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Direct calorimetry using Swan-Ganz catheter for evaluation of general metabolic expenditure in acute cerebrovascular disease--comparison between direct Fick method and indirect calorimetry technique.

Oxygen consumption calculated by the direct Fick method using a Swan-Ganz catheter (D-VO2) and indirect calorimetry using a metabolic computer (ID-VO2), carbon dioxide production calculated by the latter method, and respiratory quotient were determined pre- and postoperatively in 12 patients with acute hypertensive intracerebral hemorrhage and eight patients with acute ruptured intracranial aneurysm. The mean D-VO2 value was slightly lower than the mean ID-VO2 value, but had a significantly positive correlation. The regression curve was very close to the line of identity. The total metabolic expenditure can be calculated from D-VO2 and daily urinary nitrogen excretion. Direct calorimetry using a Swan-Ganz catheter is a simple method to evaluate metabolic expenditure in acute hemorrhagic cardiovascular disease.

Acute Disease

Indirect calorimetry as a guide to caloric replacement during total parenteral nutrition.

Fifty patients were studied by indirect calorimetry to assess caloric needs. Seventeen patients received total parenteral nutrition (TPN) in a fixed dose of 45 +/- 3 kcal/kg. Thirty-three patients were studied after acute injury. Indirect calorimetry and the basal energy expenditure equation (BEEE) were compared. In male patients receiving TPN, indirect calorimetry more closely approximated caloric needs than did the BEEE X 1.75. In female patients, the BEEE X 1.75, indirect calorimetry value, and calories infused were more equivalent, and positive nitrogen balance was consistently achieved. In thirty-three trauma patients, indirect calorimetry and the BEEE were compared. Indirect calorimetry consistently predicted higher caloric expenditure than did the BEEE X 1.75. In assessing caloric requirements in acutely catabolic patients, the BEEE X 1.75 appears to be inadequate. The BEEE does not take into account changes in temperature or degree of illness. Indirect calorimetry is easy to perform and gives more pointed information about the patient's caloric needs.

Adolescent

Energy expenditure and gas exchange measurements in postoperative patients: thermodilution versus indirect calorimetry.

OBJECTIVE: To compare a method of measuring energy expenditure and gas exchange using the Fick principle with the standard indirect calorimetry technique. DESIGN: Prospective study of a consecutive sample of postoperative patients. Oxygen consumption (VO2), CO2 production (VCO2), respiratory quotient, and energy expenditure were derived from measurements of variables, including oxygen content and cardiac output. Energy expenditure and gas exchange were measured simultaneously by continuous indirect calorimetry over a 60-min period. SETTING: Surgical ICU in a university hospital. PATIENTS: Twenty-six consecutive patients (45 to 80 yrs) who underwent sustained surgical trauma. Excluded from the study entry were patients with time-related fluctuations of hemodynamic variables, poor cooperation, patients who required supplemental oxygen, or mechanical ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: While the measurements of VO2 and VCO2 by calorimetry and thermodilution were significantly correlated with one another (for VO2, r2 = .93, p less than .001; for VCO2, r2 = .26, p less than .01), VO2 and VCO2 values by indirect calorimetry were consistently greater than VO2 and VCO2 values by the Fick method (p less than .01). The respiratory quotient calorimetric measurements ranged between 0.69 and 0.99, whereas the corresponding thermodilution measurements spread to impossible values, from 0.24 to 1.30 (0.821 +/- 0.07 vs. 0.740 +/- 0.24, p less than .05). There was an insignificant relationship (r2 = .06, p = .21) between the values of respiratory quotient by the two methods. A strong, positive correlation between energy expenditure measured by indirect calorimetry and energy expenditure measured by the Fick method was observed (r2 = .92, p less than .001). The limit of agreement between the two methods was -0.24 +/- 73 kcal/day/m2 (-1.00 +/- 305 kJ/day/m2). CONCLUSIONS: In postoperative patients, while VO2 and energy expenditure measurements by thermodilution are easy to perform and accurate for clinical purposes, VCO2, and respiratory quotient measurements are too imprecise and inaccurate to serve any useful function. Therefore, in those clinical situations in which an evaluation of respiratory quotient and substrate utilization may be useful for purposes of metabolic care of the surgical patient, precise measurements of gas exchange with indirect calorimetry are mandatory.

