危重症烧伤患者氧耗变化的测量：Fick 法和间接测热法是否可以互换？

Measurement of Oxygen Consumption Variations in Critically Ill Burns Patients: Are the Fick Method and Indirect Calorimetry Interchangeable?

机构信息

*Department of Anesthesiology and Critical Care and Burn Unit, AP-HP, Saint-Louis Hospital, Paris, France †Plastic Surgery and Burn Unit, AP-HP, Saint-Louis Hospital, Paris, France ‡Intensive Care Unit, Royal Melbourne Hospital, Parkville, Melbourne, Australia §Lariboisière, Hospital, INSERM UMR 942, Paris, France ||Paris Diderot University, Paris, France.

出版信息

Shock. 2017 Nov;48(5):532-538. doi: 10.1097/SHK.0000000000000885.

DOI:10.1097/SHK.0000000000000885

PMID:28452908

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.

摘要

目的

评估使用菲克方程（ΔVO2Fick）和间接量热法（ΔVO2Haldane）测量的耗氧量变化在危重病烧伤患者中的可互换性。

方法

这是一项在大学医院进行的前瞻性观察性单中心研究。纳入了 22 例因循环功能不全和高乳酸血症（>2mmol/L）而需要进行液体冲击（FC）的连续烧伤患者。所有患者均接受心输出量监测（经肺温度稀释技术），并接受通气和镇静。在 FC 前、FC 后即刻、休息时以及血流动力学稳定至少 1 小时后，同时进行 VO2Fick 和 VO2Haldane 的测量。VO2Fick 和 VO2Haldane 分别使用标准公式（使用血气分析仪测量的动脉和中心静脉饱和度）和代谢监测仪进行测量。

结果

共获得 44 对 VO2 测量值。在每个时间点，Haldane 法测量的 VO2 中位数（25-75 分位）均显著高于菲克法测量的 VO2 中位数（FC 前：126（103-192）比 90（66-149）mL O2/min/m，P=0.004；FC 后：129（105-189）比 80（54-119）mL O2/min/m，P=0.001）。ΔVO2Fick 和 ΔVO2Haldane（%）测量值之间的相关性较差，r=0.06，P=0.77。平均偏倚为 8.6%（LOA：-75.7%，92.9%）。