Spirometric versus Fick-derived oxygen consumption: which method is better?

Abstract

OBJECTIVE: Oxygen consumption (VO2) is often measured in critically ill patients using the Fick equation: VO2 = cardiac output x arterial-venous oxygen content difference. To determine if this method is accurate, it was compared with a spirometric technique. DESIGN: Prospective study. SETTING: University laboratory. SUBJECTS: Nineteen large adult pigs. INTERVENTIONS: Cardiac output, measured with bolus thermodilution technique, and arterial and venous oxygen content values, determined with the galvanic fuel cell method, were used to determine VO2 with the Fick equation. The spirometrically determined VO2 was the rate of disappearance of oxygen from a water-sealed spirometer. Dobutamine and labetalol were titrated to vary VO2 (range 204 to 584 mL/min). MEASUREMENTS AND MAIN RESULTS: The bias between the Fick and spirometrically determined VO2 values was 58 mL/min. The precision (SD of the bias) between the Fick and spirometrically determined Vo2 was 35 mL/min. Fick-derived Vo2 was greater than Vo2 measured spirometrically. The correlation coefficient was 0.90. CONCLUSIONS; Despite all attempts to reduce measurement error, there was an unexplained difference in Fick-derived and spirometrically measured Vo2. Therefore, I feel that the two methods are not interchangeable, and that calculations of Vo2 using the Fick method should be used cautiously when therapeutic maneuvers are based on these data.