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O2 consumption by the fick method. Methodologic factors

R Chioléro1, P Mavrocordatos, D Bracco

  • 1Department of Anesthesiology, University Hospital, Lausanne, Switzerland.

American Journal of Respiratory and Critical Care Medicine
|May 1, 1994
PubMed
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Comparing oxygen consumption methods in cardiac surgery patients, this study found room temperature saline injections accurate for Fick method (VO2F) measurements. Iced saline injections introduced significant bias, making them unsuitable for critically ill patients.

Area of Science:

  • Cardiology
  • Critical Care Medicine
  • Physiology

Background:

  • Accurate measurement of oxygen consumption (VO2) is crucial for managing critically ill patients, particularly those undergoing cardiac surgery.
  • The Fick method (VO2F) and gas-exchange method (VO2GE) are common techniques for VO2 determination, but their comparability can be influenced by methodology.
  • Discrepancies in published studies highlight the need to clarify optimal conditions for VO2 determination in this patient population.

Purpose of the Study:

  • To compare oxygen consumption (VO2) determination using the gas-exchange (VO2GE) and Fick (VO2F) methods in mechanically ventilated, postoperative cardiac surgical patients.
  • To evaluate the impact of injectate temperature (room temperature vs. iced saline) and injection timing on the accuracy and precision of VO2F measurements.
  • To assess the effect of the number of thermodilution injections on the reliability of VO2F.

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Main Methods:

  • Prospective study involving 10 mechanically ventilated postoperative cardiac surgical patients.
  • Thermodilution cardiac output measurements were performed using three techniques: room temperature saline (end expiration), room temperature saline (random respiratory cycle), and iced saline (end expiration).
  • Oxygen consumption was determined by both VO2GE and VO2F, with VO2F variability assessed across 2 and 10 injections.

Main Results:

  • The variability of VO2F was greater than VO2GE.
  • No significant bias was found between VO2GE and VO2F when using room temperature saline injectate.
  • Increasing thermodilution injections from 2 to 10 did not improve accuracy or precision.
  • A significant bias was observed with iced saline, resulting in lower VO2F values (18.0 ± 15.4 ml/min/m2 lower than VO2GE, p = 0.001).

Conclusions:

  • Room temperature saline injections are suitable for VO2F determination in cardiac surgical patients.
  • Iced saline injectate introduces significant bias and should be avoided for VO2 assessment in critically ill patients.
  • The number of thermodilution injections does not substantially impact the reliability of VO2 measurements in this context.