Abstract
New equipment designed for the routine measurement of oxygen uptake (VO2) using a closed circuit method has been validated by comparing it with a standard Douglas bag method. The equipment (The Caloric Measurement Unit, CMU) has been tested in 10 critically ill patients during mechanical ventilation (MV) and in 10 spontaneously breathing healthy subjects. Determinations of VO2 and of the resting energy expenditure (REE) were measured in duplicate with the standard method and once with the CMU. Six additional patients receiving MV were studied with the CMU to evaluate the reproducibility and the effect of FIO2=1 vs FIO2=0.43 on VO2 measurements. Considering the whole group of 10 patients and 10 subjects, the mean difference of VO2 between both methods was-2±21 ml/min (95% confidence interval,-11.8 to 7.8 ml/min, p=0.6) standard deviation. Both methods had a similar reproducibility and the mean difference of VO2 measured at the two different FIO2 with the CMU was-3.2±11 ml/min (95% confidence interval,-14.7 to 8.4 ml/min, p=0.5). No statistically significant difference was found between derived REE values obtained from either method. These data show a good correlation between the two methods suggesting that CMU may be used in place of the standard method with the same accuracy in measurement of VO2 even at FIO2=1.
Article PDF
Similar content being viewed by others
References
Askanazi J, Carpentier YA, Elwyn DH, Nordenstrom J, Jeevanadam M, Rosenbaum SH, Gump FE, Kinney JM (1980) Influence of total parenteral nutrition fuel utilization in injury and sepsis. Ann Surg 191:40
Askanazi J, Hensle TW, Starker PM, Lockhardt SH, La Sala PA, Olsson CL, Kinney JM (1986) Effect of immediate post-operative nutritional support on length of hospitalization. Ann Surg 203:236
Baker JP, Detsky AS, Wesson DE, Wolman SL, Stewart S, Whitewell J, Langer B, Jeejeebhoy JN (1982) Nutritional assessment a comparison of clinical judgement and objective measurements. N Engl J Med 306:969
Bland JM, Altman DG (1986) Statistical methods for assessing agreement between two methods of clinical measurement. Lancet I:307
Breadbacka S, Kawachi S, Norlander O, Kirk B (1984) Gas exchange during ventilator treatment: a validation of a computarized technique and its comparison with the Douglas Bag Method. Acta Anaesthesiol Scand 28:462
Browning JA, Linberg SE, Jurney SZ, Chodoff P (1982) The effects of fluctuating FIO2 on metabolic measurements in mechanically ventilated patients. Crit Care Med 10:82
Carlsson M, Nordenstrom J, Hedenstierna G (1984) Clinical implications of continuous measurements of energy expenditure in mechanically ventilated patients. Clin Nutr 3:103
Covelli HD, Black JV, Olsen MD, Berkman SF (1981) Respiratory failure produced by high carbohydrate loads. Ann Int Med 95:579
Damask MC, Weissman C, Askanazi J, Hyman AI, Rosembaun SH, Kinney JM (1982) A systematic method for validation of gas exchange measurement. Anesthesiology 57:213
Dempsey DT, Guenter P, Mullen JL (1985) Energy expenditure in acute trauma to the head with and without barbiturate therapy. Surg Gynecol Obstet 160:128
Elwin DH (1980) Nutritional requirements of adult surgical patients. Crit Care Med 8:9
Feurer ID, Mullen JL (1986) Bedside measurement of resting energy expenditure and respiratory quotient via indirect calorimetry. Nutr Clin Pract 1:43–49
Gardner MJ, Altman DG (1986) Confidence intervals rather than P values: estimation rather than hypothesis testing. Br Med J 292:746
Hunker FD, Burton CW, Hunker EM, Durham RM, Krundieck LL (1980) Metabolic and nutritional evaluation of patients supported with mechanical ventilation. Crit Care Med 8:628
Long CL, Schaffel N, Geiger JW, Schiller WR, Blakemore WS (1979) Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. JPEN 3:452
Nelson LD, Anderson HB, Garcia H (1987) Clinical validation of a new metabolic monitor suitable for use in critically ill patients. Crit Care Med 15:951
Rodriguez J, Weissman C, Damasck MC (1985) Morphine and postoperative rewarning in the critically ill. Circulation 68:1238
Warnold I, Sundholm K (1984) Clinical significance of preoperative nutrition status in 215 noncancer patients. Ann Surg 199:299
Weir JB (1949) New method for calculating metabolic rate with special references to protein metabolism. J Physiol 109:1
Weissman C, Kemper M, Askanazi J, Humann AI, Kinney JM (1986) Resting metabolic rate of the critically ill patient: measured versus predicted. Anesthesiology 64:673
Weissman C, Kemper M, Elwyn DH, Askanzi J, Hyman AI, Kinney JM (1986) The energy expenditure of the mechanically ventilated critically ill patient. An analysis. Chest 89:154
Ultman JS, Burstein S (1981) Analysis of error in the determination of respiratory gas exchange at verying FIO2. J Appl Physiol 50:210
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Raurich, J.M., Ibañez, J. & Marse, P. Validation of a new closed circuit indirect calorimetry method compared with the open Douglas bag method. Intensive Care Med 15, 274–278 (1989). https://doi.org/10.1007/BF00271067
Received:
Accepted:
Issue Date:
DOI: https://doi.org/10.1007/BF00271067