Calorimetry, Indirect

Direct correlation of structure changes and thermal events in hydrated lipid established by simultaneous calorimetry and time-resolved x-ray diffraction.

In many lipid systems, polymorphic and mesomorphic behavior depends on sample thermal history. To establish unequivocally the structural origin of endothermic and exothermic events in such systems, we have performed simultaneous calorimetry and time-resolved x-ray diffraction (SCALTRD). To this end, aluminum calorimetry crucibles were used to contain the hydrated lipid sample, and the calorimeter was mounted with the base of the crucible oriented perpendicular to a synchrotron-derived focused monochromatic x-ray beam for SCALTRD data collection. Measurements were made with hydrated monoelaidin and 1,2-dielaidoyl-sn-glycero-3-phosphoethanolamine (DEPE) contained in hermetically sealed crucibles. Time-resolved x-ray diffraction (TRXRD) data were collected using an x-ray image intensifier/video system and a streak camera containing an x-ray sensitive image plate and/or film. SCALTRD analysis of the lamellar gel to lamellar liquid crystalline phase transition in hydrated monoelaidin gives identical progress curves by calorimetry and TRXRD at a scan rate of 1 degree C/min. At faster rates, calorimetry shows a broader phase transition that starts at a lower and ends at a higher temperature than is observed by TRXRD. The disparity arises in part because the x-ray beam used in TRXRD interrogates only a small portion of the sample, whereas the calorimeter responds to the entire sample volume. Because data collection times are relatively long, radiation damage is an important potential problem for SCALTRD measurements. Such an effect was observed with DEPE/water in that TRXRD shows the lamellar gel to lamellar liquid crystalline phase transition occurring at a lower temperature than observed by calorimetry. We speculate that the sample accumulates impurities locally as a result of radiation damage that has the effect of lowering the phase transition temperature at the site of interrogation by the x-ray beam. This "methods-in-combination" SCALTRD approach facilitates the direct correlation of structure rearrangements and thermal events in the same sample under identical conditions of thermal history. The information content of the data so derived far surpasses that available from either method used in isolation.

Calorimetry

Continuous breathing circuit flow and tracheal tube cuff leak: sources of error during pediatric indirect calorimetry.

OBJECTIVE: To determine whether continuous gas flow in the breathing circuit or an airleak around the tracheal tube cuff will introduce errors into the measurement of oxygen consumption (VO2) with indirect calorimetry. DESIGN: Nonrandomized, controlled trial. SETTING: Experimental laboratory. SUBJECTS: Ten healthy, anesthetized mongrel dogs, weighing 8 to 12 kg. INTERVENTIONS: Data were recorded at seven levels of flow, from 0 to 12 L/min in excess of minute ventilation, through a continuous breathing circuit. Data were recorded at five levels of tracheal tube cuff leak from 0% to 40% of inspiratory minute volume. MEASUREMENTS AND MAIN RESULTS: VO2 was measured using an indirect calorimeter with constant internal gas flow and calculated from results of blood gas analysis, cooximetry, and thermodilution cardiac output determinations at all levels of continuous breathing circuit flow and cuff leak. BP, heart rate, respiratory rate, arterial and mixed venous blood gases, and body temperature were measured to assess stability of cardiopulmonary function. Continuous breathing circuit flow did not affect the accuracy of indirect calorimetry until the total flow reached a critical value (11.5 L/min) that was slightly below the internal flow constant of the metabolic monitor (12.4 L/min). At higher circuit flows, measured VO2 decreased in a linear fashion, while calculated VO2 remained unchanged. Above the critical flow, the error of indirect calorimetry correlated significantly only with the total circuit flow (r2 = .64), not with the exhaled concentration of CO2 (r2 = .005) or the inspiratory-expiratory oxygen difference (r2 = .004). The continuous flow rate at the critical circuit flow was 66 +/- 15% of the subjects' peak inspiratory flow. Increasing tracheal tube cuff leak produced a progressive decrease in measured VO2 but not in calculated VO2. The difference between measured and calculated VO2 was linearly related to the magnitude of the leak (r2 = .56), and was statistically significantly larger at all levels of cuff leak, when compared with measurements during complete cuff seal. CONCLUSIONS: An indirect calorimeter in which measurement of VO2 is based on internal constant flow rather than spirometry can be used to accurately measure VO2 from a continuous-flow breathing circuit, if the total circuit flow is less than the internal flow. This limitation may restrict the use of continuous flow to a level below the subject's peak inspiratory flow. The accuracy of indirect calorimetry cannot be guaranteed for any amount of tracheal tube cuff leak.

