Inaccuracy of Estimated Resting Oxygen Uptake in the Clinical Setting
BACKGROUND—The Fick principle (cardiac output = oxygen uptake ((Equation is included in full-text article.)O2)/systemic arterio-venous oxygen difference) is used to determine cardiac output in numerous clinical situations. However, estimated rather than measured (Equation is included in full-text ar...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2014-01, Vol.129 (2), p.203-210 |
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| creator | Narang, Nikhil Thibodeau, Jennifer T Levine, Benjamin D Gore, M Odette Ayers, Colby R Lange, Richard A Cigarroa, Joaquin E Turer, Aslan T de Lemos, James A McGuire, Darren K |
| description | BACKGROUND—The Fick principle (cardiac output = oxygen uptake ((Equation is included in full-text article.)O2)/systemic arterio-venous oxygen difference) is used to determine cardiac output in numerous clinical situations. However, estimated rather than measured (Equation is included in full-text article.)O2 is commonly used because of complexities of the measurement, though the accuracy of estimation remains uncertain in contemporary clinical practice.
METHODS AND RESULTS—From 1996 to 2005, resting (Equation is included in full-text article.)O2 was measured via the Douglas bag technique in adult patients undergoing right heart catheterization. Resting (Equation is included in full-text article.)O2 was estimated by each of 3 published formulae. Agreement between measured and estimated (Equation is included in full-text article.)O2 was assessed overall, and across strata of body mass index, sex, and age. The study included 535 patients, with mean age 55 yrs, mean body mass index 28.4 kg/m; 53% women; 64% non-white. Mean (±standard deviation) measured (Equation is included in full-text article.)O2 was 241 ± 57 ml/min. Measured (Equation is included in full-text article.)O2 differed significantly from values derived from all 3 formulae, with median (interquartile range) absolute differences of 28.4 (13.1, 50.2) ml/min, 37.7 (19.4, 63.3) ml/min, and 31.7 (14.4, 54.5) ml/min, for the formulae of Dehmer, LaFarge, and Bergstra, respectively (P25% in 17% to 25% of patients depending on the formula used. Median absolute differences were greater in severely obese patients (body mass index > 40 kg/m), but were not affected by sex or age.
CONCLUSIONS—Estimates of resting (Equation is included in full-text article.)O2 derived from conventional formulae are inaccurate, especially in severely obese individuals. When accurate hemodynamic assessment is important for clinical decision-making, (Equation is included in full-text article.)O2 should be directly measured. |
| doi_str_mv | 10.1161/CIRCULATIONAHA.113.003334 |
| format | Article |
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METHODS AND RESULTS—From 1996 to 2005, resting (Equation is included in full-text article.)O2 was measured via the Douglas bag technique in adult patients undergoing right heart catheterization. Resting (Equation is included in full-text article.)O2 was estimated by each of 3 published formulae. Agreement between measured and estimated (Equation is included in full-text article.)O2 was assessed overall, and across strata of body mass index, sex, and age. The study included 535 patients, with mean age 55 yrs, mean body mass index 28.4 kg/m; 53% women; 64% non-white. Mean (±standard deviation) measured (Equation is included in full-text article.)O2 was 241 ± 57 ml/min. Measured (Equation is included in full-text article.)O2 differed significantly from values derived from all 3 formulae, with median (interquartile range) absolute differences of 28.4 (13.1, 50.2) ml/min, 37.7 (19.4, 63.3) ml/min, and 31.7 (14.4, 54.5) ml/min, for the formulae of Dehmer, LaFarge, and Bergstra, respectively (P<0.0001 for each). The measured and estimated values differed by >25% in 17% to 25% of patients depending on the formula used. Median absolute differences were greater in severely obese patients (body mass index > 40 kg/m), but were not affected by sex or age.
CONCLUSIONS—Estimates of resting (Equation is included in full-text article.)O2 derived from conventional formulae are inaccurate, especially in severely obese individuals. When accurate hemodynamic assessment is important for clinical decision-making, (Equation is included in full-text article.)O2 should be directly measured.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.113.003334</identifier><identifier>PMID: 24077170</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: by the American College of Cardiology Foundation and the American Heart Association, Inc</publisher><subject>Adult ; Aged ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiac Catheterization ; Cardiac Output - physiology ; Cardiology. Vascular system ; Cardiovascular system ; Decision Making ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Hemodynamics - physiology ; Humans ; Investigative techniques of hemodynamics ; Investigative techniques, diagnostic techniques (general aspects) ; Male ; Medical sciences ; Middle Aged ; Models, Cardiovascular ; Monitoring, Physiologic - methods ; Oxygen Consumption - physiology ; Rest - physiology ; Retrospective Studies ; ROC Curve</subject><ispartof>Circulation (New York, N.Y.), 2014-01, Vol.129 (2), p.203-210</ispartof><rights>2014 by the American College of Cardiology Foundation and the American Heart Association, Inc.</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c4524-ad1f16ada5fcbe12d1c67a831d2d9635abedb932d75e129fad5446a797db128a3</citedby><cites>FETCH-LOGICAL-c4524-ad1f16ada5fcbe12d1c67a831d2d9635abedb932d75e129fad5446a797db128a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,777,781,3674,27905,27906</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=28336925$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/24077170$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Narang, Nikhil</creatorcontrib><creatorcontrib>Thibodeau, Jennifer T</creatorcontrib><creatorcontrib>Levine, Benjamin D</creatorcontrib><creatorcontrib>Gore, M Odette</creatorcontrib><creatorcontrib>Ayers, Colby R</creatorcontrib><creatorcontrib>Lange, Richard A</creatorcontrib><creatorcontrib>Cigarroa, Joaquin E</creatorcontrib><creatorcontrib>Turer, Aslan T</creatorcontrib><creatorcontrib>de Lemos, James A</creatorcontrib><creatorcontrib>McGuire, Darren K</creatorcontrib><title>Inaccuracy of Estimated Resting Oxygen Uptake in the Clinical Setting</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>BACKGROUND—The Fick principle (cardiac output = oxygen uptake ((Equation is included in full-text article.)O2)/systemic arterio-venous oxygen difference) is used to determine cardiac output in numerous clinical situations. However, estimated rather than measured (Equation is included in full-text article.)O2 is commonly used because of complexities of the measurement, though the accuracy of estimation remains uncertain in contemporary clinical practice.
