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Natarajan RK, Rodgers N, Narasimhan S, Ambrose M, Rothman A, Shyne M, Evans M, Aggarwal V. Invasive haemodynamics predict outcomes in paediatric pulmonary artery hypertension. Cardiol Young 2024:1-8. [PMID: 38572557 DOI: 10.1017/s1047951124000647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND Invasive haemodynamics are often performed for initiating and guiding pulmonary artery hypertension therapy. Little is known about the predictive value of invasive haemodynamic indices for long-term outcomes in children with pulmonary artery hypertension. We aimed to evaluate invasive haemodynamic data to help predict outcomes in paediatric pulmonary artery hypertension. METHODS Patients with pulmonary artery hypertension who underwent cardiac catheterisation (2006-2019) at a single centre were included. Invasive haemodynamic data from the first cardiac catheterisation and clinical outcomes were reviewed. The combined adverse outcome was defined as pericardial effusion (due to right ventricle failure), creation of a shunt for pulmonary artery hypertension (atrial septal defect or reverse Pott's shunt), lung transplant, or death. RESULTS Among 46 patients with a median [interquartile range (IQR)] age of 13.2 [4.1-44.7] months, 76% had CHD. Median mean pulmonary artery pressure was 37 [28-52] mmHg and indexed pulmonary vascular resistance was 6.2 [3.6-10] Woods units × m2. Median pulmonary artery pulsatility index was 4.0 [3.0-4.7] and right ventricular stroke work index was 915 [715-1734] mmHg mL/m2. After a median follow-up of 2.4 years, nine patients had a combined adverse outcome (two had a pericardial effusion, one underwent atrial level shunt, one underwent reverse Pott's shunt, and six died). Patients with an adverse outcome had higher systolic and mean pulmonary artery pressures, higher diastolic and transpulmonary pressure gradients, higher indexed pulmonary vascular resistance, higher pulmonary artery elastance, and higher right ventricular stroke work index (p < 0.05 each). CONCLUSION Invasive haemodynamics (especially mean pulmonary artery pressure and diastolic pressure gradient) obtained at first cardiac catheterisation in children with pulmonary artery hypertension predicts outcomes.
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Affiliation(s)
| | - Nathan Rodgers
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Shanti Narasimhan
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Matthew Ambrose
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
| | - Abraham Rothman
- Children's Heart Center of Nevada, UNLV School of Medicine, Las Vegas, NV, USA
| | - Michael Shyne
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Michael Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, MN, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, University of Minnesota, Minneapolis, MN, USA
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Shinozaki K, Yu PJ, Zhou Q, Cassiere HA, John S, Rolston DM, Garg N, Li T, Johnson J, Saeki K, Goto T, Okuma Y, Miyara SJ, Hayashida K, Aoki T, Wong VK, Molmenti EP, Lampe JW, Becker LB. Low respiratory quotient correlates with high mortality in patients undergoing mechanical ventilation. Am J Emerg Med 2024; 78:182-187. [PMID: 38301368 DOI: 10.1016/j.ajem.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/06/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE Oxygen consumption (VO2), carbon dioxide generation (VCO2), and respiratory quotient (RQ), which is the ratio of VO2 to VCO2, are critical indicators of human metabolism. To seek a link between the patient's metabolism and pathophysiology of critical illness, we investigated the correlation of these values with mortality in critical care patients. METHODS This was a prospective, observational study conducted at a suburban, quaternary care teaching hospital. Age 18 years or older healthy volunteers and patients who underwent mechanical ventilation were enrolled. A high-fidelity automation device, which accuracy is equivalent to the gold standard Douglas Bag technique, was used to measure VO2, VCO2, and RQ at a wide range of fraction of inspired oxygen (FIO2). RESULTS We included a total of 21 subjects including 8 post-cardiothoracic surgery patients, 7 intensive care patients, 3 patients from the emergency room, and 3 healthy volunteers. This study included 10 critical care patients, whose metabolic measurements were performed in the ER and ICU, and 6 died. VO2, VCO2, and RQ of survivors were 282 +/- 95 mL/min, 202 +/- 81 mL/min, and 0.70 +/- 0.10, and those of non-survivors were 240 +/- 87 mL/min, 140 +/- 66 mL/min, and 0.57 +/- 0.08 (p = 0.34, p = 0.10, and p < 0.01), respectively. The difference of RQ was statistically significant (p < 0.01) and it remained significant when the subjects with FIO2 < 0.5 were excluded (p < 0.05). CONCLUSIONS Low RQ correlated with high mortality, which may potentially indicate a decompensation of the oxygen metabolism in critically ill patients.
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Affiliation(s)
- Koichiro Shinozaki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States of America; Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States of America; Department of Emergency Medicine, Kindai University Faculty of Medicine, Osaka, Japan.
| | - Pey-Jen Yu
- Department of Cardiothoracic Surgery, North Shore University Hospital, Manhasset, NY, United States of America
| | - Qiuping Zhou
- Division of Critical Care Medicine of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, NY, United States of America
| | - Hugh A Cassiere
- Division of Critical Care Medicine, Department of Medicine, North Shore University Hospital, Manhasset, NY, United States of America
| | - Stanley John
- Department of Respiratory Therapy, Critical Care Serviceline, Northshore University Hospital, Manhasset, NY, United States of America
| | - Daniel M Rolston
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States of America; Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States of America
| | - Nidhi Garg
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States of America; Department of Emergency Medicine, South Shore University Hospital, Bay Shore, NY, United States of America
| | - Timmy Li
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States of America
| | - Jennifer Johnson
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States of America
| | - Kota Saeki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Nihon Kohden Innovation Center, Cambridge, MA, United States of America
| | | | - Yu Okuma
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Santiago J Miyara
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Kei Hayashida
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Tomoaki Aoki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Vanessa K Wong
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Ernesto P Molmenti
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Department of Surgery, Medicine, and Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joshua W Lampe
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; ZOLL Medical, Chelmsford, MA, USA
| | - Lance B Becker
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States of America; Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States of America
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Karlsson J, Svedmyr A, Wallin M, Hallbäck M, Lönnqvist PA. Validation of an alternative technique for RQ estimation in anesthetized pigs. Intensive Care Med Exp 2024; 12:11. [PMID: 38270695 PMCID: PMC10811304 DOI: 10.1186/s40635-024-00598-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2023] [Accepted: 01/16/2024] [Indexed: 01/26/2024] Open
Abstract
BACKGROUND Respiratory quotient (RQ) is an important variable when assessing metabolic status in intensive care patients. However, analysis of RQ requires cumbersome technical equipment. The aim of the current study was to examine a simplified blood gas-based method of RQ assessment, using Douglas bag measurement of RQ (Douglas-RQ) as reference in a laboratory porcine model under metabolic steady state. In addition, we aimed at establishing reference values for RQ in the same population, thereby generating data to facilitate further research. METHODS RQ was measured in 11 mechanically ventilated pigs under metabolic steady state using Douglas-RQ and CO-oximetry blood gas analysis of pulmonary artery and systemic carbon dioxide and oxygen content. The CO-oximetry data were used to calculate RQ (blood gas RQ). Paired recordings with both methods were made once in the morning and once in the afternoon and values obtained were analyzed for potential significant differences. RESULTS The average Douglas-RQ, for all data points over the whole day, was 0.97 (95%CI 0.95-0.99). The corresponding blood gas RQ was 0.95 (95%CI 0.87-1.02). There was no statistically significant difference in RQ values obtained using Douglas-RQ or blood gas RQ for all data over the whole day (P = 0.43). Bias was - 0.02 (95% limits of agreement ± 0.3). Douglas-RQ decreased during the day 1.00 (95%CI 0.97-1.03) vs 0.95 (95%CI 0.92-0.98) P < 0.001, whereas the decrease was not significant for blood gas RQ 1.02 (95%CI 0.89-1.16 vs 0.87 (0.80-0.94) P = 0.11. CONCLUSION RQ values obtained with blood gas analysis did not differ statistically, compared to gold standard Douglas bag RQ measurement, showing low bias but relatively large limits of agreement, when analyzed for the whole day. This indicates that a simplified blood gas-based method for RQ estimations may be used as an alternative to gold standard expired gas analysis on a group level, even if individual values may differ. In addition, RQ estimated with Douglas bag analysis of exhaled air, was 0.97 in anesthetized non-fasted pigs and decreased during prolonged anesthesia.
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Affiliation(s)
- Jacob Karlsson
- Department of Physiology and Pharmacology (FYFA), C3, PA Lönnqvist Group, Section of Anesthesiology and Intensive Care, Anestesi- och Intensivvårdsavdelningen, Karolinska Institute, 171 76, Stockholm, Sweden.
- Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Eugenivägen 23, 171 64, Stockholm, Sweden.
| | - Anders Svedmyr
- Department of Physiology and Pharmacology (FYFA), C3, PA Lönnqvist Group, Section of Anesthesiology and Intensive Care, Anestesi- och Intensivvårdsavdelningen, Karolinska Institute, 171 76, Stockholm, Sweden
- Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Eugenivägen 23, 171 64, Stockholm, Sweden
| | - Mats Wallin
- Department of Physiology and Pharmacology (FYFA), C3, PA Lönnqvist Group, Section of Anesthesiology and Intensive Care, Anestesi- och Intensivvårdsavdelningen, Karolinska Institute, 171 76, Stockholm, Sweden
| | - Magnus Hallbäck
- Maquet Critical Care AB, Röntgenvägen 2, 171 06, Solna, Sweden
| | - Per-Arne Lönnqvist
- Department of Physiology and Pharmacology (FYFA), C3, PA Lönnqvist Group, Section of Anesthesiology and Intensive Care, Anestesi- och Intensivvårdsavdelningen, Karolinska Institute, 171 76, Stockholm, Sweden
- Pediatric Perioperative Medicine and Intensive Care, Karolinska University Hospital, Eugenivägen 23, 171 64, Stockholm, Sweden
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Shinozaki K, Yu PJ, Zhou Q, Cassiere HA, John S, Rolston DM, Garg N, Li T, Johnson J, Saeki K, Goto T, Okuma Y, Miyara SJ, Hayashida K, Aoki T, Wong VK, Molmenti EP, Lampe JW, Becker LB. Continuous and repeat metabolic measurements compared between post-cardiothoracic surgery and critical care patients. BMC Pulm Med 2023; 23:390. [PMID: 37840131 PMCID: PMC10577926 DOI: 10.1186/s12890-023-02657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVE Using a system, which accuracy is equivalent to the gold standard Douglas Bag (DB) technique for measuring oxygen consumption (VO2), carbon dioxide generation (VCO2), and respiratory quotient (RQ), we aimed to continuously measure these metabolic indicators and compare the values between post-cardiothoracic surgery and critical care patients. METHODS This was a prospective, observational study conducted at a suburban, quaternary care teaching hospital. Age 18 years or older patients who underwent mechanical ventilation were enrolled. RESULTS We included 4 post-surgery and 6 critical care patients. Of those, 3 critical care patients died. The longest measurement reached to 12 h and 15 min and 50 cycles of repeat measurements were performed. VO2 of the post-surgery patients were 234 ± 14, 262 ± 27, 212 ± 16, and 192 ± 20 mL/min, and those of critical care patients were 122 ± 20, 189 ± 9, 191 ± 7, 191 ± 24, 212 ± 12, and 135 ± 21 mL/min, respectively. The value of VO2 was more variable in the post-surgery patients and the range of each patient was 44, 126, 71, and 67, respectively. SOFA scores were higher in non-survivors and there were negative correlations of RQ with SOFA. CONCLUSIONS We developed an accurate system that enables continuous and repeat measurements of VO2, VCO2, and RQ. Critical care patients may have less activity in metabolism represented by less variable values of VO2 and VCO2 over time as compared to those of post-cardiothoracic surgery patients. Additionally, an alteration of these values may mean a systemic distinction of the metabolism of critically ill patients.
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Affiliation(s)
- Koichiro Shinozaki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA.
- Department of Emergency Medicine, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan.
| | - Pey-Jen Yu
- Department of Cardiothoracic Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - Qiuping Zhou
- Division of Critical Care Medicine of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Hugh A Cassiere
- Division of Critical Care Medicine, Department of Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - Stanley John
- Division of Critical Care Medicine, Department of Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - Daniel M Rolston
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - Nidhi Garg
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Emergency Medicine, South Shore University Hospital, Bay Shore, NY, USA
| | - Timmy Li
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jennifer Johnson
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - Kota Saeki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Nihon Kohden Innovation Center, Cambridge, MA, USA
| | | | - Yu Okuma
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Santiago J Miyara
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Kei Hayashida
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Tomoaki Aoki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Vanessa K Wong
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Ernesto P Molmenti
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Surgery, Medicine, and Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joshua W Lampe
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- ZOLL Medical, Chelmsford, MA, USA
| | - Lance B Becker
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA
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Reproducibility of the energy metabolism response to an oral glucose tolerance test: influence of a postcalorimetric correction procedure. Eur J Nutr 2023; 62:351-361. [PMID: 36006468 PMCID: PMC9899729 DOI: 10.1007/s00394-022-02986-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/03/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE Metabolic flexibility (MetF), which is a surrogate of metabolic health, can be assessed by the change in the respiratory exchange ratio (RER) in response to an oral glucose tolerance test (OGTT). We aimed to determine the day-to-day reproducibility of the energy expenditure (EE) and RER response to an OGTT, and whether a simulation-based postcalorimetric correction of metabolic cart readouts improves day-to-day reproducibility. METHODS The EE was assessed (12 young adults, 6 women, 27 ± 2 years old) using an Omnical metabolic cart (Maastricht Instruments, Maastricht, The Netherlands) after an overnight fast (12 h) and after a 75-g oral glucose dose on 2 separate days (48 h). On both days, we assessed EE in 7 periods (one 30-min baseline and six 15-min postprandial). The ICcE was performed immediately after each recording period, and capillary glucose concentration (using a digital glucometer) was determined. RESULTS We observed a high day-to-day reproducibility for the assessed RER (coefficients of variation [CV] < 4%) and EE (CVs < 9%) in the 7 different periods. In contrast, the RER and EE areas under the curve showed a low day-to-day reproducibility (CV = 22% and 56%, respectively). Contrary to our expectations, the postcalorimetric correction procedure did not influence the day-to-day reproducibility of the energy metabolism response, possibly because the Omnical's accuracy was ~ 100%. CONCLUSION Our study demonstrates that the energy metabolism response to an OGTT is poorly reproducible (CVs > 20%) even using a very accurate metabolic cart. Furthermore, the postcalorimetric correction procedure did not influence the day-to-day reproducibility. Trial registration NCT04320433; March 25, 2020.
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Shinozaki K, Yu PJ, Zhou Q, Cassiere HA, Stanley J, Rolston DM, Garg N, Li T, Johnson J, Saeki K, Goto T, Okuma Y, Miyara SJ, Hayashida K, Aoki T, Wong V, Molmenti EP, Lampe JW, Becker LB. An Automation System Equivalent to the Douglas Bag Technique Enables Continuous and Repeat Metabolic Measurements in Patients Undergoing Mechanical Ventilation. Clin Ther 2022; 44:1471-1479. [DOI: 10.1016/j.clinthera.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
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Validity of four commercially available metabolic carts for assessing resting metabolic rate and respiratory exchange ratio in non-ventilated humans. Clin Nutr 2022; 41:746-754. [DOI: 10.1016/j.clnu.2022.01.031] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2021] [Revised: 01/21/2022] [Accepted: 01/31/2022] [Indexed: 11/21/2022]
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Robles-González L, Gutiérrez-Hellín J, Aguilar-Navarro M, Ruiz-Moreno C, Muñoz A, Del-Coso J, R. Ruiz J, Amaro-Gahete FJ. Inter-Day Reliability of Resting Metabolic Rate and Maximal Fat Oxidation during Exercise in Healthy Men Using the Ergostik Gas Analyzer. Nutrients 2021; 13:nu13124308. [PMID: 34959860 PMCID: PMC8708346 DOI: 10.3390/nu13124308] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 11/25/2021] [Accepted: 11/25/2021] [Indexed: 12/23/2022] Open
Abstract
The attainment of high inter-day reliability is crucial to determine changes in resting metabolic rate (RMR), respiratory exchange ratio (RER), maximal fat oxidation during exercise (MFO) and the intensity that elicits MFO (Fatmax) after an intervention. This study aimed to analyze the inter-day reliability of RMR, RER, MFO and Fatmax in healthy adults using the Ergostik gas analyzer. Fourteen healthy men (age: 24.4 ± 5.0 years, maximum oxygen uptake (VO2max): 47.5 ± 11.9 mL/kg/min) participated in a repeated-measures study. The study consisted of two identical experimental trials (Day 1 and Day 2) in which the participants underwent an indirect calorimetry assessment at resting and during an incremental exercise test. Stoichiometric equations were used to calculate energy expenditure and substrate oxidation rates. There were no significant differences when comparing RMR (1999.3 ± 273.9 vs. 1955.7 ± 362.6 kcal/day, p = 0.389), RER (0.87 ± 0.05 vs. 0.89 ± 0.05, p = 0.143), MFO (0.32 ± 0.20 vs. 0.31 ± 0.20 g/min, p = 0.776) and Fatmax (45.0 ± 8.6 vs. 46.4 ± 8.4% VO2max, p = 0.435) values in Day 1 vs. Day 2. The inter-day coefficient of variation for RMR, RER, MFO and Fatmax were 4.85 ± 5.48%, 3.22 ± 3.14%, 7.78 ± 5.51%, and 6.51 ± 8.04%, respectively. In summary, the current results show a good inter-day reliability when RMR, RER, MFO and Fatmax are determined in healthy men using the Ergostik gas analyzer.
