Division of Anaesthesia and Intensive Care, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden.
Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden.
PLoS One. 2024 Jul 25;19(7):e0272239. doi: 10.1371/journal.pone.0272239. eCollection 2024.
Feasible estimations of perioperative changes in oxygen consumption (VO2) could enable larger studies of its role in postoperative outcomes. Current methods, either by reverse Fick calculations using pulmonary artery catheterisation or metabolic by breathing gas analysis, are often deemed too invasive or technically requiring. In addition, reverse Fick calculations report generally lower values of oxygen consumption.
We investigated the relationship between perioperative estimations of VO2 (EVO2), from LiDCO™plus-derived (LiDCO Ltd, Cambridge, UK) cardiac output and arterial-central venous oxygen content difference (Ca-cvO2), with indirect calorimetry (GVO2) by QuarkRMR (COSMED srl. Italy), using data collected 2017-2018 during a prospective observational study on perioperative oxygen transport in 20 patients >65 years during epidural and general anaesthesia for open pancreatic or liver resection surgery. Eighty-five simultaneous intra- and postoperative measurements at different perioperative stages were analysed for prediction, parallelity and by traditional agreement assessment.
Unadjusted bias between GVO2 and EVO2 indexed for body surface area was 26 (95% CI 20 to 32) with limits of agreement (1.96SD) of -32 to 85 ml min-1m-2. Correlation adjusted for the bias was moderate, intraclass coefficient(A,1) 0.51(95% CI 0.34 to 0.65) [F (84,84) = 3.07, P<0.001]. There was an overall association between GVO2 and EVO2, in a random coefficient model [GVO2 = 73(95% CI 62 to 83) + 0.45(95% CI 0.29 to 0.61) EVO2 ml min-1m-2, P<0.0001]. GVO2 and EVO2 changed in parallel intra- and postoperatively when normalised to their respective overall means.
Based on this data, estimations from LiDCO™plus-derived cardiac output and Ca-cvO2 are not reliable as a surrogate for perioperative VO2. Results were in line with previous studies comparing Fick-based and metabolic measurements but limited by variability of data and possible underpowering. The parallelity at different perioperative stages and the prediction model can provide useful guidance and methodological tools for future studies on similar methods in larger samples.
对围术期氧耗量（VO2）变化进行可行的估计，可使更多研究其在术后转归中的作用成为可能。目前的方法，无论是通过肺动脉导管化的逆向 Fick 计算，还是通过代谢呼吸气体分析，往往被认为过于侵入性或技术上需要。此外，逆向 Fick 计算报告的氧耗量通常较低。
我们使用 LiDCOplus 衍生的（LiDCO Ltd，英国剑桥）心输出量和动静脉血氧含量差（Ca-cvO2），对 2017-2018 年期间在接受硬膜外和全身麻醉下进行胰腺或肝脏开放性切除术的 20 名年龄>65 岁的患者进行了围术期氧转运的前瞻性观察研究中收集的数据进行了研究，探讨了围术期 VO2 估计值（EVO2）与间接热量测定法（GVO2）之间的关系。采用 QuarkRMR（COSMED srl. 意大利）进行分析。对不同围术期阶段的 85 次同时进行的术中及术后测量进行了预测、平行性和传统一致性评估。
GVO2 与 EVO2 指数化的未调整偏差为 26（95%置信区间 20 至 32），一致性界限（1.96SD）为-32 至 85ml min-1m-2。调整偏倚后的相关性为中度，组内系数（A，1）为 0.51（95%置信区间 0.34 至 0.65）[F（84，84）=3.07，P<0.001]。在随机系数模型中，GVO2 与 EVO2 之间存在总体关联[GVO2=73（95%置信区间 62 至 83）+0.45（95%置信区间 0.29 至 0.61）EVO2ml min-1m-2，P<0.0001]。当正常化到各自的总体平均值时，GVO2 和 EVO2 在术中及术后呈平行变化。
根据这些数据，LiDCOplus 衍生的心输出量和 Ca-cvO2 估计值不能作为围术期 VO2 的可靠替代物。结果与先前比较 Fick 法和代谢测量的研究一致，但受到数据变异性和可能的功效不足的限制。在不同的围术期阶段的平行性和预测模型可以为未来在更大样本量上使用类似方法的研究提供有用的指导和方法学工具。
