakis  1 , Dimitrios Ragias  2 , Nicoleta Ntalarizou  3 , Eleni Laou  4 , Aikaterini Kyriakaki  5 , Theodoros Mavridis  6 , Amir Vahedian-Azimi  7 , Minas Sakellakis  8 , Athanasios Chalkias  9   10
Affiliations

Transitions from Aerobic to Anaerobic Metabolism and Oxygen Debt during Elective Major and Emergency Non-Cardiac Surgery

Nikolaos Papagiannakis et al. Biomedicines. .

Abstract

Introduction: Intraoperative hemodynamic and metabolic optimization of both the high-risk surgical patients and critically ill patients remains challenging. Reductions in oxygen delivery or increases in oxygen consumption can initiate complex cellular processes precipitating oxygen debt (OXD).

Methods: This study tested the hypothesis that intraoperative changes in sublingual microcirculatory flow reflect clinically relevant transitions from aerobic to anaerobic metabolism (TRANAM). We included patients undergoing elective major and emergency non-cardiac surgery. Macro- and microcirculatory variables, oxygen extraction, and transitions of metabolism were assessed in both cohorts.

Results: In the elective group, OXD was progressively increased over time, with an estimated 2.24 unit increase every 30 min (adjusted p < 0.001). Also, OXD was negatively correlated with central venous pressure (ρ = -0.247, adjusted p = 0.006) and positively correlated with stroke volume variation (ρ = 0.185, adjusted p = 0.041). However, it was not significantly correlated with sublingual microcirculation variables. In the emergency surgery group, OXD increased during the first two intraoperative hours and then gradually decreased until the end of surgery. In that cohort, OXD was positively correlated with diastolic arterial pressure (ρ = 0.338, adjpatients and the critically ill patients remains challengingsted p = 0.015). Also, OXD was negatively correlated with cardiac index (ρ = -0.352, adjusted p = 0.003), Consensus Proportion of Perfused Vessels (PPV) (ρ = -0.438, adjusted p < 0.001), and Consensus PPV (small) (ρ = -0.434, adjusted p < 0.001).

Conclusions: TRANAM were evident in both the elective major and emergency non-cardiac surgery cohorts independent of underlying alterations in the sublingual microcirculation.

Keywords: aerobic metabolism; anaerobic metabolism; cardiovascular dynamics; emergency surgery; hemodynamic coherence; hemodynamics; major non-cardiac surgery; microcirculation; oxygen debt; oxygen transport.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Variation in oxygen debt during elective major and emergency non-cardiac surgery.
Figure 2
Figure 2
Correlation of oxygen debt with central venous pressure and stroke volume variation during elective major non-cardiac surgery. CVP, central venous pressure; SVV, stroke volume variation.
Figure 3
Figure 3
Correlation of oxygen debt with sublingual microcirculation variables during elective major and emergency non-cardiac surgery. PPV, proportion of perfused vessels.
Figure 4
Figure 4
Correlation of oxygen debt with oxygen extraction ratio during elective major and emergency non-cardiac surgery. O2ER, oxygen extraction ratio.
Figure 5
Figure 5
Correlation of oxygen debt with macrohemodynamic variables during emergency non-cardiac surgery. CI, cardiac index; DAP, diastolic arterial pressure; MAP, mean arterial pressure; SVR, systemic vascular resistance.
Figure 6
Figure 6
OXD and TRANAM may occur due to abnormal alterations at multiple biological levels simultaneously, indicating the existence of modifiable biological networks that generate clinical phenotypes. CVP, central venous pressure; CO, cardiac output; SVR, systemic vascular resistance; MAP, mean arterial pressure; Pmca, mean circulatory filling pressure analogue; PPV, proportion of perfused vessels; DO2, oxygen delivery; VO2, oxygen consumption; OXD, oxygen debt; TRANAM, transition from aerobic to anaerobic metabolism.
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