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Affiliation(s)
- Lidia Robles-González
- EFFECTS-262 Research Group, Department of Medical Physiology, Faculty of Medicine, University of Granada, 18011 Granada, Spain;
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Department of Physical and Sports Education, School of Sports Science, University of Granada, 18011 Granada, Spain;
| | - Jorge Gutiérrez-Hellín
- Exercise and Sport Science, Faculty of Health Sciences, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain; (J.G.-H.); (M.A.-N.); (A.M.)
| | - Millán Aguilar-Navarro
- Exercise and Sport Science, Faculty of Health Sciences, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain; (J.G.-H.); (M.A.-N.); (A.M.)
| | - Carlos Ruiz-Moreno
- Exercise Physiology Laboratory, Camilo José Cela University, 28692 Villanueva de la Cañada, Spain;
| | - Alejandro Muñoz
- Exercise and Sport Science, Faculty of Health Sciences, Universidad Francisco de Vitoria, 28223 Pozuelo de Alarcón, Spain; (J.G.-H.); (M.A.-N.); (A.M.)
| | - Juan Del-Coso
- Centre for Sport Studies, Rey Juan Carlos University, 28943 Fuenlabrada, Spain;
| | - Jonatan R. Ruiz
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Department of Physical and Sports Education, School of Sports Science, University of Granada, 18011 Granada, Spain;
| | - Francisco J. Amaro-Gahete
- EFFECTS-262 Research Group, Department of Medical Physiology, Faculty of Medicine, University of Granada, 18011 Granada, Spain;
- PROmoting FITness and Health through Physical Activity Research Group (PROFITH), Department of Physical and Sports Education, School of Sports Science, University of Granada, 18011 Granada, Spain;
- Correspondence:
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Cordoza M, Chan LN, Bridges E, Thompson H. Methods for Estimating Energy Expenditure in Critically Ill Adults. AACN Adv Crit Care 2021; 31:254-264. [PMID: 32866253 DOI: 10.4037/aacnacc2020110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Energy expenditure (EE) is the sum of metabolic activity within the body at a given time and comprises basal EE, diet-induced thermogenesis, and physical activity. In the intensive care unit, EE is most often assessed to determine a patient's caloric requirements. Energy expenditure also may be useful to understand disease states and the metabolic impact of interventions. Several methods for estimating EE are relevant for clinical use, including indirect calorimetry, predictive equations, exhaled carbon dioxide volume, and the Fick method. Indirect calorimetry is the preferred method for evaluating EE and is considered the gold standard for estimating EE in hospitalized patients. However, use of indirect calorimetry is not always practical or possible. Therefore, other methods of estimating EE must be considered. In this review, methods of evaluating EE in critically ill adults are examined and the benefits and limitations of each method are discussed, with practical considerations for use.
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Affiliation(s)
- Makayla Cordoza
- Makayla Cordoza is Postdoctoral Fellow, Division of Sleep and Chronobiology, Perelman School of Medicine, University of Pennsylvania, 1013 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104
| | - Lingtak-Neander Chan
- Lingtak-Neander Chan is Professor, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington
| | - Elizabeth Bridges
- Elizabeth Bridges is Professor, University of Washington, Seattle, Washington
| | - Hilaire Thompson
- Hilaire Thompson is Professor, Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington
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Shinozaki K, Okuma Y, Saeki K, Miyara SJ, Aoki T, Molmenti EP, Yin T, Kim J, Lampe JW, Becker LB. A method for measuring the molecular ratio of inhalation to exhalation and effect of inspired oxygen levels on oxygen consumption. Sci Rep 2021; 11:12815. [PMID: 34140533 PMCID: PMC8211831 DOI: 10.1038/s41598-021-91246-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/17/2021] [Indexed: 01/15/2023] Open
Abstract
Using a new method for measuring the molecular ratio (R) of inhalation to exhalation, we investigated the effect of high fraction of inspired oxygen (FIO2) on oxygen consumption (VO2), carbon dioxide generation (VCO2), and respiratory quotient (RQ) in mechanically ventilated rats. Twelve rats were equally assigned into two groups by anesthetics: intravenous midazolam/fentanyl vs. inhaled isoflurane. R, VO2, VCO2, and RQ were measured at FIO2 0.3 or 1.0. R error was ± 0.003. R was 1.0099 ± 0.0023 with isoflurane and 1.0074 ± 0.0018 with midazolam/fentanyl. R was 1.0081 ± 0.0017 at an FIO2 of 0.3 and 1.0092 ± 0.0029 at an FIO2 of 1.0. There were no differences in VCO2 among the groups. VO2 increased at FIO2 1.0, which was more notable when midazolam/fentanyl was used (isoflurane-FIO2 0.3: 15.4 ± 1.1; isoflurane-FIO2 1.0: 17.2 ± 1.8; midazolam/fentanyl-FIO2 0.3: 15.4 ± 1.1; midazolam/fentanyl-FIO2 1.0: 21.0 ± 2.2 mL/kg/min at STP). The RQ was lower at FIO2 1.0 than FIO2 0.3 (isoflurane-FIO2 0.3: 0.80 ± 0.07; isoflurane-FIO2 1.0: 0.71 ± 0.05; midazolam/fentanyl-FIO2 0.3: 0.79 ± 0.03; midazolam/fentanyl-FIO2 1.0: 0.59 ± 0.04). R was not affected by either anesthetics or FIO2. Inspired 100% O2 increased VO2 and decreased RQ, which might be more remarkable when midazolam/fentanyl was used.
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Affiliation(s)
- Koichiro Shinozaki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Department of Emergency Medicine, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health, 300 Community Dr., Manhasset, NY, 11030, USA.
| | - Yu Okuma
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Kota Saeki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Nihon Kohden Innovation Center, Cambridge, MA, USA
| | - Santiago J Miyara
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
| | - Tomoaki Aoki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Ernesto P Molmenti
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Surgery, Medicine, and Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Tai Yin
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Junhwan Kim
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Joshua W Lampe
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- ZOLL Medical, Chelmsford, MA, USA
| | - Lance B Becker
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Emergency Medicine, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health, 300 Community Dr., Manhasset, NY, 11030, USA
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11
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Wilkinson OM, Bates A, Cusack R. An observational feasibility study - does early limb ergometry affect oxygen delivery and uptake in intubated critically ill patients - a comparison of two assessment methods. BMC Anesthesiol 2021; 21:27. [PMID: 33494702 PMCID: PMC7829323 DOI: 10.1186/s12871-020-01227-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 12/25/2020] [Indexed: 11/17/2022] Open
Abstract
Background Early rehabilitation can reduce ventilation duration and improve functional outcomes in critically ill patients. Upper limb strength is associated with ventilator weaning. Passive muscle loading may preserve muscle fibre function, help recover peripheral muscle strength and improve longer term, post-hospital discharge function capacity. The physiological effects of initiating rehabilitation soon after physiological stabilisation of these patients can be concerning for clinicians. This study investigated the feasibility of measuring metabolic demand and the safety and feasibility of early upper limb passive ergometry. An additional comparison of results, achieved from simultaneous application of the methods, is reported. Methods This was an observational feasibility study undertaken in an acute teaching hospital’s General Intensive Care Unit in the United Kingdom. Twelve haemodynamically stable, mechanically ventilated patients underwent 30 minutes of arm ergometry. Cardiovascular and respiratory parameters were monitored. A Friedman test identified changes in physiological parameters. A metabolic cart was attached to the ventilator to measure oxygen uptake. Oxygen uptake was concurrently calculated by the reverse Fick method, utilising cardiac output from the LiDCO™ and paired mixed venous and arterial samples. A comparison of the two methods was made. Data collection began 10 minutes before ergometry and continued to recovery. Paired mixed venous and arterial samples were taken every 10 minutes. Results Twelve patients were studied; 9 male, median age 55 years, range (27–82), median APACHE score 18.5, range (7–31), median fraction inspired oxygen 42.5%, range (28–60). Eight patients were receiving noradrenaline. Mean dose was 0.07 mcg/kg/min, range (0.01–0.15). Early ergometry was well tolerated. There were no clinically significant changes in respiratory, haemodynamic or metabolic variables pre ergometry to end recovery. There was no significant difference between the two methods of calculating VO2 (p = 0.70). Conclusions We report the feasibility of using the reverse Fick method and indirect calorimetry to measure metabolic demand during early physical rehabilitation of critically ill patients. More research is needed to ascertain the most reliable method. Minimal change in metabolic demand supports the safety and feasibility of upper limb ergometry. These results will inform future study designs for further research into exercise response in critically ill patients. Trial Registration Clinicaltrials.gov No. NCT04383171. Registered on 06 May 2020 - Retrospectively registered. http://www.clinicaltrials.gov.
