Evaluating the effects of continuous veno-venous hemodiafiltration on O2 and CO2 removal and energy expenditure measurement using indirect calorimetry
Abstract Background Continuous veno-venous hemodiafiltration (CVVHDF) is used in critically ill patients, but its impact on O₂ and CO₂ removal, as well as the accuracy of resting energy expenditure (REE) measurement using indirect calorimetry (IC) remains unclear. This study aims to evaluate the eff...
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SpringerOpen
2025-01-01
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| Series: | Annals of Intensive Care |
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| Online Access: | https://doi.org/10.1186/s13613-025-01426-2 |
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| author | Weronika Wasyluk Robert Fiut Marcin Czop Agnieszka Zwolak Wojciech Dąbrowski Manu L N G Malbrain Joop Jonckheer |
| author_facet | Weronika Wasyluk Robert Fiut Marcin Czop Agnieszka Zwolak Wojciech Dąbrowski Manu L N G Malbrain Joop Jonckheer |
| author_sort | Weronika Wasyluk |
| collection | DOAJ |
| description | Abstract Background Continuous veno-venous hemodiafiltration (CVVHDF) is used in critically ill patients, but its impact on O₂ and CO₂ removal, as well as the accuracy of resting energy expenditure (REE) measurement using indirect calorimetry (IC) remains unclear. This study aims to evaluate the effects of CVVHDF on O₂ and CO₂ removal and the accuracy of REE measurement using IC in patients undergoing continuous renal replacement therapy. Design Prospective, observational, single-center study. Methodology Patients with sepsis undergoing CVVHDF had CO₂ flow (QCO₂) and O₂ flow (QO₂) measured at multiple sampling points before and after the filter. REE was calculated using the Weir equation based on V̇CO₂ and V̇O₂ measured by IC, using true V̇CO₂ accounting for the CRRT balance, and estimated using the Harris-Benedict equation. The respiratory quotient (RQ), the ratio of V̇CO₂ to V̇O₂, was evaluated by comparing measured and true values. Results The mean QCO₂ levels measured upstream of the filter were 76.26 ± 17.33 ml/min and significantly decreased to 62.12 ± 13.64 ml/min downstream of the filter (p < 0.0001). The mean QO₂ levels remained relatively unchanged. The mean true REE was 1774.28 ± 438.20 kcal/day, significantly different from both the measured REE of 1758.59 ± 434.06 kcal/day (p = 0.0029) and the estimated REE of 1619.36 ± 295.46 kcal/day (p = 0.0475). The mean measured RQ value was 0.693 ± 0.118, while the mean true RQ value was 0.731 ± 0.121, with a significant difference (p < 0.0001). Conclusions CVVHDF may significantly alter QCO₂ levels without affecting QO₂, influencing the REE and RQ results measured by IC. However, the impact on REE is not clinically significant, and the REE value obtained via IC is closer to the true REE than that estimated using the Harris-Benedict equation. Further studies are recommended to confirm these findings. Graphical Abstract |
| format | Article |
| id | doaj-art-03a06b86ad1c41ad9a28de786b200535 |
| institution | Kabale University |
| issn | 2110-5820 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | SpringerOpen |
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| series | Annals of Intensive Care |
| spelling | doaj-art-03a06b86ad1c41ad9a28de786b2005352025-01-26T12:52:21ZengSpringerOpenAnnals of Intensive Care2110-58202025-01-0115111010.1186/s13613-025-01426-2Evaluating the effects of continuous veno-venous hemodiafiltration on O2 and CO2 removal and energy expenditure measurement using indirect calorimetryWeronika Wasyluk0Robert Fiut1Marcin Czop2Agnieszka Zwolak3Wojciech Dąbrowski4Manu L N G Malbrain5Joop Jonckheer6Department of Internal Medicine and Internal Medicine in Nursing, Medical University of LublinDepartment of Clinical Physiotherapy, Medical University of LublinDepartment of Clinical Genetics, Medical University of LublinDepartment of Internal Medicine and Internal