Compensation: Initially when O2 delivery (DO2) is decreased tissues compensate by extracting a greater percentage of delivered O2. Current guidelines provide for interventions that will maintain mixed-venous O2 saturation above 30%. Additionally low arterial pressure triggers an adrenergic response with sympathetic-mediated vasoconstriction and often increased heart rate. Initially vasoconstriction is selective shunting blood to the heart and brain. Circulating β-adrenergic amines (epinephrine norepinephrine) also increase cardiac contractility and trigger release of corticosteroids from the adrenal gland renin from the kidney and glucose from the liver. Increased glucose may overwhelm ailing mitochondria causing further lactate production.

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