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Affiliation(s)
- Olive M Wilkinson
- Centre for Innovation and Leadership, Faculty of Health Sciences, University of Southampton, Building 45, Room 2035, Highfield Campus, S017 1BJ, Southampton, UK.
| | - Andrew Bates
- Critical Care Anaesthesia and Perioperative Research Unit and Integrative Physiology, Clinical Experimental Sciences and NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust and University Hospital Southampton, Southampton, UK
| | - Rebecca Cusack
- Centre for Innovation and Leadership, Faculty of Health Sciences, University of Southampton, Building 45, Room 2035, Highfield Campus, S017 1BJ, Southampton, UK. .,Critical Care Anaesthesia and Perioperative Research Unit and Integrative Physiology, Clinical Experimental Sciences and NIHR Respiratory Biomedical Research Unit, University Hospital Southampton NHS Foundation Trust and University Hospital Southampton, Southampton, UK.
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12
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Abstract
Respiratory function is fundamental in the practice of anesthesia. Knowledge of basic physiologic principles of respiration assists in the proper implementation of daily actions of induction and maintenance of general anesthesia, delivery of mechanical ventilation, discontinuation of mechanical and pharmacologic support, and return to the preoperative state. The current work provides a review of classic physiology and emphasizes features important to the anesthesiologist. The material is divided in two main sections, gas exchange and respiratory mechanics; each section presents the physiology as the basis of abnormal states. We review the path of oxygen from air to the artery and of carbon dioxide the opposite way, and we have the causes of hypoxemia and of hypercarbia based on these very footpaths. We present the actions of pressure, flow, and volume as the normal determinants of ventilation, and we review the resulting abnormalities in terms of changes of resistance and compliance.
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13
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Impact of the Method Used to Select Gas Exchange Data for Estimating the Resting Metabolic Rate, as Supplied by Breath-by-Breath Metabolic Carts. Nutrients 2020; 12:nu12020487. [PMID: 32075052 PMCID: PMC7071290 DOI: 10.3390/nu12020487] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 01/28/2020] [Accepted: 02/10/2020] [Indexed: 01/06/2023] Open
Abstract
The method used to select representative gas exchange data from large datasets influences the resting metabolic rate (RMR) returned. This study determines which of three methods yields the lowest RMR (as recommended for use in human energy balance studies), and in which method the greatest variance in RMR is explained by classical determinants of this variable. A total of 107 young and 74 middle-aged adults underwent a 30 min RMR examination using a breath-by-breath metabolic cart. Three gas exchange data selection methods were used: (i) steady state (SSt) for 3, 4, 5, or 10 min, (ii) a pre-defined time interval (TI), i.e., 6–10, 11–15, 16–20, 21–25, 26–30, 6–25, or 6–30 min, and (iii) “filtering”, setting thresholds depending on the mean RMR value obtained. In both cohorts, the RMRs yielded by the SSt and filtering methods were significantly lower (p < 0.021) than those yielded by the TI method. No differences in RMR were seen under the different conditions of the SSt method, or of the filtering method. No differences were seen between the methods in terms of the variance in RMR explained by its classical determinants. In conclusion, the SSt and filtering methods return the lowest RMRs and intra-measurement coefficients of variation when using breath-by-breath metabolic carts.
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14
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Mtaweh H, Garros C, Ashkin A, Tuira L, Allard JP, Pencharz P, Pullenayegum E, Joffe A, Parshuram CS. An Exploratory Retrospective Study of Factors Affecting Energy Expenditure in Critically Ill Children. JPEN J Parenter Enteral Nutr 2019; 44:507-515. [PMID: 31267545 DOI: 10.1002/jpen.1673] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 05/31/2019] [Indexed: 01/28/2023]
Abstract
BACKGROUND Accurate measurement of energy expenditure is not widely available. Patient and clinical factors associated with energy expenditure have been poorly explored, leading to errors in estimation formulae. The objective of this study was to determine clinical factors associated with measured energy expenditure (MEE), expressed in kcal/kg/d, in critically ill children. METHODS This was a retrospective study at 2 Canadian pediatric intensive care units (ICUs). Patients were mechanically ventilated children who had 1 or more MEE using indirect calorimetry. Associations between MEE and 28 clinical factors were evaluated in univariate regression and 16 factors in a multivariate regression model accounting for repeated measurements. RESULTS Data from 239 patients (279 measurements) were analyzed. Median (Q1, Q3) MEE was 34.8 (26.8, 46.2) kcal/kg/d. MEE was significantly associated with weight, heart rate, diastolic blood pressure, ICU day of indirect calorimetry (P = 0.004), minute ventilation, vasoactive inotropic score (P = 0.004), opioids, chloral hydrate, dexmedetomidine, inhaled salbutamol (P = 0.02), and propofol dose (all P < 0.0001 unless otherwise specified) in the final multivariate regression model. CONCLUSIONS This study demonstrated association between MEE (kcal/kg/d) and factors not previously explored in pediatric critical illness. Further evaluation of these factors to confirm associations and more precisely quantify the magnitude of effect is required to support refinement of formulae to estimate energy expenditure.
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Affiliation(s)
- Haifa Mtaweh
- Department of Pediatrics, Division of Critical Care, The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | | | - Allison Ashkin
- Department of Dietetics, Stollery Children's Hospital, Edmonton, Canada
| | - Lori Tuira
- Department of Dietetics, The Hospital for Sick Children, Toronto, Canada
| | - Johane P Allard
- Department of Medicine, Toronto General Hospital, University of Toronto, Toronto, Canada
| | - Paul Pencharz
- Department of Paediatrics and Nutritional Sciences, University of Toronto, Toronto, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
| | - Ari Joffe
- Department of Pediatrics, Division of Critical Care, Stollery Children's Hospital, University of Alberta, Edmonton, Canada
| | - Christopher S Parshuram
- Department of Pediatrics, Division of Critical Care, The Hospital for Sick Children, Toronto, Canada.,Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, Canada
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15
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Black C, Grocott M, Singer M. The oxygen cost of rehabilitation interventions in mechanically ventilated patients: an observational study. Physiotherapy 2019; 107:169-175. [PMID: 32026817 DOI: 10.1016/j.physio.2019.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2018] [Revised: 03/11/2019] [Accepted: 06/21/2019] [Indexed: 12/28/2022]
Abstract
OBJECTIVE Early rehabilitation is assumed to be a crucial intervention to facilitate weaning from mechanical ventilation in critically ill patients and to limit their long-term functional dependence. However, little is known about the physiological load imposed on patients during such interventions. Without the ability to quantify the exercise intensity of rehabilitation interventions it is impossible to establish a clear separation between usual care and intervention groups in randomised controlled trials. This may explain the lack of definitive benefit of rehabilitation in published trials. We sought to characterise the physiological load, measured as oxygen consumption (V˙O2), of the physical activities carried out during rehabilitation interventions in mechanically ventilated participants. DESIGN Observational study. SETTING Single centre medical-surgical university hospital ICU. PARTICIPANTS 26 mechanically ventilated participants ventilated >7 days, able to participate in a rehabilitation program. INTERVENTION Oxygen consumption (measured by the Medgraphics Ultima breath-by-breath gas exchange analysis system) and heart rate were measured continuously pre-, during and post-standard rehabilitation sessions. RESULTS 52 sessions were recorded in 26 participants. There was considerable variation in the oxygen cost of the physical activities between participants. The recovery time for 1 in 4 rehabilitation sessions was longer than the rehabilitation activity time. CONCLUSIONS Absolute exercise intensity in mechanically ventilated ICU participants, as measured by oxygen consumption, is not activity-dependent.
