Marson Flávio, Auxiliadora Martins Maria, Coletto Francisco Antonio, Campos Antonio Dorival, Basile-Filho Anibal
Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brasil.
Arq Bras Cardiol. 2004 Jan;82(1):77-81, 72-6. doi: 10.1590/s0066-782x2004000100007. Epub 2004 Feb 12.
To compare the oxygen consumption index measured by using indirect calorimetry (VO2I Delta) with a portable metabolic cart and calculated according to Fick's principle (VO2 I Fick) in critically ill patients.
Fourteen patients (10 men and 4 women, mean age 39.4 +/- 5.4 years) were analyzed, 5 of them trauma victims and 9 sepsis victims. The following mean scores were obtained for these patients: APACHE II = 21.3+/-1.8, ISS = 24.8+/-6, and sepsis score = 19.6+/-2.3. The mortality risk (odds ratio), calculated from APACHE II, was 41.9+/-7.1%. All patients underwent mechanical ventilation and invasive hemodynamic monitoring with a Swan-Ganz catheter. VO2 was obtained using the 2 methods (VO2I Delta and VO2I Fick) at 4 different times (T1-T4).
A good correlation was found between the 2 methods (r=0.77) for the mean of the 4 serial measurements. No statistically significant differences were observed between indirect calorimetry and Fick's equation at T1 (VO2I Delta = 138+/-28 and VO2I Fick = 59+/-38 mL.min-2.m-2, P=0.10) and T3 (VO2I Delta = 144+/-26 and VO2I Fick = 158+/-35 mL.min-2.m-2, P=0.14), but a significant difference was observed at T2 (VO2I Delta = 141+/-27 and VO2I Fick = 155+/-26 mL.min-2.m-2, P=0.03) and T4 (VO2I Delta = 145+/-24 and VO2I Fick = 162+/-26 mL.min-2.m-2, P=0.01).
We may state that indirect calorimetry can be used for oxygen consumption analysis in critically ill patients and is as efficient as Fick's reverse equation, with the benefit of being a noninvasive and risk-free procedure.
比较使用便携式代谢车通过间接测热法测得的氧耗指数（VO2I Delta）与根据菲克原理计算得出的氧耗指数（VO2I Fick）在危重症患者中的情况。
分析了14例患者（10例男性和4例女性，平均年龄39.4±5.4岁），其中5例为创伤患者，9例为脓毒症患者。这些患者获得了以下平均评分：急性生理与慢性健康状况评分系统II（APACHE II）=21.3±1.8，损伤严重度评分（ISS）=24.8±6，脓毒症评分=19.6±2.3。根据APACHE II计算的死亡风险（比值比）为41.9±7.1%。所有患者均接受机械通气，并使用Swan-Ganz导管进行有创血流动力学监测。在4个不同时间点（T1-T4）使用两种方法（VO2I Delta和VO2I Fick）获取VO2。
4次连续测量的平均值在两种方法之间发现有良好的相关性（r=0.77）。在T1（VO2I Delta =138±28且VO II Fick =59±38 mL·min⁻²·m⁻²）和T3（VO2I Delta =144±26且VO2I Fick =158±35 mL·min⁻²·m⁻²）时，间接测热法与菲克方程之间未观察到统计学上的显著差异（P=0.10和P=0.14），但在T2（VO2I Delta =141±27且VO2I Fick =155±26 mL·min⁻²·m⁻²）和T4（VO2I Delta =145±24且VO2I Fick =162±26 mL·min⁻²·m⁻²）时观察到显著差异（P=0.03和P=0.01）。
我们可以说间接测热法可用于危重症患者的氧耗分析，并且与菲克逆方程一样有效，其优点是为一种非侵入性且无风险的操作。
