Semsroth M
Infusionsther Klin Ernahr. 1986 Feb;13(1):44-62.
After the new device for measurement of oxygen uptake (VO2) and carbon dioxide elimination (VCO2) was tested in a pneumatic lung model, we investigated its clinical practicability. First the level of VO2 and VCO2 in the early postoperative phase was determined. Secondly we examined alterations in gasexchange caused by various intensive care activities. Whereby main concern was the change from mechanical ventilation to spontaneous CPAP-breathing. Ten children undergoing cardiac surgery (age: 10 days to 10 years) were included in the study. Three children were primarily investigated on the CPAP-system. Data from another six were collected under controlled ventilation as well as under spontaneous CPAP-breathing. One child had to be ventilated for a longer time (greater than 24 h). The change from mechanical ventilation to spontaneous breathing was accompanied with a temporary increase of VO2 and VCO2. As expected, all stressful factors like tracheal suction, pain or anxiety increased these two variables. Also some drugs showed remarkable changes. While marked increases under Normastigmine, Naloxone, and Dopamine could be observed, gas exchange was decreased under Morphine. However, heart rate showed no good correlation with VO2. We conclude that the developed prototype is a reliable device for measuring VO2 and VCO2. Our results suggest that spontaneous CPAP-breathing is not always accompanied with increased gas exchange. If there is an increased gas exchange, it may refer to transient changes during the adaption phase. Therefore, a continuous monitoring of VO2 and VCO2 over a longer period of time is necessary. Consequently the first phase after changing ventilatory support has to be viewed carefully. The heart rate in children, undergone cardiac surgery, is not a good predictor for determination of VO2 and thus for energy expenditure. This device allows to quantify accurately oxygen consumption and carbon dioxide elimination in ventilated children. Furthermore, alterations in metabolism and cardiopulmonary variables caused by intensive care and therapeutic interventions can be examined continuously. It seems to be a valuable tool for metabolic and cardiopulmonary monitoring in critically ill children.
在新型氧气摄取量（VO₂）和二氧化碳排出量（VCO₂）测量装置在气动肺模型中进行测试后，我们对其临床实用性进行了研究。首先测定术后早期的VO₂和VCO₂水平。其次，我们检查了各种重症监护活动引起的气体交换变化。其中主要关注的是从机械通气转换为自主持续气道正压通气（CPAP）呼吸的变化。10名接受心脏手术的儿童（年龄：10天至10岁）被纳入该研究。3名儿童主要在CPAP系统上进行研究。另外6名儿童的数据在控制通气以及自主CPAP呼吸状态下收集。1名儿童需要较长时间（超过24小时）通气。从机械通气转换为自主呼吸伴随着VO₂和VCO₂的暂时增加。正如预期的那样，所有应激因素，如气管吸引、疼痛或焦虑都会使这两个变量增加。一些药物也显示出显著变化。虽然可观察到在新斯的明、纳洛酮和多巴胺作用下有明显增加，但在吗啡作用下气体交换减少。然而，心率与VO₂没有良好的相关性。我们得出结论，所开发的原型是一种用于测量VO₂和VCO₂的可靠装置。我们的结果表明，自主CPAP呼吸并不总是伴随着气体交换增加。如果气体交换增加，可能是指适应阶段的短暂变化。因此，有必要在较长时间内持续监测VO₂和VCO₂。因此，必须仔细观察通气支持改变后的第一阶段。接受心脏手术的儿童的心率并不是用于确定VO₂进而确定能量消耗的良好预测指标。该装置能够准确量化通气儿童的氧气消耗量和二氧化碳排出量。此外，可以持续检查重症监护和治疗干预引起的代谢和心肺变量变化。它似乎是用于危重症儿童代谢和心肺监测的有价值工具。
