Influence of ventilatory settings on indirect calorimetry in mechanically ventilated patients

With the aim to assess metabolic monitor's suitability to the use in mechanically ventilated patients, a method, based on the comparison between the measurements performed by the monitor and the ventilator, is here described. In particular, the effects of positive end-expiratory pressure and oxygen inspiratory fraction (FiO2) on the metabolic measurements in presence of bias flow are investigated. In this study a metabolic monitor is used to estimate the energy expenditure of 10 mechanically ventilated cardiosurgical patients at different positive end-expiratory pressure, FiO2 and two different modes of ventilation, with bias flow. The influence of the ventilatory settings on the parameters measured by the monitor is here quantified: a slight decrease of respiratory quotient and a slight increase of resting energy expenditure are observed with the increase of FiO2. This study shows a good agreement between the measurements of the two devices: FiO2, expiratory volume (mean difference lower than 3%), and respiratory frequency (mean difference lower than 1%). This also demonstrates the capability of the metabolic monitor to reject the effect of the bias flow.