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Affiliation(s)
- Claire Black
- University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; Bloomsbury Institute for Intensive Care Medicine, University College London, Cruciform Building, Gower Street, London WC1E 6BT, UK.
| | - Micheal Grocott
- Anaesthesia and Critical Care Research Unit, University Hospital Southampton NHS Foundation Trust, Tremona Road, Southampton SO16 6YD, UK.
| | - Mervyn Singer
- University College London Hospitals NHS Foundation Trust, 235 Euston Road, London NW1 2BU, UK; Bloomsbury Institute for Intensive Care Medicine, University College London, Cruciform Building, Gower Street, London WC1E 6BT, UK.
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16
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In vitro validation of indirect calorimetry device developed for the ICALIC project against mass spectrometry. Clin Nutr ESPEN 2019; 32:50-55. [PMID: 31221290 DOI: 10.1016/j.clnesp.2019.05.004] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2019] [Revised: 05/01/2019] [Accepted: 05/06/2019] [Indexed: 11/21/2022]
Abstract
RATIONALE Accurate evaluation of the energy needs is required to optimize nutrition support of critically ill patients. Recent evaluations of indirect calorimeters revealed significant differences among the devices available on the market. A new indirect calorimeter (Q-NRG®, Cosmed, Roma, Italy) has been developed by a group of investigators supporting the international calorimetry study initiative (ICALIC) to achieve ultimate accuracy for measuring energy expenditure while being easy to use, and affordable. This study aims to validate the precision and the accuracy of the Q-NRG® in the in-vitro setting, within the clinically relevant range for adults on mechanical ventilation in the ICU. Mass spectrometry is the reference method for the gas composition analysis to evaluate the analytic performances of the Q-NRG®. METHODS The accuracy and precision of the O2 and CO2 measurements by the Q-NRG were evaluated by comparing the measurements of known O2 and CO2 gas mixtures with the measurements by the mass spectrometer (Extrel, USA). The accuracy and precision of the Q-NRG® for measurements of VO2 (oxygen consumption) and VCO2 (CO2 production) at clinically relevant ranges (150, 250 and 400 ml/min STPD) were evaluated by measuring simulated gas exchange under mechanically ventilated setting at different FiO2 settings (21-80%), in comparison to the reference measurements by the mass spectrometer-based mixing chamber system. RESULTS The measurements of gas mixtures of predefined O2 and CO2 concentrations by the Q-NRG® were within 2% accuracy versus the mass spectrometer measurements in Passing Bablok regression analysis. In a mechanically ventilated setting of FiO2 from 21 up to 70%, the Q-NRG® measurements of simulated VO2 and VCO2 were within 5% difference of the reference mass spectrometer measurements. CONCLUSION In vitro evaluation confirms that the accuracy of the Q-NRG® indirect calorimeter is within 5% at oxygen enrichment to 70%; i.e. maximum expected for clinical use. Further recommendations for the clinical use of the Q-NRG® by will be released once the ongoing multi-center study is completed.
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17
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Mini-trampoline enhances cardiovascular responses during a stationary running exergame in adults. Biol Sport 2019; 35:335-342. [PMID: 30765918 PMCID: PMC6358523 DOI: 10.5114/biolsport.2018.78052] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/23/2018] [Accepted: 04/09/2018] [Indexed: 01/10/2023] Open
Abstract
A new class of video game called exergame (EXG) has been used to promote physical activity and cardiovascular fitness, but EXGs are not as efficient as traditional aerobic exercises. However, auxiliary tools, such as the mini trampoline (MT), may enhance the physiological responses obtained by the EXG. The aim of this study was to compare the metabolic and cardiovascular responses of a stationary running EXG with and without an MT. Nineteen healthy males performed a treadmill test for the determination of VO2max and HRmax. In sequence, the VO2, HR, and METs were measured during the Free Run, a Nintendo Wii's stationary running EXG, according to two distinct protocols. One protocol used the traditional EXG (EXG-PT), and the other protocol used an MT during the EXG (MT-PT). The normalized data were analyzed by statistical software SPSS 20.0 using a t-test and ANOVA for repeated measures (p < 0.05). The results supported that stationary running EXG performed on an MT showed an increased intensity, in all variables analyzed, when compared with the traditional EXG. Furthermore, the MT-PT was classified as a vigorous-intensity exercise and EXG-PT as a moderate to vigorous intensity exercise. In conclusion, these findings support that the MT is a feasible auxiliary tool to enhance physiologic responses during a stationary running EXG.
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18
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Poulsen MK, Thomsen LP, Kjaergaard S, Rees SE, Karbing DS. Reliability of, and Agreement Between, two Breath-by-Breath Indirect Calorimeters at Varying Levels of Inspiratory Oxygen. Nutr Clin Pract 2019; 34:767-774. [PMID: 30714634 DOI: 10.1002/ncp.10250] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
BACKGROUND Indirect calorimetry (IC) is considered the accurate way of measuring energy expenditure (EE). IC devices often apply the Haldane transformation, introducing errors at inspiratory oxygen fraction (FiO2 ) >60%. The aim was to assess measurement reliability and agreement between an unevaluated IC (device 2) (Beacon Caresystem, Mermaid Care A/S, Noerresundby, Denmark) not using Haldane transformation and an IC that does (device 1) (Ecovx, GE, Helsinki, Finland) at varying FiO2 . METHODS Twenty healthy male subjects participated, with 16 completing the study (33 ± 9 years, 83.3 ± 16 kg, 1.83 ± 0.08 m). Subjects were mechanically ventilated in pressure support (3cmH2 O; positive end-expiratory pressure: 3cmH2 O) at FiO2 of 21%, 50%, 85%, and 21% for 15 minutes at each FiO2 . Mean EE, oxygen consumption (VO2 ), and CO2 production (VCO2 ) were compared within and between devices across FiO2 levels. RESULTS Device 2 showed within-device EE significant differences at 21% vs 50% FiO2 and device 1 for VCO2 at 50% vs. 85% FiO2 . For all variables, both devices showed reliable measurements at 21% and 50% FiO2 , but at 85%, FiO2 bias and limits of agreement increased. Between devices, there were significant differences for EE at both 21% and 85% FiO2 for VO2 and for VCO2 at 85% FiO2 . CONCLUSION Both systems measured EE, VO2 , and VCO2 at 21%-85% FiO2 reliably but with bias at 85% FiO2 . The devices were in agreement at 21% and 50% FiO2 , but further studies need to confirm accuracy at high FiO2 .
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Affiliation(s)
- Mathias Krogh Poulsen
- Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Lars Pilegaard Thomsen
- Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Søren Kjaergaard
- Department of Anesthesiology, Aalborg University Hospital, Aalborg, Denmark
| | - Stephen Edward Rees
- Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
| | - Dan Stieper Karbing
- Respiratory and Critical Care Group, Department of Health Science and Technology, Aalborg University, Aalborg, Denmark
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19
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Sanchez-Delgado G, Alcantara JM, Ortiz-Alvarez L, Xu H, Martinez-Tellez B, Labayen I, Ruiz JR. Reliability of resting metabolic rate measurements in young adults: Impact of methods for data analysis. Clin Nutr 2018; 37:1618-1624. [DOI: 10.1016/j.clnu.2017.07.026] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2017] [Revised: 07/26/2017] [Accepted: 07/28/2017] [Indexed: 11/16/2022]
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20
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Alcantara JMA, Sanchez-Delgado G, Martinez-Tellez B, Merchan-Ramirez E, Labayen I, Ruiz JR. Congruent validity and inter-day reliability of two breath by breath metabolic carts to measure resting metabolic rate in young adults. Nutr Metab Cardiovasc Dis 2018; 28:929-936. [PMID: 29739678 DOI: 10.1016/j.numecd.2018.03.010] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 03/16/2018] [Accepted: 03/20/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND & AIMS Achieving high inter-day reliability is a key factor to analyze the magnitude of change in RMR, for instance after an intervention. The aims of this study were: i) to determine the congruent validity of RMR and respiratory quotient (RQ) with two breath by breath commercially available metabolic carts [CCM Express (CCM) and Ultima CardiO2 (MGU)]; and ii) to analyze the inter-day reliability of RMR and RQ measurements. METHODS & RESULTS Seventeen young adults participated in the study. RMR measurements were performed during two consecutive 30-min periods, on two consecutive days with both metabolic carts. The 5-min period that met the steady state criteria [Coefficient of variance (CV) < 10% for VO2, VCO2, and VE, and CV<5% for RQ] and with the lowest CV average was included in further analysis. RMR values were higher with the MGU than with the CCM on both days (two-way ANOVA, P = 0.021), however, no differences were found on RQ values obtained by both metabolic carts (P = 0.642). Absolute inter-day RMR differences obtained with the MGU were higher than those obtained with the CCM (219 ± 185 vs. 158 ± 154 kcal/day, respectively, P = 0.002; 18.3 ± 17.2% vs. 13.5 ± 15.3%, respectively, P = 0.046). We observed a significant positive association of absolute inter-day differences in RMR obtained with both metabolic carts (β = 0.717; R2 = 0.743; P < 0.001). CONCLUSIONS The CCM metabolic cart provides lower RMR values and seems more reliable than the MGU in our sample of young adults. Our findings also suggest that a great part of inter-day variability is explained by the individuals.
