Pedraza MA, Monares ZE, Aguirre SJS, Camarena AG, Franco GJ

Language: Spanish
References: 21
Page: 145-151
PDF size: 197.49 Kb.

ABSTRACT

Introduction: Obtaining the maximum oxygen consumption (VO₂max) in a direct way requires equipment and trained personnel, which are not available in most intensive care units. We modified the formula from Uths Niels et al: VO₂max = 15 x (maximum heart rate during exercise/heart rate at rest), replacing the maximum rate during exercise with maximum heart rate for age and frequency at rest with heart rate at 24 hours from admission to the intensive care unit (ICU). VO₂max modified = 15 x maximum heart rate for age/heart rate at 24 hours.
Objective: To determine the threshold of maximum oxygen uptake estimated in patients with sepsis and septic shock that represents a prognostic marker.
Material and methods: Cohort, prospective, longitudinal study. Patients over 18 years old admitted to the ICU with a diagnosis of sepsis. The maximum oxygen consumption upon the admission of patients with sepsis was calculated, and compared between groups based on VO2max modified. A bivariate analysis was performed using χ², ROC curve and relative risk.
Results: Seventy-eight patients were analyzed, 42 men (54%), aged 68 ± 16 years; on 57%, the primary site of infection was the lungs, followed by the urinary tract (19%), with MODS 6 ± 3 points; 39% with sepsis and 61% with septic shock; 21 patients died (27%). The ROC curve was obtained for VO₂max at 24 hours modified, with an AUC 0.70, CI from 0.64 to 0.89; p = 0.03, with a cutoff of 25 mL/kg/min, sensitivity and specificity of 70 and 70%, respectively. Patients with VO₂max higher than 25 mL/kg/min have RR of 0.4 (CI 0.2-0.7) for mortality at 30 days.
Conclusions: Modified VO₂max could be a useful tool to identify septic patients with adequate reanimation. This trial suggests that a VO₂max value calculated at 24 hours from ICU admission greater than 25 mL/kg/min is a reflection of good reanimation. However, future research is needed to corroborate the prognostic utility and to set a reanimation goal.

REFERENCES

1. Nichols D, Nielsen ND. Oxygen delivery and consumption: a macrocirculatory perspective. Crit Care Clin. 2010;26(2):239-253.

2. Permpikul C, Cheranakhorn C. The temporal changes of tissue oxygen saturation (StO2) and central venous oxygen saturation (ScvO2) during sepsis/septic shock resuscitation. J Med Assoc Thai. 2014;97 Suppl 3:S168-S175.

3. Barden J, Lawrenson L, Poole JG, Kim J, Wray DW, Bailey DM, et al. Limitations to vasodilatory capacity and VO2 max in trained human skeletal muscle. Am J Physiol Heart Circ Physiol. 2007;292(5):H2491-H2497.

4. Gifford JR, Garten RS, Nelson AD, Trinity JD, Layec G, Witman MA, et al. Symmorphosis and skeletal muscle VO2 max : in vivo and in vitro measures reveal differing constraints in the exercise-trained and untrained human. J Physiol. 2016;594(6):1741-1751.

5. Lundby C, Montero D. CrossTalk opposing view: Diffusion limitation of O2 from microvessels into muscle does not contribute to the limitation of VO2max. J Physiol. 2015;593(17):3759-3761.

6. Saunders PU, Garvican-Lewis LA, Schmidt WF, Gore CJ. Relationship between changes in haemoglobin mass and maximal oxygen uptake after hypoxic exposure. Br J Sports Med. 2013;47 Suppl 1:i26-i30.

7. Koutlianos N, Dimitros E, Metaxas T, Cansiz M, Deligiannis A, Kouidi E. Indirect estimation of VO2max in athletes by ACSM’s equation: valid or not? Hippokratia. 2013;17(2):136-140.

8. De Souza E, Silva CG, Franklin BA, Forman DE, Araujo CG. Influence of age in estimating maximal oxygen uptake. J Geriatr Cardiol. 2016;13(2):126-131.

9. Dolezal BA, Barr D, Boland DM, Smith DL, Cooper CB. Validation of the firefighter WFI treadmill protocol for predicting VO2 max. Occup Med (Lond). 2015;65(2):143-146.

10. Shete AN, Bute SS, Deshmukh PR. A study of VO2 max and body fat percentage in female athletes. J Clin Diagn Res. 2014;8(12):BC01-BC03.

11. Sánchez-Otero T, Iglesias-Soler E, Boullosa DA, Tuimil JL. Verification criteria for the determination of Vo2 MAX in the field. J Strength Cond Res. 2014;28(12):3544-3551.

12. Elliott AD, Skowno J, Prabhu M, Noakes TD, Ansley L. Evidence of cardiac functional reserve upon exhaustion during incremental exercise to determine VO2max. Br J Sports Med. 2015;49(2):128-132.

13. Wilcox SL, Broxterman RM, Barstow TJ. Constructing quasi-linear VO2 responses from nonlinear parameters. J Appl Physiol (1985). 2016;120(2):121-129.

14. Bazerbashi H, Merriman KW, Toale KM, Chaftari P, Cruz-Carreras MT, Henderson JD, et al. Low tissue oxygen saturation at emergency center triage is predictive of intensive care unit admission. J Crit Care. 2014;29(5):775-779.

15. Malekmohammad M, Ahmadi-Nejad M, Adimi P, Jamaati HR, Marashian SM. Evaluation of maximum O2 consumption: using ergo-spirometry in severe heart failure. Acta Med Iran. 2012;50(9):619-623.

16. Harms FA, Bodmer SI, Raat NJ, Mik EG. Cutaneous mitochondrial respirometry: non-invasive monitoring of mitochondrial function. J Clin Monit Comput. 2015;29(4):509-519.

17. Pettitt RW, Symons JD, Taylor JE, Eisenman PA, White AT. Adjustment for gas exchange threshold enhances precision of heart rate-derived VO2 estimates during heavy exercise. Appl Physiol Nutr Metab. 2008;33(1):68-74.

18. Yamamoto J, Harada T, Okada A, Maemura Y, Yamamoto M, Tabira K. Difference in physiological components of VO2 max during incremental and constant exercise protocols for the cardiopulmonary exercise test. J Phys Ther Sci. 2014;26(8):1283-1286.

19. Uth N, Sørensen H, Overgaard K, Pedersen PK. Estimation of VO2max from the ratio between HRmax and Hrrest —the heart rate ratio method. Eur J Appl Physiol. 2004;91(1):111-115.

20. Makey I, Berger RL, Cabral HJ, Celli B, Folch E, Whyte RI. Maximal oxygen uptake —risk predictor of NSCLC resection in patients with comorbid emphysema: lessons from NETT. Semin Thorac Cardiovasc Surg. 2015;27(2):225-231.

21. Solheim TJ, Keller BG, Fountaine CJ. VO2 reserve vs. heart rate reserve during moderate intensity treadmill exercise. Int J Exerc Sci. 2014;7(4):311-317.