Comparison of Closed-Circuit and Fick-Derived Oxygen Consumption during Anaesthesia for Liver Transplantation in Patients

  • Jan Hofland
  • Robert Tenbrinck
  • Wilhelm Erdmann
Part of the Advances in Experimental Medicine and Biology book series (AEMB, volume 540)


During human liver transplantation major cardiovascular effects are reported.1 Changes in the VO2 level during the intra-operative period of major surgery, e.g. liver reperfusion, are often not measured.2 Before major elective surgery preoperative optimisation of oxygen delivery is recommended to improve outcome.3 Since the 1980s, tissue oxygen debt, reflected by inadequate oxygen consumption (VO2) in the intraoperative and immediate postoperative periods is considered a common determinant of multi-system organ failure and death.4 The PhysioFlex® ventilator performs quantitative closed system anaesthesia; it shows continuously the intra-operative oxygen uptake.5 These VO2 curves seem to follow the actual intra-operative cardiovascular responses to surgical manipulation.6 In this study we compared the continuous, PhysioFlex®-derived VO2 measurements, V02(Flex), with the accepted method of intermittently Fick-derived VO2 calculations by means of a pulmonary artery catheter, V02(Pac).


Oxygen Consumption Primary Biliary Cirrhosis Orthotopic Liver Transplantation Linear Regression Line Human Liver Transplantation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Y. G. Kang, J. A. Freeman, S. Aggarwal, and A. M. DeWolf, Hemodynamic instability during liver transplantation, Transplant Proc 21, 3489–3492 (1989).PubMedGoogle Scholar
  2. 2.
    S. Gelman, The pathophysiology of aortic cross-clamping and unclamping, Anesthesiology 82, 1026–1060 (1995).PubMedCrossRefGoogle Scholar
  3. 3.
    J. Wilson, I. Woods, J. Fawcett, et al, Reducing the risk of major elective surgery: randomized controlled trial of preoperative optimization of oxygen delivery, BMJ 318, 1099–1103 (1999).CrossRefGoogle Scholar
  4. 4.
    W. C. Shoemaker, P. L. Appel, and H. B. Kram, Tissue oxygen debt as a determinant of lethal and nonlethal postoperative organ failure, Crit Care Med 16, 1117–1120 (1988).PubMedCrossRefGoogle Scholar
  5. 5.
    L. Rendell-Baker, Future directions in anesthesia apparatus, in: Anesthesia Equipment, principles and applications,edited by J. Ehrenwerth, and J. B. Eisenkraft (Mosby-Year Book, St Louis, 1993), pp. 674697:Google Scholar
  6. 6.
    A. P. K. Verkaaik, J. W. Kroon, H. G. M. van den Broek, and W. Erdmann, Non-invasive, on-line measurement of oxygen consumption during anesthesia, Adv Exp Med Biol 317, 331–341 (1992).PubMedCrossRefGoogle Scholar
  7. 7.
    J. F. Nunn, Measurement of oxygen consumption and delivery, in: Nunn’s applied respiratory physiology, edited by J. F. Nunn ( Butterworth-Heinemann, Cambridge, 1993 ), pp. 247–305.Google Scholar
  8. 8.
    J. A. Baum, in: Low flow anaesthesia, the theory and practice of low flow, minimal flow and closed system anaesthesia,edited by J. A. Baum (Butterworth-Heinemann, Oxford, 2001), pp. 38–53, and 109–167.Google Scholar
  9. 9.
    J. H. Philip, Closed circuit anesthesia, in: Anesthesia equipment, principles and applications, edited by J. Ehrenwerth, and J. B. Eisenkraft ( Mosby-Year Book, St Louis, 1993 ), pp. 617–635.Google Scholar
  10. 10.
    J. M. Bland, and D. G. Altman, Statistical methods for assessing agreement between two methods of clinical measurement, Lancet i, 307–310 (1986).Google Scholar
  11. 11.
    J. M. Bland, and D. G. Altman, Comparing methods of measurement: why plotting difference against standard method is misleading, Lancet 346, 1085–1087 (1995).PubMedCrossRefGoogle Scholar
  12. 12.
    P. S. Myles, and T. Gin, Regression and Correlation, in: Statistical methods for anaesthesia and intensive care, edited by P. S. Myles and T. Gin, ( Butterworth-Heinemann, Oxford, 2000 ), pp. 78–93.Google Scholar
  13. 13.
    R. L. Chathurn, Evaluation of instrument error and method agreement, AANA J 64, 261–268 (1996).Google Scholar
  14. 14.
    M. N. Smithies, B. Royston, K. Makita, K. Konieczko, and J. F. Nunn, Comparison of oxygen consumption measurements: Indirect calorimetry versus the reversed Fick method, Crit Care Med 19, 1401–1406 (1991).PubMedCrossRefGoogle Scholar
  15. 15.
    M. C. Stock, M. E. Ryan, Oxygen consumption calculated from the Fick equation has limited utility, Crit Care Med 24, 86–90 (1996).PubMedCrossRefGoogle Scholar
  16. 16.
    D. N. Thrush, Spirometric versus Fick-derived oxygen consumption: which method is better?, Crit Care Med 24, 91–95 (1996).PubMedCrossRefGoogle Scholar
  17. 17.
    Technical data, in: PhysioFlex ® quantitative anaesthesia, user manual 1999, software V6.06.n/NL6n, (Physio B. V., Haarlem, The Netherlands, 1999 ), pp. 120–126.Google Scholar
  18. 18.
    A. Suzuki, H. Bito, T. Katoh, and S. Sato, Evaluation of the PhysioFlexTM closed-circuit anaesthesia machine, EurJAnaesth 17, 359–363 (2000).Google Scholar
  19. 19.
    L. Versichelen, and G. Roily, Mass-spectrometic evaluation of some recently introduced low flow, closed circuit systems, Acta Anaesthesiol Belg 41, 225–237 (1990).PubMedGoogle Scholar
  20. 20.
    T. Nishikawa, and S. Dohi, Errors in the measurement of cardiac output by thermodilution, Can J Anaesth 40, 142–153 (1993).PubMedCrossRefGoogle Scholar
  21. 21.
    T. S. Walsh, P. Hopton, and A. Lee, A comparison between the Fick method and indirect calorimetry for determining oxygen consumption in patients with fulminant hepatic failure, Crit Care Med 26, 1200–1207 (1998).PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2003

Authors and Affiliations

  1. 1.Department of AnaesthesiologyErasmus Medical Centre RotterdamRotterdamThe Netherlands
  2. 2.Department of Intensive Care MedicineOnze Lieve Vrouwe GasthuisAmsterdamThe Netherlands

Personalised recommendations