• Koichiro Shinozaki, Pey-Jen Yu, Qiuping Zhou, Hugh A Cassiere, Stanley John, Daniel M Rolston, Nidhi Garg, Timmy Li, Jennifer Johnson, Kota Saeki, Taiki Goto, Yu Okuma, Santiago J Miyara, Kei Hayashida, Tomoaki Aoki, Vanessa K Wong, Ernesto P Molmenti, Joshua W Lampe, and Lance B Becker.
• The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States of America; Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States of America; Department of Emergency Medicine, Kindai University Faculty of Medicine, Osaka, Japan. Electronic address: shino@gk9.so-net.ne.jp.
• Am J Emerg Med. 2024 Apr 1; 78: 182187182-187.

ObjectiveOxygen consumption (VO2), carbon dioxide generation (VCO2), and respiratory quotient (RQ), which is the ratio of VO2 to VCO2, are critical indicators of human metabolism. To seek a link between the patient's metabolism and pathophysiology of critical illness, we investigated the correlation of these values with mortality in critical care patients.MethodsThis was a prospective, observational study conducted at a suburban, quaternary care teaching hospital. Age 18 years or older healthy volunteers and patients who underwent mechanical ventilation were enrolled. A high-fidelity automation device, which accuracy is equivalent to the gold standard Douglas Bag technique, was used to measure VO2, VCO2, and RQ at a wide range of fraction of inspired oxygen (FIO2).ResultsWe included a total of 21 subjects including 8 post-cardiothoracic surgery patients, 7 intensive care patients, 3 patients from the emergency room, and 3 healthy volunteers. This study included 10 critical care patients, whose metabolic measurements were performed in the ER and ICU, and 6 died. VO2, VCO2, and RQ of survivors were 282 +/- 95 mL/min, 202 +/- 81 mL/min, and 0.70 +/- 0.10, and those of non-survivors were 240 +/- 87 mL/min, 140 +/- 66 mL/min, and 0.57 +/- 0.08 (p = 0.34, p = 0.10, and p < 0.01), respectively. The difference of RQ was statistically significant (p < 0.01) and it remained significant when the subjects with FIO2 < 0.5 were excluded (p < 0.05).ConclusionsLow RQ correlated with high mortality, which may potentially indicate a decompensation of the oxygen metabolism in critically ill patients.Copyright © 2024 Elsevier Inc. All rights reserved.

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