Indirect calorimetry with a hood: flow requirements, accuracy, and minute ventilation measurement

Flow-dilution-based hood systems for indirect calorimetry eliminate the conventional mouthpiece or mask of sealed-circuit systems allow measurements with improved patient comfort. This feature is particularly relevant when measurements are made over long periods of time or are repeated often. The flow of air pulled through the hood into the calorimeter in these systems is necessary to clear CO2 from inside the hood. The errors in these systems are greater than those in the sealed-circuit systems and are proportional to the flow. We show that the CO2 concentration within the hood at steady state does not depend on hood size. We describe the accuracy in determination of O2 consumption (VO2), CO2 production, and respiratory exchange ratio with a hood system as a function of the accuracy of the O2 and CO2 analyzers and the water vapor in collected gas. For example, we show that if there is a 1% error in O2 concentration, the percent error in VO2 changes from 5% in a sealed circuit to 51% when a cleansing flow of 50 l/min is introduced. The error in VO2 caused by a 5% error in CO2 determination is 10.6% at this cleansing flow. Removal of 90% of the water vapor (instead of 100%) before analysis of the expired gas introduces a 15.8% error in VO2. By use of the equations described, the accuracy of any measurement system can be determined. In addition, we demonstrate that the measurement of ventilation, usually lost in a hood system, can be preserved using dual pneumotachographs and a sealed hood.