METHODS AND RESULTS—From 1996 to 2005, resting (Equation is included in full-text article.)O2 was measured via the Douglas bag technique in adult patients undergoing right heart catheterization. Resting (Equation is included in full-text article.)O2 was estimated by each of 3 published formulae. Agreement between measured and estimated (Equation is included in full-text article.)O2 was assessed overall, and across strata of body mass index, sex, and age. The study included 535 patients, with mean age 55 yrs, mean body mass index 28.4 kg/m; 53% women; 64% non-white. Mean (±standard deviation) measured (Equation is included in full-text article.)O2 was 241 ± 57 ml/min. Measured (Equation is included in full-text article.)O2 differed significantly from values derived from all 3 formulae, with median (interquartile range) absolute differences of 28.4 (13.1, 50.2) ml/min, 37.7 (19.4, 63.3) ml/min, and 31.7 (14.4, 54.5) ml/min, for the formulae of Dehmer, LaFarge, and Bergstra, respectively (P<0.0001 for each). The measured and estimated values differed by >25% in 17% to 25% of patients depending on the formula used. Median absolute differences were greater in severely obese patients (body mass index > 40 kg/m), but were not affected by sex or age.
CONCLUSIONS—Estimates of resting (Equation is included in full-text article.)O2 derived from conventional formulae are inaccurate, especially in severely obese individuals. When accurate hemodynamic assessment is important for clinical decision-making, (Equation is included in full-text article.)O2 should be directly measured.</description><subject>Adult</subject><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiac Catheterization</subject><subject>Cardiac Output - physiology</subject><subject>Cardiology. Vascular system</subject><subject>Cardiovascular system</subject><subject>Decision Making</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Female</subject><subject>Hemodynamics - physiology</subject><subject>Humans</subject><subject>Investigative techniques of hemodynamics</subject><subject>Investigative techniques, diagnostic techniques (general aspects)</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Models, Cardiovascular</subject><subject>Monitoring, Physiologic - methods</subject><subject>Oxygen Consumption - physiology</subject><subject>Rest - physiology</subject><subject>Retrospective Studies</subject><subject>ROC Curve</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2014</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNqNkE9PwjAYhxujEUS_gqkHEy9g_2wrPXggCwoJkQThvLxrO5iMDdstyLe3BNR489T27fO-_fVB6I6SHqURfYzHs3gxGczH09fBaOBrvEcI5zw4Q20asqAbhFyeozYhRHYFZ6yFrpx798eIi_AStVhAhKCCtNFwXIJSjQW1x1WGh67ON1AbjWfGb8slnn7ul6bEi20Na4PzEtcrg-MiL3MFBX4z9YG6RhcZFM7cnNYOWjwP5_GoO5m-jOPBpKuCQyzQNKMRaAgzlRrKNFWRgD6nmmkZ8RBSo1PJmRahv5UZ6DAIIhBS6JSyPvAOejjO3drqo_EJk03ulCkKKE3VuIQGkkSyz0noUXlEla2csyZLttZ_ze4TSpKDxeSvRV_jydGi7709PdOkG6N_Or-1eeD-BIDzGjILpcrdL9fnPJLsEOLpyO2qojbWrYtmZ2yyMlDUq38E-QLYe49F</recordid><startdate>20140114</startdate><enddate>20140114</enddate><creator>Narang, Nikhil</creator><creator>Thibodeau, Jennifer T</creator><creator>Levine, Benjamin D</creator><creator>Gore, M Odette</creator><creator>Ayers, Colby R</creator><creator>Lange, Richard A</creator><creator>Cigarroa, Joaquin E</creator><creator>Turer, Aslan T</creator><creator>de Lemos, James A</creator><creator>McGuire, Darren K</creator><general>by the American College of Cardiology Foundation and the American Heart Association, Inc</general><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20140114</creationdate><title>Inaccuracy of Estimated Resting Oxygen Uptake in the Clinical Setting</title><author>Narang, Nikhil ; Thibodeau, Jennifer T ; Levine, Benjamin D ; Gore, M Odette ; Ayers, Colby R ; Lange, Richard A ; Cigarroa, Joaquin E ; Turer, Aslan T ; de Lemos, James A ; McGuire, Darren K</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c4524-ad1f16ada5fcbe12d1c67a831d2d9635abedb932d75e129fad5446a797db128a3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2014</creationdate><topic>Adult</topic><topic>Aged</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiac Catheterization</topic><topic>Cardiac Output - physiology</topic><topic>Cardiology. Vascular system</topic><topic>Cardiovascular system</topic><topic>Decision Making</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Female</topic><topic>Hemodynamics - physiology</topic><topic>Humans</topic><topic>Investigative techniques of