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Affiliation(s)
- J M A Alcantara
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Ctra. de Alfacar s/n C.P, 18071, Spain.
| | - G Sanchez-Delgado
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Ctra. de Alfacar s/n C.P, 18071, Spain
| | - B Martinez-Tellez
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Ctra. de Alfacar s/n C.P, 18071, Spain; Department of Medicine, Division of Endocrinology, and Einthoven Laboratory for Experimental Vascular Medicine, Leiden University Medical Center, Albinusdreef 2, 2333, Leiden, The Netherlands
| | - E Merchan-Ramirez
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Ctra. de Alfacar s/n C.P, 18071, Spain
| | - I Labayen
- Department of Health Sciences, Public University of Navarra, Avda. Barañain s/n, 31008, Pamplona, Spain
| | - J R Ruiz
- PROFITH "PROmoting FITness and Health Through Physical Activity" Research Group, Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Ctra. de Alfacar s/n C.P, 18071, Spain
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21
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Shinozaki K, Becker LB, Saeki K, Kim J, Yin T, Da T, Lampe JW. Dissociated Oxygen Consumption and Carbon Dioxide Production in the Post-Cardiac Arrest Rat: A Novel Metabolic Phenotype. J Am Heart Assoc 2018; 7:JAHA.117.007721. [PMID: 29959138 PMCID: PMC6064898 DOI: 10.1161/jaha.117.007721] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background The concept that resuscitation from cardiac arrest (CA) results in a metabolic injury is broadly accepted, yet patients never receive this diagnosis. We sought to find evidence of metabolic injuries after CA by measuring O2 consumption and CO2 production (VCO2) in a rodent model. In addition, we tested the effect of inspired 100% O2 on the metabolism. Methods and Results Rats were anesthetized and randomized into 3 groups: resuscitation from 10‐minute asphyxia with inhaled 100% O2 (CA–fraction of inspired O2 [FIO2] 1.0), with 30% O2 (CA‐FIO2 0.3), and sham with 30% O2 (sham‐FIO2 0.3). Animals were resuscitated with manual cardiopulmonary resuscitation. The volume of extracted O2 (VO2) and VCO2 were measured for a 2‐hour period after resuscitation. The respiratory quotient (RQ) was RQ=VCO2/VO2. VCO2 was elevated in CA‐FIO2 1.0 and CA‐FIO2 0.3 when compared with sham‐FIO2 0.3 in minutes 5 to 40 after resuscitation (CA‐FIO2 1.0: 16.7±2.2, P<0.01; CA‐FIO2 0.3: 17.4±1.4, P<0.01; versus sham‐FIO2 0.3: 13.6±1.1 mL/kg per minute), and then returned to normal. VO2 in CA‐FIO2 1.0 and CA‐FIO2 0.3 increased gradually and was significantly higher than sham‐FIO2 0.3 2 hours after resuscitation (CA‐FIO2 1.0: 28.7±6.7, P<0.01; CA‐FIO2 0.3: 24.4±2.3, P<0.01; versus sham‐FIO2 0.3: 15.8±2.4 mL/kg per minute). The RQ of CA animals persistently decreased (CA‐FIO2 1.0: 0.54±0.12 versus CA‐FIO2 0.3: 0.68±0.05 versus sham‐FIO2 0.3: 0.93±0.11, P<0.01 overall). Conclusions CA altered cellular metabolism resulting in increased VO2 with normal VCO2. Normal VCO2 suggests that the postresuscitation Krebs cycle is operating at a presumably healthy rate. Increased VO2 in the face of normal VCO2 suggests a significant alteration in O2 utilization in postresuscitation. Several RQ values fell well outside the normally cited range of 0.7 to 1.0. Higher FIO2 may increase VO2, leading to even lower RQ values.
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Affiliation(s)
- Koichiro Shinozaki
- Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY
| | - Lance B Becker
- Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY
| | - Kota Saeki
- Nihon Kohden Innovation Center, INC., Cambridge, MA
| | - Junhwan Kim
- Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY
| | - Tai Yin
- Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY
| | - Tong Da
- Center for Cellular Immunotherapies, The University of Pennsylvania, Philadelphia, PA
| | - Joshua W Lampe
- Feinstein Institute for Medical Research, Northwell Health System, Manhasset, NY.,ZOLL Medical, Chelmsford, MA
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Measurement of Oxygen Consumption Variations in Critically Ill Burns Patients: Are the Fick Method and Indirect Calorimetry Interchangeable? Shock 2018; 48:532-538. [PMID: 28452908 DOI: 10.1097/shk.0000000000000885] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES To evaluate the interchangeability of oxygen consumption variations measured with the Fick equation (ΔVO2Fick) and indirect calorimetry (ΔVO2Haldane) in critically ill burns patients. METHODS Prospective observational single-center study conducted in a university hospital. Twenty-two consecutive burns patients with circulatory insufficiency and hyperlactatemia (>2 mmol/L) who required a fluid challenge (FC) were included. All patients had cardiac output monitoring (transpulmonary thermodilution technique) and were ventilated and sedated. Simultaneous measurements of VO2Fick and VO2Haldane were performed before and immediately after the FC, at rest, and in hemodynamic conditions stabilized for at least 1 h. VO2Fick and VO2Haldane were measured, respectively, with the standard formulae (using arterial and central venous saturation measured with a blood gas analyzer) and with a metabolic monitor. RESULTS Forty-four paired measurements of VO2 were obtained. At each timepoint, the median (interquartile range, 25-75) VO2Haldane values were significantly higher than the median VO2Fick values (126 (103-192) vs. 90 (66-149) mL O2/min/m (P = 0.004) before FC and 129 (105-189) vs. 80 (54-119) mL O2/min/m (P = 0.001) after FC). Correlation between the ΔVO2Fick and the ΔVO2Haldane (%) measurements was poor, with an r = 0.06, (P = 0.77). The mean bias was 8.6% [limits of agreement (LOA): -75.7%, 92.9%]. CONCLUSIONS Analysis of agreement showed poor concordance for the ΔVO2Haldane and the ΔVO2Fick (%) with a low mean bias but large and clinically unacceptable LOA. ΔVO2Haldane and ΔVO2Fick (%) are not interchangeable in these conditions.
