The concept of oxygen transport, defined as the relation between oxygen consumption (VO2) and delivery (DO2), is of fundamental importance in critically ill patients. The past 200 years have witnessed a stepwise progressive improvement in the understanding of pathophysiological disturbances in the balance of DO2 and VO2 in critically ill patients including those after cardiopulmonary bypass surgery. Intermittent spectacular technological achievements have accelerated the rate of progress. Therapeutic advances have been particularly impressive during the recent decades. Examination of the relation between DO2 and VO2 provides a useful framework around which the care of the critically ill may be developed. Until now, only a few groups have used this framework to examine children after cardiopulmonary bypass. The key topics that will be covered in this review article are the evolution of the concept from its early development to its present, increasingly sophisticated, role in the management of critically ill patients, with a focus on children after cardiopulmonary bypass surgery.

l-Carnitine supplementation can stimulate erythropoiesis, reduce exercise-induced plasma lactate concentrations and decrease post-exercise muscle damage. Next to horses, Greyhounds represent the premier animal racing species and perform short-duration, very high-intensity exercise that has the potential to incur substantial muscle damage. Under resting and standard racing conditions (5/16 mile), we tested the novel hypotheses that l-carnitine supplementation in Greyhounds would: (1) elevate haematocrit at rest and immediately post-exercise; (2) reduce peak post-exercise plasma lactate; and (3) reduce indices of muscle damage (plasma creatine phosphokinase, CPK and aspartate aminotransferase, AST). Six conditioned Greyhounds (30.1 ± 1.6 kg) underwent a randomized placebo-controlled crossover study to determine the effects of 6 weeks of l-carnitine supplementation (100 mg kg− 1 of body weight/day) at rest and following a maximal speed 5/16 mile race. In accordance with our hypotheses, l-carnitine elevated resting and immediately post-race haematocrit (control, 60.1 ± 1.7, l-carnitine, 63.6 ± 1.7; P < 0.05) and reduced peak post-race plasma CPK and AST concentrations (both P < 0.05). Those dogs with the highest peak post-exercise plasma CPK concentrations under placebo conditions evidenced the greatest reduction with l-carnitine supplementation (r = 0.99, P < 0.01). However, contrary to our hypotheses, l-carnitine did not change peak post-exercise plasma lactate concentrations (control, 27.0 ± 2.1, l-carnitine, 27.7 ± 1.3; P>0.05). We conclude that l-carnitine supplementation increases the potential for oxygen transport and reduces plasma indicators of muscle damage, CPK and AST in racing Greyhounds.