Analysis of Variance

Thermodynamics of ion binding to phosphatidic acid bilayers. Titration calorimetry of the heat of dissociation of DMPA.

The heat of dissociation of the second proton of 1,2-dimyristoylphosphatidic acid (DMPA) was studied as a function of temperature using titration calorimetry. The dissociation of the second proton of DMPA was induced by addition of NaOH. From the calorimetric titration experiment, the intrinsic pK0 for the dissociation reaction could be determined by applying the Gouy-Chapman theory. pK0 decreases with temperature from ca. 6.2 at 11 degrees C to 5.4 at 54 degrees C. From the total heat of reaction, the dissociation enthalpy, delta Hdiss, was determined by subtracting the heat of neutralization of water and the heat of dilution of NaOH. In the temperature range between 2 and 23 degrees C, delta Hdiss is endothermic with an average value of ca. 2.5 kcal.mol-1 and shows no clear-cut temperature dependence. In the temperature range between 23 and 52 degrees C, delta Hdiss calculated after subtraction of the heat of neutralization and dilution is not the true dissociation enthalpy but includes contributions from the phase transition enthalpy, delta Htrans, as the pH jump induces a transition from the gel to the liquid-crystalline phase. The delta Cp for the reaction enthalpy observed in this temperature range is positive. Above 53 degrees C, the pH jump induces again only the dissociation of the second proton, and the bilayers stay in the liquid-crystalline phase. In this temperature range, delta Hdiss seems to decrease with temperature. The thermodynamic data from titration calorimetry and differential scanning calorimetry as a function of pH can be combined to construct a complete enthalpy-temperature diagram of DMPA in its two ionization states.

Calorimetry, Differential Scanning

Comparison of carbohydrate utilization in man using indirect calorimetry and mass spectrometry after an oral load of 100 g naturally-labelled [13C]glucose.

1. Carbohydrate (CHO) oxidation was measured simultaneously in a group of five normal subjects after an oral load of 100 g naturally-labelled [13C]glucose, using indirect calorimetry and mass spectrometry. 2. CHO utilization, calculated from the results of indirect calorimetry, increased 30 min after the glucose load to reach a peak at 90 min. It then decreased to reach basal values at 380 min. Cumulative total CHO oxidation at 480 min was 83 +/- 8 g, and CHO oxidized above basal levels, 37 +/- 3 g. 3. Enrichment of expired carbon dioxide with 13C began at 60 min and maximum values were observed at 270 min. At 480 min, cumulative CHO oxidation measured by use of [13C]glucose was 29 g. The difference from calorimetric values can be attributed in part to the slow isotopic dilution in the glucose and bicarbonate pools. 4. Thus, approximately 30% of the glucose load was oxidized during the 8 h after its ingestion and this accounts for a significant part of the increased CHO oxidation (37 g), as measured by indirect calorimetry.

