Influence of different ventilator modes on Vo2 and Vco2 measurements using a compact metabolic monitor

Briassoulis, George; Michaeloudi, Evi; Fitrolaki, Diana-Michaela; Spanaki, Anna‐Maria; Briassouli, Efrossini

doi:10.1016/j.nut.2009.01.018

Cited by 34 publications

(30 citation statements)

References 32 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The modern metabolic cart is portable and it provides reproducible data that can be useful for directing nutrition intervention at the bedside. Newer compact metabolic monitors may allow easier calibration, portability, and ability to use in patients requiring frequent respiratory interventions or different ventilator modes (46, 47). In an era of resource constraints, IC may be targeted to patients who are at risk of metabolic instability, in which equation estimates are often unreliable and likelihood of energy imbalance is high (6).…”

Section: Discussionmentioning

confidence: 99%

“…With the advent of newer technology, continuous and accurate metabolic monitoring in critically ill children may be possible at the bedside. Studies evaluating the accuracy of devices providing continuous metabolic monitoring, the relationship between inflammatory state and metabolic state, and the application of this technology in the PICU are needed (46, 47). …”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Energy imbalance and the risk of overfeeding in critically ill children*

Mehta

Bechard

Dolan

et al. 2011

Pediatric Critical Care Medicine

122

102

View full text Add to dashboard Cite

Objective To examine the role of targeted indirect calorimetry in detecting the adequacy of energy intake and the risk of cumulative energy imbalance in a subgroup of critically ill children suspected to have alterations in resting energy expenditure. We examined the accuracy of standard equations used for estimating resting energy expenditure in relation to measured resting energy expenditure in relation to measured resting energy expenditure and cumulative energy balance over 1 week in this cohort. Design A prospective cohort study. Setting Pediatric intensive care unit in a tertiary academic center. Interventions A subgroup of critically ill children in the pediatric intensive care unit was selected using a set of criteria for targeted indirect calorimetry. Measurements Measured resting energy expenditure from indirect calorimetry and estimated resting energy expenditure from standard equations were obtained. The metabolic state of each patient was assigned as hypermetabolic (measured resting energy expenditure/estimated resting energy expenditure >110%), hypometabolic (measured resting energy expenditure/estimated resting energy expenditure <90%), or normal (measured resting energy expenditure/estimated resting energy expenditure = 90– 110%). Clinical variables associated with metabolic state and factors influencing the adequacy of energy intake were examined. Main Results Children identified by criteria for targeted indirect calorimetry, had a median length of stay of 44 days, a high incidence (72%) of metabolic instability and alterations in resting energy expenditure with a predominance of hypometabolism in those admitted to the medical service. Physicians failed to accurately predict the true metabolic state in a majority (62%) of patients. Standard equations overestimated the energy expenditure and a high incidence of overfeeding (83%) with cumulative energy excess of up to 8000 kcal/week was observed, especially in children <1 yr of age. We did not find a correlation between energy balance and respiratory quotient (RQ) in our study. Conclusions We detected a high incidence of overfeeding in a subgroup of critically ill children using targeted indirect calorimetry The predominance of hypometabolism, failure of physicians to correctly predict metabolic state, use of stress factors, and inaccuracy of standard equations all contributed to overfeeding in this cohort. Critically ill children, especially those with a longer stay in the PICU, are at a risk of unintended overfeeding with cumulative energy excess.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Energy imbalance and the risk of overfeeding in critically ill children*

Mehta

Bechard

Dolan

et al. 2011

Pediatric Critical Care Medicine

122

102

View full text Add to dashboard Cite

show abstract

“…In our study we found a good reproducibility of the V O 2 measurements obtained during two different study phases; the system has been validated mainly by comparisons with the previous Deltatrac monitor, 14,28,29 showing a good reliability. Although the different inspiratory flow profiles have not been found to affect measurement reproducibility, 30 no data are available on the potential effect of different tidal volumes or respiratory rates. Moreover, reports concerning comparisons with the reverse Fick methods, although promising, are limited.…”

Section: Discussionmentioning

confidence: 99%

Increase of Oxygen Consumption during a Progressive Decrease of Ventilatory Support Is Lower in Patients Failing the Trial in Comparison with Those Who Succeed