Medicine in Nursing, Medical University of Lublin1st Department of Anaesthesiology and Intensive Therapy, Medical University of Lublin1st Department of Anaesthesiology and Intensive Therapy, Medical University of LublinDepartment of Intensive Care Medicine, Universitaire Ziekenhuis Brussel (UZ Brussel), Vrije Universiteit Brussel (VUB)Abstract Background Continuous veno-venous hemodiafiltration (CVVHDF) is used in critically ill patients, but its impact on O₂ and CO₂ removal, as well as the accuracy of resting energy expenditure (REE) measurement using indirect calorimetry (IC) remains unclear. This study aims to evaluate the effects of CVVHDF on O₂ and CO₂ removal and the accuracy of REE measurement using IC in patients undergoing continuous renal replacement therapy. Design Prospective, observational, single-center study. Methodology Patients with sepsis undergoing CVVHDF had CO₂ flow (QCO₂) and O₂ flow (QO₂) measured at multiple sampling points before and after the filter. REE was calculated using the Weir equation based on V̇CO₂ and V̇O₂ measured by IC, using true V̇CO₂ accounting for the CRRT balance, and estimated using the Harris-Benedict equation. The respiratory quotient (RQ), the ratio of V̇CO₂ to V̇O₂, was evaluated by comparing measured and true values. Results The mean QCO₂ levels measured upstream of the filter were 76.26 ± 17.33 ml/min and significantly decreased to 62.12 ± 13.64 ml/min downstream of the filter (p < 0.0001). The mean QO₂ levels remained relatively unchanged. The mean true REE was 1774.28 ± 438.20 kcal/day, significantly different from both the measured REE of 1758.59 ± 434.06 kcal/day (p = 0.0029) and the estimated REE of 1619.36 ± 295.46 kcal/day (p = 0.0475). The mean measured RQ value was 0.693 ± 0.118, while the mean true RQ value was 0.731 ± 0.121, with a significant difference (p < 0.0001). Conclusions CVVHDF may significantly alter QCO₂ levels without affecting QO₂, influencing the REE and RQ results measured by IC. However, the impact on REE is not clinically significant, and the REE value obtained via IC is closer to the true REE than that estimated using the Harris-Benedict equation. Further studies are recommended to confirm these findings. Graphical Abstracthttps://doi.org/10.1186/s13613-025-01426-2OxygenCarbon dioxideIndirect calorimetryResting energy expenditureRespiratory quotientSepsis |
| spellingShingle | Weronika Wasyluk Robert Fiut Marcin Czop Agnieszka Zwolak Wojciech Dąbrowski Manu L N G Malbrain Joop Jonckheer Evaluating the effects of continuous veno-venous hemodiafiltration on O2 and CO2 removal and energy expenditure measurement using indirect calorimetry Annals of Intensive Care Oxygen Carbon dioxide Indirect calorimetry Resting energy expenditure Respiratory quotient Sepsis |
| title | Evaluating the effects of continuous veno-venous hemodiafiltration on O2 and CO2 removal and energy expenditure measurement using indirect calorimetry |
| title_full | Evaluating the effects of continuous veno-venous hemodiafiltration on O2 and CO2 removal and energy expenditure measurement using indirect calorimetry |
| title_fullStr | Evaluating the effects of continuous veno-venous hemodiafiltration on O2 and CO2 removal and energy expenditure measurement using indirect calorimetry |
| title_full_unstemmed | Evaluating the effects of continuous veno-venous hemodiafiltration on O2 and CO2 removal and energy expenditure measurement using indirect calorimetry |
| title_short | Evaluating the effects of continuous veno-venous hemodiafiltration on O2 and CO2 removal and energy expenditure measurement using indirect calorimetry |
| title_sort | evaluating the effects of continuous veno venous hemodiafiltration on o2 and co2 removal and energy expenditure measurement using indirect calorimetry |
| topic | Oxygen Carbon dioxide Indirect calorimetry Resting energy expenditure Respiratory quotient Sepsis |
| url | https://doi.org/10.1186/s13613-025-01426-2 |
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