Comparison of methods of measurements of oxygen consumption in mechanically ventilated patients with multiple trauma: The Fick method versus indirect calorimetry

Objective: The purpose of this study was to compare the measurements of whole body oxygen consumption determined by the Fick method and by indirect calorimetry in mechanically ventilated patients with multiple trauma. Design: A prospective, correlational, within-subjects design. Setting: Surgical intensive care unit of a Level I trauma center. Patients: Thirty-eight mechanically ventilated adults with multiple injuries who received a pulmonary artery catheter within 24 hrs of admission to the surgical intensive care unit. Measurements and Main Results:After the initial resuscitation, simultaneous measurements of oxygen consumption ((V) over dotO(2)) by the reverse Fick equation and by indirect calorimetry were performed every 6 hrs for 24 hrs in normothermic patients who were at rest for at least 30 mins. At each measurement period, the mean (V) over dotO(2) values determined by indirect calorimetry were significantly greater than the mean (V) over dotO(2), values determined by the Fick method (time 1: 172 +/- 38 vs. 125 +/- 47 mL/min/m(2), p < .0001; time 2: 170 +/- 31 vs. 130 +/- 48 mL/min/m(2), p < .0001; time 3: 170 +/- 32 vs. 132 +/- 53 mL/min/m(2), p < .0001; time 4: 169 +/- 29 vs. 130 +/- 60 mL/min/m(2), p < .0002). By using the Bland and Altman technique, the mean bias was 41 +/- 3.95 mL/min/m(2). Correlation coefficients of (V) over dotO(2) values between methods of measurements were statistically significant (r(2) = .32, p = .0001; r(2) = .32, p = .0001; r(2) = .33, p = .0001; r(2) = .18, p = .0001). Conclusions: Indirect calorimetry should be the preferred standard for measurement of oxygen consumption in severely injured patients.