Bellani¹,

Spagnolli

Milan³

et al. 2010

Anesthesiology

View full text Add to dashboard Cite

Background:The aim of this study was to test the hypothesis that, during weaning from mechanical ventilation, when the pressure support level is reduced, oxygen consumption increases more in patients unable to sustain the decrease in ventilatory assistance (weaning failure). Methods: Patients judged eligible for weaning were enrolled. Starting from 20 cm H 2 O, pressure support was decreased in 4-cm H 2 O steps, lasting 10 min each, until 0 cm H 2 O; this level was kept for 1 h. The average oxygen consumption from the last 3 min of each step, along with other ventilatory variables, was measured by indirect calorimetry (M-CAiOVX "metabolic module," Engstrom Carestation; GE Healthcare, Madison, WI) and recorded. Patients were defined as belonging to the failure group if, at any moment, they developed signs of respiratory distress according to standard criteria, or to the success group otherwise. Results: Twenty-eight patients were studied. In most patients, the minimum oxygen consumption was not recorded at the highest pressure support applied. Sixteen patients were able to complete the weaning trial successfully, whereas 12 failed it; the success group had a minimum oxygen consumption lower than failure group (mean Ϯ SD: 174 Ϯ 44 vs. 215 Ϯ 53 ml/min, P Ͻ 0.05). Moreover, although respiratory drive (assessed by P0.1) increased more in the failure group, this group had a lower increase in oxygen consumption, contradicting our hypothesis. Conclusions: Patients failing a decremental pressure support trial, in comparison with those who succeed, had an higher baseline oxygen consumption and were not able to increase their oxygen consumption in response to an increased demand.

show abstract

“…The E-COVX compact metabolic module has the advantage of not being influenced by uneventful open endotracheal suctioning [3]. It is suitable for repeated 30-min measurements in well-sedated mechanically ventilated children with stable respiratory patterns in a variety of ventilation modes [4]. We hypothesized that IC using the E-COVX would show that energy expenditure is unpredictable in malnourished children and that replacing REE with any PEE equation, including the new PICU-oriented equations, might not be applicable for estimating energy expenditure in patients suffering from malnutrition during a critical illness.…”

mentioning

confidence: 99%

Unpredictable combination of metabolic and feeding patterns in malnourished critically ill children: the malnutrition–energy assessment question

et al. 2013

View full text Add to dashboard Cite

Dear Editor, Advances in paediatric critical care have resulted in the increased survival of chronically ill patients. In many units, such patients represent [50 % of the workload and are often malnourished [1]. Prediction of energy expenditure (PEE) equations are simple alternatives to the gold standard of assessing resting energy expenditure (REE) by indirect calorimetry (IC). However, recent work has suggested that PEE equations fail to adequately predict REE. New paediatric intensive care unit (PICU)-oriented equations have been found to be no better than well-established tools, such as the Schofield-HW equation [2]. We have compared PICU-specialized and commonly used PEE equations with REE using a new modular metabolic monitor (E-COVX) in well-nourished and malnourished critically ill children. The E-COVX compact metabolic module has the advantage of not being influenced by uneventful open endotracheal suctioning [3]. It is suitable for repeated 30-min measurements in well-sedated mechanically ventilated children with stable respiratory patterns in a variety of ventilation modes [4]. We hypothesized that IC using the E-COVX would show that energy expenditure is unpredictable in malnourished children and that replacing REE with any PEE equation, including the new PICU-oriented equations, might not be applicable for estimating energy expenditure in patients suffering from malnutrition during a critical illness. The Ethics Committee of the Institutional Review Board approved this study, and parents or guardians of the children gave informed, written consent.Mechanically ventilated critically ill children, consecutively admitted to the PICU of the University Hospital, Heraklion, Crete, were enrolled in the study. Thirty consecutive 1-min gas exchange measurements (VO 2 and VCO 2 ) were taken and the respiratory quotient (RQ) and REE were calculated for each patient (results were blinded from the attending physician). The nutritional status was evaluated for the presence of proteinenergy malnutrition as defined by Waterlow [5]. The PEE was estimated and basal metabolic rate (PBMR) was predicted using the common Harris-Benedict, Schofield-HW, Seashore, Fleisch, CaldwellKennedy and Henrys formulas, as well as equations specifically developed for the PICU by White and by Meyer [2]. Patients were classified as hypermetabolic, normometabolic and hypometabolic when the REE was [110, 90-110 and \90 % of the Schofield-PBMR, respectively, and as overfed, adequately fed and underfed when the caloric intake was [110, 80-110 and \80 % of the REE, respectively.Forty-four patients (28 boys, 16 girls) were studied (total measurements 1,320). Four patients were admitted after an elective procedure; the remaining patients were admitted as a result of an acute illness or injury. Twelve (27.3 %) patients presented severe (4) or moderate (8) malnutrition. All patients survived.The REE did not differ between patients according to a body temperature of \37.1°C (1,068 ± 460 kcal/ day) or C37.1°C (824 ± 217 kcal/ day) or with a Ramsey s...

show abstract

Influence of different ventilator modes on Vo2 and Vco2 measurements using a compact metabolic monitor

Cited by 34 publications

References 32 publications

Energy imbalance and the risk of overfeeding in critically ill children*

Energy imbalance and the risk of overfeeding in critically ill children*

Increase of Oxygen Consumption during a Progressive Decrease of Ventilatory Support Is Lower in Patients Failing the Trial in Comparison with Those Who Succeed

Unpredictable combination of metabolic and feeding patterns in malnourished critically ill children: the malnutrition–energy assessment question

Contact Info

Product

Resources

About