A method for increasing confidence in respiratory gas exchange measurements in mechanically ventilated patients

Measurement of O2 uptake (VO2) and CO2 output (VCO2) with automated instruments can be used to optimize nutritional management of critically ill patients. However, these measurements may be made infrequently because of calibration problems or suspected inaccuracies, especially when the patient is given supplemental oxygen. A simple method is described for periodic testing of automated gas exchange measurements. While a test lung is mechanically ventilated an accurately known mixture of CO2 and nitrogen is introduced into the inspired gas, simulating VO2 by dilution and VCO2 by addition of CO2. The ratio of VCO2:VO2 (respiratory gas exchange ratio, R) in the "expired gas" should be [FGCO2/(1-FGCO2)] x [(1-FIO2)/FIO2], where FGCO2 is the fraction of CO2 in the diluting gas and FIO2 is the fraction of O2 in the inspired gas. R is independent of the flow rate of the diluting gas or the rate of ventilation of the test lung. Using a mixing chamber-mass spectrometer, we found that R calculated from measurement of CO2 and O2 concentrations in the simulated mixed expired gas closely matched the predicted R for FIO2 = 0.21-0.50. On the other hand, when an automated gas exchange measurement device was tested, R was sometimes excessively high, especially for FIO2 greater than 0.35. This method, using a single diluting gas and without precision flowmeters, may be useful for periodic testing of respiratory gas exchange instruments in the intensive care unit. If a discrepancy is found between measured and predicted R, measurements should not be relied upon until further calibration or repairs can be effected.