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A Device for the Quantification of Oxygen Consumption and Caloric Expenditure in the Neonatal Range. Anesth Analg 2018; 127:95-104. [PMID: 29505450 DOI: 10.1213/ane.0000000000003308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND The accurate measurement of oxygen consumption (VO2) and energy expenditure (EE) may be helpful to optimize the treatment of critically ill patients. However, current techniques are limited in their ability to accurately quantify these end points in infants due to a low VO2, low tidal volume, and rapid respiratory rate. This study describes and validates a new device intended to perform in this size range. METHODS We created a customized device that quantifies inspiratory volume using a pneumotachometer and concentrations of oxygen and carbon dioxide gas in the inspiratory and expiratory limbs. We created a customized algorithm to achieve precise time alignment of these measures, incorporating bias flow and compliance factors. The device was validated in 3 ways. First, we infused a certified gas mixture (50% oxygen/50% carbon dioxide) into an artificial lung circuit, comparing measured with simulated VO2 and carbon dioxide production (VCO2) within a matrix of varying tidal volume (4-20 mL), respiratory rate (20-80 bpm), and fraction of inspired oxygen (0.21-0.8). Second, VO2, VCO2, and EE were measured in Sprague Dawley rats under mechanical ventilation and were compared to simultaneous Douglas bag collections. Third, the device was studied on n = 14 intubated, spontaneously breathing neonates and infants, comparing measured values to Douglas measurements. In all cases, we assessed for difference between the device and reference standard by linear regression and Bland-Altman analysis. RESULTS In vitro, the mean ± standard deviation difference between the measured and reference standard VO2 was +0.04 ± 1.10 (95% limits of agreement, -2.11 to +2.20) mL/min and VCO2 was +0.26 ± 0.31 (-0.36 to +0.89) mL/min; differences were similar at each respiratory rate and tidal volume measured, but higher at fraction of inspired oxygen of 0.8 than at 0.7 or lower. In rodents, the mean difference was -0.20 ± 0.55 (-1.28 to +0.89) mL/min for VO2, +0.16 ± 0.25 (-0.32 to +0.65) mL/min for VCO2, and -0.84 ± 3.29 (-7.30 to +5.61) kcal/d for EE. In infants, the mean VO2 was 9.0 ± 2.5 mL/kg/min by Douglas method and was accurately measured by the device (bias, +0.22 ± 0.87 [-1.49 to +1.93] mL/kg/min). The average VCO2 was 8.1 ± 2.3 mL/kg/min, and the device exhibited a bias of +0.33 ± 0.82 (-1.27 to +1.94) mL/kg/min. Mean bias was +2.56% ± 11.60% of the reading for VO2 and +4.25% ± 11.20% of the reading for VCO2; among 56 replicates, 6 measurements fell outside of the 20% error range, and no patient had >1 of 4 replicates with a >20% error in either VO2 or VCO2. CONCLUSIONS This device can measure VO2, VCO2, and EE with sufficient accuracy for clinical decision-making within the neonatal and pediatric size range, including in the setting of tachypnea or hyperoxia.
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Mtaweh H, Tuira L, Floh AA, Parshuram CS. Indirect Calorimetry: History, Technology, and Application. Front Pediatr 2018; 6:257. [PMID: 30283765 PMCID: PMC6157446 DOI: 10.3389/fped.2018.00257] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 08/28/2018] [Indexed: 12/29/2022] Open
Abstract
Measurement of energy expenditure is important in order to determine basal metabolic rate and inform energy prescription provided. Indirect calorimetry is the reference standard and clinically recommended means to measure energy expenditure. This article reviews the historical development, technical, and logistic challenges of indirect calorimetry measurement, and provides case examples for practicing clinicians. Formulae to estimate energy expenditure are highly inaccurate and reinforce the role of the indirect calorimetry and the importance of understanding the strength and limitation of the method and its application.
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Affiliation(s)
- Haifa Mtaweh
- Department of Critical Care Medicine, The Hospital for Sick Children, University Ave, Toronto, ON, Canada
| | - Lori Tuira
- Department of Clinical Dietetics, The Hospital for Sick Children, University Ave, Toronto, ON, Canada
| | - Alejandro A Floh
- Department of Critical Care Medicine, The Hospital for Sick Children, University Ave, Toronto, ON, Canada
| | - Christopher S Parshuram
- Department of Critical Care Medicine, The Hospital for Sick Children, University Ave, Toronto, ON, Canada
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Abstract
Transfusion decision making (TDM) in the critically ill requires consideration of: (1) anemia tolerance, which is linked to active pathology and to physiologic reserve, (2) differences in donor RBC physiology from that of native RBCs, and (3) relative risk from anemia-attributable oxygen delivery failure vs hazards of transfusion, itself. Current approaches to TDM (e.g. hemoglobin thresholds) do not: (1) differentiate between patients with similar anemia, but dissimilar pathology/physiology, and (2) guide transfusion timing and amount to efficacy-based goals (other than resolution of hemoglobin thresholds). Here, we explore approaches to TDM that address the above gaps.
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Affiliation(s)
- Chris Markham
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, McDonnell Pediatric Research Building, Campus Box 8208, 660 South Euclid Avenue, St Louis, MO 63110-1093, USA
| | - Sara Small
- Social Systems Design Laboratory, Brown School of Social Work, Washington University, Campus Box 1196, 1 Brookings Drive, St Louis, MO 63130, USA
| | - Peter Hovmand
- Social Systems Design Laboratory, Brown School of Social Work, Washington University, Campus Box 1196, 1 Brookings Drive, St Louis, MO 63130, USA
| | - Allan Doctor
- Division of Critical Care Medicine, Department of Pediatrics, Washington University School of Medicine, McDonnell Pediatric Research Building, Campus Box 8208, 660 South Euclid Avenue, St Louis, MO 63110-1093, USA.
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Ferreruela M, Raurich JM, Llompart-Pou JA, Colomar A, Ayestarán I. Effect of FiO 2 in the measurement of VO 2 and VCO 2 using the E-COXV metabolic monitor. Med Intensiva 2017; 41:461-467. [PMID: 28283325 DOI: 10.1016/j.medin.2016.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/02/2016] [Accepted: 12/14/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE We evaluated the effect of changes in FiO2 on the bias and accuracy of the determination of oxygen consumption (V˙O2) and carbon dioxide production (V˙CO2) using the E-COVX monitor in patients with mechanical ventilation. DESIGN Descriptive of concordance. SETTING Intensive Care Unit. PATIENTS OR PARTICIPANTS Patients with mechanical ventilation. INTERVENTIONS We measured V˙O2 and V˙CO2 using the E-COVX monitor. Values recorded were the average in 5min. Two groups of 30 patients. We analyzed: 1) the reproducibility in the measurement of V˙O2 and V˙CO2 at FiO2 0.4, and 2) the effect of the changes in FiO2 on the measurement of V˙O2 and V˙CO2. Statistical analysis was performed using Bland and Altman test. VARIABLES OF MAIN INTEREST Bias and accuracy. RESULTS 1) FiO2 0.4 reproducibility: The bias in the measurement of V˙O2 and V˙CO2 was 1.6 and 2.1mL/min, respectively, and accuracy was 9.7 to -8.3% and 7.2 to -5.2%, respectively, and 2) effect of FiO2 on V˙O2: The bias of V˙O2 measured at FiO2 0.4 and 0.6 was -4.0mL/min and FiO2 0.4 and 0.8 was 5.2mL/min. Accuracy between FiO2 0.4 and 0.6 was 11.9 to -14.1%, and between FiO2 0.4 and 0.8 was 43.9 to -39.7%. CONCLUSIONS The E-COVX monitor evaluates V˙O2 and V˙CO2 in critical patients with mechanical ventilation with a clinically acceptable accuracy until FiO2 0.6.
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Affiliation(s)
- M Ferreruela
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - J M Raurich
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España.
| | - J A Llompart-Pou
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - A Colomar
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
| | - I Ayestarán
- Servei de Medicina Intensiva, Hospital Universitari Son Espases, Palma de Mallorca, España
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Allingstrup MJ, Kondrup J, Perner A, Christensen PL, Jensen TH, Henneberg SW. Indirect Calorimetry in Mechanically Ventilated Patients: A Prospective, Randomized, Clinical Validation of 2 Devices Against a Gold Standard. JPEN J Parenter Enteral Nutr 2016; 41:1272-1277. [DOI: 10.1177/0148607116662000] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Affiliation(s)
| | - Jens Kondrup
- Department of Clinical Nutrition, Copenhagen University Hospital, Rigshospitalet, Denmark
| | - Anders Perner
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
| | | | - Tom Hartvig Jensen
- Department of Intensive Care, Copenhagen University Hospital, Rigshospitalet, Denmark
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Ciaffoni L, O’Neill DP, Couper JH, Ritchie GAD, Hancock G, Robbins PA. In-airway molecular flow sensing: A new technology for continuous, noninvasive monitoring of oxygen consumption in critical care. SCIENCE ADVANCES 2016; 2:e1600560. [PMID: 27532048 PMCID: PMC4980105 DOI: 10.1126/sciadv.1600560] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2016] [Accepted: 07/12/2016] [Indexed: 05/24/2023]
Abstract
There are no satisfactory methods for monitoring oxygen consumption in critical care. To address this, we adapted laser absorption spectroscopy to provide measurements of O2, CO2, and water vapor within the airway every 10 ms. The analyzer is integrated within a novel respiratory flow meter that is an order of magnitude more precise than other flow meters. Such precision, coupled with the accurate alignment of gas concentrations with respiratory flow, makes possible the determination of O2 consumption by direct integration over time of the product of O2 concentration and flow. The precision is illustrated by integrating the balance gas (N2 plus Ar) flow and showing that this exchange was near zero. Measured O2 consumption changed by <5% between air and O2 breathing. Clinical capability was illustrated by recording O2 consumption during an aortic aneurysm repair. This device now makes easy, accurate, and noninvasive measurement of O2 consumption for intubated patients in critical care possible.
