Measurement of Oxygen Consumption in Critically Ill Children: Breath-by-Breath Method vs Mass Spectrometry.

Long Guo Yong Cui Prashant Bobhate Shine Kumar Shreepal Jain Mohamed Elgendi Scott Pharis Lindsay Ryerson Ian Adatia

Am J Crit Care

Long Guo, Yong Cui, Prashant Bobhate, Shine Kumar, and Shreepal Jain were pulmonary hypertension service clinical research fellows; Scott Pharis was a pediatric cardiology fellow; Lindsay Ryerson is an assistant professor of pediatrics and a pediatric cardiac intensivist; and Ian Adatia is a professor of pediatrics, director of the pediatric pulmonary hypertension service, and a cardiac intensivist in the pediatric cardiac critical care unit at Stollery Children's Hospital, Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Canada. Cui is now a cardiac surgeon, Changhai Hospital, Second Military Medical University, Shanghai, People's Republic of China. Pharis is now a staff pediatric cardiologist, Royal University Hospital, Saskatoon, Saskatchewan, Canada. Mohamed Elgendi is a postdoctorate research fellow, Department of Mathematics and Computing Science, University of Alberta, Edmonton, Canada.

Published: May 2016

Measurement of oxygen consumption (Vȯ2) is crucial for assessing cardiac index and systemic vascular resistance in children, but it's challenging to obtain accurate readings.
A study compared oxygen consumption measurements between respiratory mass spectrometry and a breath-by-breath method in mechanically ventilated children, showing a strong correlation between the two techniques.
The results indicated that both methods yielded similar Vȯ2 values and did not significantly affect the calculation of cardiac index, suggesting the breath-by-breath method could be a practical choice in critically ill pediatric patients.

Background: Measurement of oxygen consumption (Vȯ2) is difficult in children but is essential to calculate cardiac index and systemic vascular resistance.

Objective: To compare measurements of Vȯ2 using respiratory mass spec trometry and the breath-by-breath method.

Methods: Vȯ2 was measured simultaneously and continuously for 10 minutes by using respiratory mass spectrometry and the breath-by-breath method in children receiving mechanical ventilation via cuffed endotracheal tubes.

Results: Sixteen children (7 boys; median [range]: age, 1.5 [0.2-6] years; weight, 11.5 [2.8-23.5] kg; body surface area, 0.55 [0.18-0.98] m(2)) were studied. The correlation between measurements of Vȯ2 by the 2 methods was good (R = 0.924). Mean Vȯ2 measured by mass spectrometry was 63 (95% CI, 47-78) mL/min vs 65 (95% CI, 47-83) mL/min measured by the breath-by-breath method. The mean Vȯ2 difference between the 2 methods was 3 (95% CI, -9 to 5) mL/min and statistically insignificant. Bland-Altman analysis showed that the 95% limits of agreement were between -28 and +23. Cardiac index did not differ significantly when calculated using Vȯ2 measured with one method or the other (mean difference, 0.1; 95% CI, -0.2 to 0.3).

Conclusions: Measurements of Vȯ2 did not differ between mass spectrometry and the breath-by-breath method. Use of the breath-by-breath method may facilitate calculation of cardiac index and systemic vascular resistance in critically ill children.

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http://dx.doi.org/10.4037/ajcc2016897	DOI Listing

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