ABSTRACT
Restoration of oxygen transport as an endpoint of resuscitation remains controversial.
The available literature investigating this idea supports widely disparate conclusions. The
following discussion views restoration of oxygen transport as one of the foundations of
modern critical care. When successfully achieved, along with source control and metabolic
support, improved mortality can be demonstrated. An analysis of this controversy and criti-
cal review of the literature leads to a model that supports our perspective. The interested
reader can refer to Chapter 63 for a detailed discussion. Despite the controversy surround-
ing oxygen transport, the initial priorities of managing a patient admitted to the surgical
intensive care unit are well defined. Once the airway has been safely secured, source
control becomes the next priority. Hemorrhage must be stopped. Abscesses must be
drained, since even small amounts of undrained pus can produce grave systemic conse-
quences. Other infections must be treated as specifically as possible. When adequate
source control has been established, the next mandate, although controversial, is resto-
ration of oxygen transport. After oxygen transport has been restored, appropriate metabolic
support becomes the next goal (see Chapter 3 for a discussion of metabolic support).
