Inaccuracy of estimated resting oxygen uptake in the clinical setting

Nikhil Narang, Jennifer T. Thibodeau, Benjamin D. Levine, M. Odette Gore, Colby R. Ayers, Richard A. Lange, Joaquin Cigarroa, Aslan T. Turer, James A. De Lemos, Darren K. McGuire

    Research output: Contribution to journalArticle

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    Abstract

    The Fick principle (cardiac output = oxygen uptake (VO2)/ systemic arterio-venous oxygen difference) is used to determine cardiac output in numerous clinical situations. However, estimated rather than measured VO 2 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 VO2 was measured via the Douglas bag technique in adult patients undergoing right heart catheterization. Resting VO2 was estimated by each of 3 published formulae. Agreement between measured and estimated VO2 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/m2; 53% women; 64% non-white. Mean (±standard deviation) measured VO2 was 241 ± 57 ml/min. Measured VO 2 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/m2), but were not affected by sex or age. Conclusions-Estimates of resting VO2 derived from conventional formulae are inaccurate, especially in severely obese individuals. When accurate hemodynamic assessment is important for clinical decision-making, VO2 should be directly measured.

    Original languageEnglish (US)
    Pages (from-to)203-210
    Number of pages8
    JournalCirculation
    Volume129
    Issue number2
    DOIs
    StatePublished - Jan 14 2014

    Fingerprint

    Body Mass Index
    Oxygen
    Cardiac Output
    Patient Rights
    Cardiac Catheterization
    Hemodynamics
    Clinical Decision-Making

    Keywords

    • cardiac output
    • catheterization
    • hemodynamics

    ASJC Scopus subject areas

    • Physiology (medical)
    • Cardiology and Cardiovascular Medicine

    Cite this

    Narang, N., Thibodeau, J. T., Levine, B. D., Gore, M. O., Ayers, C. R., Lange, R. A., ... McGuire, D. K. (2014). Inaccuracy of estimated resting oxygen uptake in the clinical setting. Circulation, 129(2), 203-210. https://doi.org/10.1161/CIRCULATIONAHA.113.003334

    Inaccuracy of estimated resting oxygen uptake in the clinical setting. / Narang, Nikhil; Thibodeau, Jennifer T.; Levine, Benjamin D.; Gore, M. Odette; Ayers, Colby R.; Lange, Richard A.; Cigarroa, Joaquin; Turer, Aslan T.; De Lemos, James A.; McGuire, Darren K.

    In: Circulation, Vol. 129, No. 2, 14.01.2014, p. 203-210.

    Research output: Contribution to journalArticle

    Narang, N, Thibodeau, JT, Levine, BD, Gore, MO, Ayers, CR, Lange, RA, Cigarroa, J, Turer, AT, De Lemos, JA & McGuire, DK 2014, 'Inaccuracy of estimated resting oxygen uptake in the clinical setting', Circulation, vol. 129, no. 2, pp. 203-210. https://doi.org/10.1161/CIRCULATIONAHA.113.003334
    Narang N, Thibodeau JT, Levine BD, Gore MO, Ayers CR, Lange RA et al. Inaccuracy of estimated resting oxygen uptake in the clinical setting. Circulation. 2014 Jan 14;129(2):203-210. https://doi.org/10.1161/CIRCULATIONAHA.113.003334
    Narang, Nikhil ; Thibodeau, Jennifer T. ; Levine, Benjamin D. ; Gore, M. Odette ; Ayers, Colby R. ; Lange, Richard A. ; Cigarroa, Joaquin ; Turer, Aslan T. ; De Lemos, James A. ; McGuire, Darren K. / Inaccuracy of estimated resting oxygen uptake in the clinical setting. In: Circulation. 2014 ; Vol. 129, No. 2. pp. 203-210.
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    abstract = "The Fick principle (cardiac output = oxygen uptake (VO2)/ systemic arterio-venous oxygen difference) is used to determine cardiac output in numerous clinical situations. However, estimated rather than measured VO 2 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 VO2 was measured via the Douglas bag technique in adult patients undergoing right heart catheterization. Resting VO2 was estimated by each of 3 published formulae. Agreement between measured and estimated VO2 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/m2; 53{\%} women; 64{\%} non-white. Mean (±standard deviation) measured VO2 was 241 ± 57 ml/min. Measured VO 2 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/m2), but were not affected by sex or age. Conclusions-Estimates of resting VO2 derived from conventional formulae are inaccurate, especially in severely obese individuals. When accurate hemodynamic assessment is important for clinical decision-making, VO2 should be directly measured.",
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    AU - Ayers, Colby R.

    AU - Lange, Richard A.

    AU - Cigarroa, Joaquin

    AU - Turer, Aslan T.

    AU - De Lemos, James A.

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