Adolescent

Comparison of indirect calorimetry and a new breath 13C/12C ratio method during strenuous exercise.

A new stable isotope method for the determination of substrate oxidation rates in vivo is described and compared with indirect calorimetry at rest and during high-intensity exercise (30 min at 80-85% maximal O2 uptake capacity) in six well-trained cyclists. This method uses the absolute ratios of 13C/12C in expired air, endogenous glucose, fat, and protein in addition to O2 consumption and is independent of CO2 production (VCO2). Carbohydrate and fat oxidation rates at rest, calculated by both methods, were not significantly different. During exercise the breath 13C/12C ratio increased and reached a steady state after 15-20 min. Carbohydrate oxidation rates during exercise were 39.4 +/- 5.2 and 41.7 +/- 5.7 mg.kg-1.min-1 [not significant (NS)], and fat oxidation rates were 7.3 +/- 1.3 and 6.9 +/- 1.2 mg.kg-1.min-1 (NS), using indirect calorimetry, and the breath ratio method, respectively. We conclude that the breath 13C/12C ratio method can be used to calculate substrate oxidation under different conditions, such as the basal state and exercise. In addition, the results obtained by this new method support the validity of the underlying assumption that indirect calorimetry regards VCO2 as a reflection of tissue CO2 production, during exercise in trained subjects, even up to 80-85% maximal O2 uptake.

Adult

Determining energy expenditure in preterm infants: comparison of 2H(2)18O method and indirect calorimetry.

The doubly labeled water (2H(2)18O) method used to estimate total energy expenditure (EETotal) is particularly sensitive to analytic error in preterm infants, because of their high percentage of body water and the high ratio of water flux to CO2 production. To evaluate further use of this method, the EE of 12 preterm infants was measured by indirect calorimetry and 2H(2)18O simultaneously and continuously for 5 days. Initial infant weight, age, and postconceptional age were (means +/- SD) 1,674 +/- 173 g, 4.4 +/- 2.6 wk, and 34.6 +/- 1.6 wk, respectively. The indirect calorimeter system included an air-temperature-controlled chamber and heart rate monitor. EE was measured by indirect calorimetry for 85.6 +/- 4.7% of study time and estimated from the linear regression of heart rate on EE for 14.4 +/- 4.7% of study time. The 2H(2)18O method entailed an initial dose of 100 mg 2H2O and 250 mg 18O/kg and a final dose of 75 mg 18O/kg; urine was collected twice daily. 2H and 18O enrichments were measured by gas-isotope-ratio mass spectrometry. EE was calculated from measured 2H and 18O dilution spaces (NH, NO), turnover rates (kH, kO), and measured respiratory quotient. The ratio of 2H to 18O dilution spaces was 1.01 +/- 0.01 and the ratio of kO to kH was 1.16 +/- 0.04. Estimation of EE from 2H(2)18O and indirect calorimetry agreed within 1%, although individual variability in methods was large.

Anthropometry

Prospective applications of calorimetry in the clinical laboratory.

Calorimetric analysis depends on the direct proportionality between the heat changes that occur during chemical reactions and the amount of reacting substances. Potential uses of calorimetry in the clinical laboratory are discussed, with examples. The calorimetric technique does not require optically clear specimens, and if the specificity of the measured reaction is assured, calorimetry can be used for quantitative determinations of components that are present in a complex matrix system such as body fluids. Specific enzymic reactions have been used to measure substrates and enzyme activities in biological specimens calorimetrically, with precision, sensitivity, and accuracy comparable to routine photometric techniques. The application of calorimetry in the clinical laboratory is limited now by its slowness, but development of automated instruments may enable the technique to become competitive with conventional analytical techniques in the clinical laboratory.

Calorimetry

Differential scanning calorimetry and enzymic activity of rat liver microsomes in the presence and absence of delta1-tetrahydrocannabinol.