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Affiliation(s)
- Luca Ciaffoni
- Department of Chemistry, Physical and Theoretical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford OX1 3QZ, UK
| | - David P. O’Neill
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford OX1 3PT, UK
| | - John H. Couper
- Department of Chemistry, Physical and Theoretical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford OX1 3QZ, UK
| | - Grant A. D. Ritchie
- Department of Chemistry, Physical and Theoretical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford OX1 3QZ, UK
| | - Gus Hancock
- Department of Chemistry, Physical and Theoretical Chemistry Laboratory, University of Oxford, South Parks Road, Oxford OX1 3QZ, UK
| | - Peter A. Robbins
- Department of Physiology, Anatomy and Genetics, University of Oxford, Sherrington Building, Parks Road, Oxford OX1 3PT, UK
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Oshima T, Berger MM, De Waele E, Guttormsen AB, Heidegger CP, Hiesmayr M, Singer P, Wernerman J, Pichard C. Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group. Clin Nutr 2016; 36:651-662. [PMID: 27373497 DOI: 10.1016/j.clnu.2016.06.010] [Citation(s) in RCA: 142] [Impact Index Per Article: 17.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2016] [Revised: 06/09/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND & AIMS This review aims to clarify the use of indirect calorimetry (IC) in nutritional therapy for critically ill and other patient populations. It features a comprehensive overview of the technical concepts, the practical application and current developments of IC. METHODS Pubmed-referenced publications were analyzed to generate an overview about the basic knowledge of IC, to describe advantages and disadvantages of the current technology, to clarify technical issues and provide pragmatic solutions for clinical practice and metabolic research. The International Multicentric Study Group for Indirect Calorimetry (ICALIC) has generated this position paper. RESULTS IC can be performed in in- and out-patients, including those in the intensive care unit, to measure energy expenditure (EE). Optimal nutritional therapy, defined as energy prescription based on measured EE by IC has been associated with better clinical outcome. Equations based on simple anthropometric measurements to predict EE are inaccurate when applied to individual patients. An ongoing international academic initiative to develop a new indirect calorimeter aims at providing innovative and affordable technical solutions for many of the current limitations of IC. CONCLUSION Indirect calorimetry is a tool of paramount importance, necessary to optimize the nutrition therapy of patients with various pathologies and conditions. Recent technical developments allow broader use of IC for in- and out-patients.
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Affiliation(s)
- Taku Oshima
- Department of Emergency and Critical Care Medicine, Chiba University Graduate School of Medicine, 1-8-1 Inohana Chuou-ku, Chiba City, Chiba 260-8677, Japan.
| | - Mette M Berger
- Adult Intensive Care, Lausanne University Hospital, 1011 Lausanne, Switzerland.
| | - Elisabeth De Waele
- Department of Intensive Care, Vrije Universiteit Brussel, Brussels, Belgium.
| | - Anne Berit Guttormsen
- Department of Anaesthesiology and Intensive Care, Haukeland University Hospital, Jonas Liesvei 65, 5021 Bergen, Norway; Department of Clinical Medicine University of Bergen, Bergen, Norway; Haukeland Universitetssykehus Laboratoriebygget, 7. etg. Heis øst, Norway.
| | - Claudia-Paula Heidegger
- Service of Intensive Care, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
| | - Michael Hiesmayr
- Division of Cardiac Thoracic Vascular Anesthesia and Intensive Care Medicine, University Hospital of Vienna, Waehrihger Guertel 18-20, 1090 Vienna, Austria.
| | - Pierre Singer
- Critical Care Medicine, Institute for Nutrition Research, Rabin Medical Center, Beilison Hospital, Petah Tikva 49100, Israel.
| | - Jan Wernerman
- Department of Anesthesiology and Intensive Care Medicine, Karolinska University Hospital Huddinge, Sweden.
| | - Claude Pichard
- Nutrition Unit, Geneva University Hospital, Rue Gabrielle-Perret-Gentil 4, 1211 Geneva 14, Switzerland.
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30
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De Waele E, Honore PM, Spapen HD. New generation indirect calorimeters for measuring energy expenditure in the critically ill: a rampant or reticent revolution? CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:138. [PMID: 27262591 PMCID: PMC4893421 DOI: 10.1186/s13054-016-1315-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
To lower the risk of incorrectly feeding critically ill patients, indirect calorimetry (IC) is proposed as the most ideal method to evaluate energy expenditure and to establish caloric goals. New IC devices are progressively introduced but validation of this new generation remains challenging and arduous.
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Affiliation(s)
- Elisabeth De Waele
- ICU Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101, Laarbeeklaan, 1090, Brussels, Belgium.
| | - Patrick M Honore
- ICU Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101, Laarbeeklaan, 1090, Brussels, Belgium
| | - Herbert D Spapen
- ICU Department, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, 101, Laarbeeklaan, 1090, Brussels, Belgium
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31
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Rehal MS, Fiskaare E, Tjäder I, Norberg Å, Rooyackers O, Wernerman J. Measuring energy expenditure in the intensive care unit: a comparison of indirect calorimetry by E-sCOVX and Quark RMR with Deltatrac II in mechanically ventilated critically ill patients. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2016; 20:54. [PMID: 26951095 PMCID: PMC4782362 DOI: 10.1186/s13054-016-1232-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/06/2016] [Accepted: 02/10/2016] [Indexed: 11/24/2022]
Abstract
Background Indirect calorimetry allows the determination of energy expenditure in critically ill patients by measuring oxygen consumption (VO2) and carbon dioxide production (VCO2). Recent studies have demonstrated variable performance of “breath-by-breath” instruments compared to mixing chamber technology. The aim of this study was to validate two modern devices (E-sCOVX and Quark RMR) against a reference method (Deltatrac II). Method Measurements of VO2/VCO2 with the test and reference devices were performed simultaneously over a 20-min period in mechanically ventilated adult intensive care unit patients. Accuracy and precision of instruments were analyzed using Bland-Altman plots. Results Forty-eight measurements in 22 patients were included for analysis. Both E-sCOVX and Quark RMR overestimated VO2 and VCO2 compared to Deltatrac II, corresponding to a 10 % higher mean resting energy expenditure. Limits of agreement of resting energy expenditure within ±2 standard deviations were ±461 kcal/24 h (±21 % expressed as percentage error) for ΔE-sCOVX–Deltatrac II and ±465 kcal/24 h (±22 %) for ΔQuark RMR–Deltatrac II. Conclusion Both test devices overestimate VO2 and VCO2 compared to Deltatrac II. The observed limits of agreement are comparable to those commonly accepted in evaluations of circulatory monitoring, and significantly less than results from predictive equations. We hypothesize that the discrepancy between methods is due to patient/ventilator-related factors that affect the synchronization of gas and spirometry waveforms. Trial registration Australian New Zealand Clinical Trials Registry, Trial ID ACTRN12615000205538. Date registered 3 March 2015.
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Affiliation(s)
- Martin Sundström Rehal
- Department of Anesthesiology and Intensive Care Medicine, K32, Karolinska University Hospital Huddinge, Hälsovägen 13, 14186, Stockholm, Sweden. .,Division of Anesthesia and Intensive Care, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen 13, 14186, Stockholm, Sweden.
| | - Erik Fiskaare
- Division of Anesthesia and Intensive Care, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen 13, 14186, Stockholm, Sweden.
| | - Inga Tjäder
- Department of Anesthesiology and Intensive Care Medicine, K32, Karolinska University Hospital Huddinge, Hälsovägen 13, 14186, Stockholm, Sweden. .,Division of Anesthesia and Intensive Care, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen 13, 14186, Stockholm, Sweden.
| | - Åke Norberg
- Department of Anesthesiology and Intensive Care Medicine, K32, Karolinska University Hospital Huddinge, Hälsovägen 13, 14186, Stockholm, Sweden. .,Division of Anesthesia and Intensive Care, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen 13, 14186, Stockholm, Sweden.
| | - Olav Rooyackers
- Division of Anesthesia and Intensive Care, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen 13, 14186, Stockholm, Sweden.
| | - Jan Wernerman
- Department of Anesthesiology and Intensive Care Medicine, K32, Karolinska University Hospital Huddinge, Hälsovägen 13, 14186, Stockholm, Sweden. .,Division of Anesthesia and Intensive Care, Department of Clinical Sciences, Intervention and Technology (CLINTEC), Karolinska Institutet, Hälsovägen 13, 14186, Stockholm, Sweden.
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