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Abstract 4146800: A Retrospective Analysis of Measured Versus Estimated Resting Oxygen Uptake for Derivation of Fick Cardiac Output in Patients in the Cardiac Intensive Care Unit
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Background:
Estimated cardiac output using the Fick principal (estFickCO) frequently informs clinical decision making in Cardiology Intensive Care Units (CICU). Assessment of estFickCO relies on estimation of resting oxygen uptake (rVO
2
). We hypothesized that large variance will be present between rVO
2
measured with a metabolic cart and the estimated rVO2 often used in CICUs.
Methods:
In this single-center study, 275 CICU patients with pulmonary arterial catheters in place to guide heart failure management underwent breath-by-breath metabolic cart measurement of rVO
2
for 10 minutes coupled with duplicate measures of arterio-venous oxygen content to derive Fick CO. Four equations to estimate rVO
2
were evaluated: weight-based only (3.5ml/kg/min, 1 MET); accounting for sex and BSA (Dehmer); sex, BSA, and age (Bergstra); and sex, BSA, age, and heart rate (LeFarge). Bland-Altman analysis and derivation of coefficients of variation were performed to evaluate the agreement between each equation and actual measured rVO
2
.
Results:
In this cohort of 275 patients (age 57.8±14.4, 24% female, BMI 28±6.9 kg/m
2
) the mean measured rVO
2
was 276±71 mL/min and Fick CO was 4.7±1.6 L/min. Using 1 MET to estimate rVO
2
equated to a mean rVO
2
of 292±81 mL/min, the Dehmer equation estimated a mean rVO
2
of 283±49 mL/min, Bergstra estimated a mean rVO
2
of 248±37 mL/min, and the LaFarge equation estimated a mean rVO
2
of 239±53 mL/min. The frequency of error being >25% was calculated at 24%, 15%, 17%, and 19% respective to each equation. When analyzed using Bland-Altman plots, the Dehmer equation demonstrated the lowest mean bias as well as the lowest coefficient of variation when compared to the other three estimates (
Figure
) yet limits of agreement span VO
2
values associated with > 3 L/min differences in Fick CO across all 4 estimates.
Conclusion:
Measured VO
2
varies significantly from estimated VO
2
among CICU patients. Accounting for sex and BSA with use of the Dehmer equation was associated with the closest approximation of actual VO
2
values among 4 estimates analyzed in our study. High variance in rVO
2
estimates and impacts on management should be considered when interpreting estFickCO in CICU patients.
Ovid Technologies (Wolters Kluwer Health)
Title: Abstract 4146800: A Retrospective Analysis of Measured Versus Estimated Resting Oxygen Uptake for Derivation of Fick Cardiac Output in Patients in the Cardiac Intensive Care Unit
Description:
Background:
Estimated cardiac output using the Fick principal (estFickCO) frequently informs clinical decision making in Cardiology Intensive Care Units (CICU).
Assessment of estFickCO relies on estimation of resting oxygen uptake (rVO
2
).
We hypothesized that large variance will be present between rVO
2
measured with a metabolic cart and the estimated rVO2 often used in CICUs.
Methods:
In this single-center study, 275 CICU patients with pulmonary arterial catheters in place to guide heart failure management underwent breath-by-breath metabolic cart measurement of rVO
2
for 10 minutes coupled with duplicate measures of arterio-venous oxygen content to derive Fick CO.
Four equations to estimate rVO
2
were evaluated: weight-based only (3.
5ml/kg/min, 1 MET); accounting for sex and BSA (Dehmer); sex, BSA, and age (Bergstra); and sex, BSA, age, and heart rate (LeFarge).
Bland-Altman analysis and derivation of coefficients of variation were performed to evaluate the agreement between each equation and actual measured rVO
2
.
Results:
In this cohort of 275 patients (age 57.
8±14.
4, 24% female, BMI 28±6.
9 kg/m
2
) the mean measured rVO
2
was 276±71 mL/min and Fick CO was 4.
7±1.
6 L/min.
Using 1 MET to estimate rVO
2
equated to a mean rVO
2
of 292±81 mL/min, the Dehmer equation estimated a mean rVO
2
of 283±49 mL/min, Bergstra estimated a mean rVO
2
of 248±37 mL/min, and the LaFarge equation estimated a mean rVO
2
of 239±53 mL/min.
The frequency of error being >25% was calculated at 24%, 15%, 17%, and 19% respective to each equation.
When analyzed using Bland-Altman plots, the Dehmer equation demonstrated the lowest mean bias as well as the lowest coefficient of variation when compared to the other three estimates (
Figure
) yet limits of agreement span VO
2
values associated with > 3 L/min differences in Fick CO across all 4 estimates.
Conclusion:
Measured VO
2
varies significantly from estimated VO
2
among CICU patients.
Accounting for sex and BSA with use of the Dehmer equation was associated with the closest approximation of actual VO
2
values among 4 estimates analyzed in our study.
High variance in rVO
2
estimates and impacts on management should be considered when interpreting estFickCO in CICU patients.
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