The thermal transitions of rat liver microsomes and isolated lipids were investigated by using differential scanning calorimetry. Endothermic transitions at approximately-5 degrees C and between approximately18 degrees and 40 degrees C were detected in the membranes and at approximately-10 degrees C and between approximately 10 degress and 20 degrees C in the extracted lipids. Interaction with delta1-tetrahydrocannabinol of microsomal membranes and of extracted lipids influences the thermotrophic behaviour as revealed by differential scanning calorimetry and eliminates the break in the Arrhenius plot of the enzymic activity of O-demethylase.

Animals

A consensus guide to preclinical indirect calorimetry experiments.

Understanding the complex factors influencing mammalian metabolism and body weight homeostasis is a long-standing challenge requiring knowledge of energy intake, absorption and expenditure. Using measurements of respiratory gas exchange, indirect calorimetry can provide non-invasive estimates of whole-body energy expenditure. However, inconsistent measurement units and flawed data normalization methods have slowed progress in this field. This guide aims to establish consensus standards to unify indirect calorimetry experiments and their analysis for more consistent, meaningful and reproducible results. By establishing community-driven standards, we hope to facilitate data comparison across research datasets. This advance will allow the creation of an in-depth, machine-readable data repository built on shared standards. This overdue initiative stands to markedly improve the accuracy and depth of efforts to interrogate mammalian metabolism. Data sharing according to established best practices will also accelerate the translation of basic findings into clinical applications for metabolic diseases afflicting global populations.

Calorimetry, Indirect

Thermic effect of glucose in obese subjects studied by direct and indirect calorimetry.

1. The thermic effect of a glucose load (50 g) was studied in ten control and eleven obese female subjects, using both direct and indirect calorimetry simultaneously. Experiments were done under conditions of thermal equilbrium (28 degrees and 30% relative humidity). 2. Thermal balance (heat production measured by indirect calorimetry minus heat losses measured directly) was negative in the control group during the fasting period (heat deficit -14-2 +/- 5-0 kJ/m2 per h), whereas that of the obese group was in equilibrium (+ 1-4 +/- 4-8 kJ/m2 per h). 3. After the glucose load, metabolic rate increased 13-0 +/- 1-5 and 1-3% in the control and obese groups respectively. 4. In contrast to the metabolic rate, total heat losses were not significantly altered in either group after the glucose load. Total heat losses of the obese group were significantly lower than those of the control group throughout the experimental period. 5. During the experiments the amount of heat stored was increased in both groups. Thermal balance in the control group became positive while that of the obese group remained positive. 6. During the fasting period, the control subjects oxidized more carbohydrates (90-4 mg/min) than lipids (68-8 mg/min), whereas obese subjects oxidized more lipids (103-7 mg/min) than carbohydrates (50.2 mg/min). After the glucose load, the oxidation rate of carbohydrates was increased in both groups to 158-1 mg/min in control subjects and 95-6 mg/min in obese subjects. 7. The mean skin temperature of the control subjects was significantly higher than that of the obese subjects and remained higher throughout the postprandial period. 8. These results indicate that: (a) during the fasting period, the energy sources utilized and the thermal balance of the two groups were different; (b) the thermic effect of glucose was less in the obese subjects and, therefore, might be a factor contributing to their low energy expenditure.

Adult

[Heat production in the early stages of axolotl growth according to direct and indirect calorimetry findings].

The level of energetic metabolism of the growing axolotls was studied by the methods of direct and indirect calorimetry. Just after the hatching the heat production of the larvae calculated by the gas exchange exceeds markedly the level of heat production measured by the calorimeter. During the subsequent growth the level of heat production changes as a transitional process, so that therafter indirect calorimetry gives constantly higher values of energetic metabolism than direct one.

Ambystoma

Quantitative crystallinity determinations for beta-lactam antibiotics by solution calorimetry: correlations with stability.

