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 E. Cigarroa, Aslan T. Turer, James A. De Lemos, Darren K. McGuire

Research output: Contribution to journalArticle

26 Citations (Scopus)

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

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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 E.; 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, JE, 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 E. ; 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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