hemodynamics</topic><topic>Investigative techniques, diagnostic techniques (general aspects)</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Models, Cardiovascular</topic><topic>Monitoring, Physiologic - methods</topic><topic>Oxygen Consumption - physiology</topic><topic>Rest - physiology</topic><topic>Retrospective Studies</topic><topic>ROC Curve</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Narang, Nikhil</creatorcontrib><creatorcontrib>Thibodeau, Jennifer T</creatorcontrib><creatorcontrib>Levine, Benjamin D</creatorcontrib><creatorcontrib>Gore, M Odette</creatorcontrib><creatorcontrib>Ayers, Colby R</creatorcontrib><creatorcontrib>Lange, Richard A</creatorcontrib><creatorcontrib>Cigarroa, Joaquin E</creatorcontrib><creatorcontrib>Turer, Aslan T</creatorcontrib><creatorcontrib>de Lemos, James A</creatorcontrib><creatorcontrib>McGuire, Darren K</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Narang, Nikhil</au><au>Thibodeau, Jennifer T</au><au>Levine, Benjamin D</au><au>Gore, M Odette</au><au>Ayers, Colby R</au><au>Lange, Richard A</au><au>Cigarroa, Joaquin E</au><au>Turer, Aslan T</au><au>de Lemos, James A</au><au>McGuire, Darren K</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Inaccuracy of Estimated Resting Oxygen Uptake in the Clinical Setting</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2014-01-14</date><risdate>2014</risdate><volume>129</volume><issue>2</issue><spage>203</spage><epage>210</epage><pages>203-210</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>BACKGROUND—The Fick principle (cardiac output = oxygen uptake ((Equation is included in full-text article.)O2)/systemic arterio-venous oxygen difference) is used to determine cardiac output in numerous clinical situations. However, estimated rather than measured (Equation is included in full-text article.)O2 is commonly used because of complexities of the measurement, though the accuracy of estimation remains uncertain in contemporary clinical practice.
METHODS AND RESULTS—From 1996 to 2005, resting (Equation is included in full-text article.)O2 was measured via the Douglas bag technique in adult patients undergoing right heart catheterization. Resting (Equation is included in full-text article.)O2 was estimated by each of 3 published formulae. Agreement between measured and estimated (Equation is included in full-text article.)O2 was assessed overall, and across strata of body mass index, sex, and age. The study included 535 patients, with mean age 55 yrs, mean body mass index 28.4 kg/m; 53% women; 64% non-white. Mean (±standard deviation) measured (Equation is included in full-text article.)O2 was 241 ± 57 ml/min. Measured (Equation is included in full-text article.)O2 differed significantly from values derived from all 3 formulae, with median (interquartile range) absolute differences of 28.4 (13.1, 50.2) ml/min, 37.7 (19.4, 63.3) ml/min, and 31.7 (14.4, 54.5) ml/min, for the formulae of Dehmer, LaFarge, and Bergstra, respectively (P<0.0001 for each). The measured and estimated values differed by >25% in 17% to 25% of patients depending on the formula used. Median absolute differences were greater in severely obese patients (body mass index > 40 kg/m), but were not affected by sex or age.
CONCLUSIONS—Estimates of resting (Equation is included in full-text article.)O2 derived from conventional formulae are inaccurate, especially in severely obese individuals. When accurate hemodynamic assessment is important for clinical decision-making, (Equation is included in full-text article.)O2 should be directly measured.</abstract><cop>Hagerstown, MD</cop><pub>by the American College of Cardiology Foundation and the American Heart Association, Inc</pub><pmid>24077170</pmid><doi>10.1161/CIRCULATIONAHA.113.003334</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Ovid Autoload |
| subjects | Adult Aged Biological and medical sciences Blood and lymphatic vessels Cardiac Catheterization Cardiac Output - physiology Cardiology. Vascular system Cardiovascular system Decision Making Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Hemodynamics - physiology Humans Investigative techniques of hemodynamics Investigative techniques, diagnostic techniques (general aspects) Male Medical sciences Middle Aged Models, Cardiovascular Monitoring, Physiologic - methods Oxygen Consumption - physiology Rest - physiology Retrospective Studies ROC Curve |
| title | Inaccuracy of Estimated Resting Oxygen Uptake in the Clinical Setting |
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