The solution calorimetry method is based on the observation that amorphous forms are normally significantly higher in energy than are crystalline forms. The utility and validity of the calorimetric method were investigated for cephalothin sodium, cefazolin sodium, cefamandole nafate, and cefamandole sodium. Amorphous, partially crystalline, and crystalline forms were prepared and characterized by X-ray diffraction (powder), by solution calorimetry, and, for cephalothin sodium, by the thermal decomposition rate at 50 degrees. Qualitatively, there was a good correlation between calorimetric crystallinity and the (less precise) crystallinity derived from X-ray data. The energy and structure of the amorphous state depend on the history of the sample; even samples of the same crystalline polymorph, containing no amorphous phase, may differ in energy. Thus, the absolute value of the crystallinity (X-ray or calorimetric) depends on the choice of amorphous and crystalline standards. The heat of solution is a precise (+/- 1%) and unambiguous measure of the relative crystallinity; and provided amorphous and crystalline standards are appropriately chosen, the calorimetric crystallinity correlates well with chemical stability.

Absorption

Fluorescence probes in biochemistry: an examination of the non-fluorescent behavior of dansylamide by photoacoustic calorimetry.

Photoacoustic calorimetry is shown to be a simple, precise, and accurate method for the quantification of the photophysics of a fluorescence probe, e.g., dansylamide, in a variety of solvents. This technique, which is described in detail, provides a direct measurement of the energy that is released nonradiatively following photostimulation, and can therefore be used to indirectly determine the amount of energy released via luminescent pathways. Photoacoustic calorimetry combined with established absorption and fluorescence methodologies provides a complete arsenal for characterizing the photophysical properties of many systems. Comparison of the photoacoustic signal for dansylamide versus standard compounds (ferrocene, tetraphenylethylene, 8-anilinonaphthalene-1-sulfonate, and/or 5,5'-dithiobis(2-nitrobenzoic acid) in 12 different solvents gave fh values (fraction of each absorbed 337.1-nm photon returned as heat) from a low of 0.530 in 1,4-dioxane to a high of 0.973 in water. The trend noted with solvent polarity is different and more revealing than that determined by the more classical approach of examining either the wavelength of the emission maximum or the fluorescence quantum yield.

Calorimetry

Thermal stability of fatty acid-serum albumin complexes studied by differential scanning calorimetry.

Differential scanning calorimetry has been used to study the thermal stability of bovine serum albumin as affected by binding of fatty acids (lauric acid and stearic acid) and sodium dodecyl sulfate (SDS). All the ligands stabilized the protein molecules in a similar manner, but to different levels. A maximum increase in denaturation temperature of 30 degrees C was obtained with lauric acid. The thermograms indicate the presence of several ligand-albumin complexes having different heat stabilities. Variations in pH in 0.9% NaCl affected the heat stability of both ligand-poor and ligand-rich albumin, the former being more sensitive to variations in pH within the physiological range. Variations in NaCl concentration affected the thermal stabilities at neutral pH, expecially at low salt concentrations. While ligand-rich albumin was somewhat destabilized by increasing NaCl concentrations, ligand-poor albumin was strongly stabilized. The potential use of differential scanning calorimetry in ligand-albumin research is discussed.

Animals

Solid-state stability testing of drugs by isothermal calorimetry.

A new technique has been developed to calculate rapidly the solid-state room-temperature degradation rate of drugs and drug candidates. The technique utilizes measurements of the initial rate of heat output at several elevated temperatures by isothermal calorimetry and the degradation rate of the compound determined at a single elevated temperature by chromatography. The activation energies and degradation rates at 25 degrees C calculated by conventional methods and by isothermal calorimetry are compared and discussed. The compounds studied were phenytoin, triamterene, digoxin, tetracycline, theophylline, diltiazem, and several proprietary ICI compounds.

Calorimetry