British Journal of Anaesthesia, 2003, Vol. 91, No. 1 120-131
© 2003 The Board of Management and Trustees of the British Journal of Anaesthesia
Review Article |
Recent advances in gas exchange measurement in intensive care patients
Royal Infirmary, Edinburgh EH3 9YW, UKE-mail: tim@walsh.sol.co.uk
Keywords: measurement techniques, gas exchange; metabolism, energy expenditure; metabolism, oxygen consumption; oxygen, consumption
| The first 150 words of the full text of this article appear below. |
Adequate resuscitation, shock reversal, and prevention of organ failure are central to modern intensive care. Shock is frequently defined as the presence of insufficient oxygen supply to tissues to meet metabolic demands. The measurement of oxygen consumption by critically ill patients is potentially useful, because it indicates the net result of oxygen delivery to the tissues and the ability of cells in the tissues to use oxygen. Assessment of carbon dioxide elimination can provide information about respiratory physiology and, when combined with oxygen consumption, energy expenditure and metabolism. It has been recognized for many years that oxygen delivery and utilization are often abnormal in many types of critical illness.27 52 Despite these observations the relevant literature is confusing and contradictory. One reason for this is misunderstanding of the methodological limitations of techniques for assessing gas exchange.18 61 This article reviews key methodological issues relating to gas exchange measurement in the ICU, some
Historical perspective
Nutrition
Oxygen kinetics
Determinants of metabolic gas exchange in the critically ill
Oxygen consumption
Carbon dioxide elimination
Respiratory quotient (RQ)
Energy expenditure
Methods of measuring gas exchange in the critically ill
The inverse Fick method
Factors limiting the accuracy of inverse Fick calculations
Mathematical coupling
Measurements based on gas analysis
Closed circuit techniques
Open circuit techniques
Methodological issues in mechanically ventilated critically ill patients
Current gold standard for gas exchange measurements
Principles of measurements
Accuracy
New devices
Potential applications of gas exchange measurements in the ICU
Nutritional assessment
Measuring metabolic stress
Oxygen kinetics
Assessment of pulmonary physiology
Conclusions
Acknowledgement
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