Validation of a volumeless breath-by-breath method for measurement of respiratory quotient

Abstract

Measurement of respiratory quotient (RQ) is useful as an indicator of changes in CO2 equilibrium or metabolism. Because of technical difficulties when volumetric or mixed expired methods are applied to clinical practice, we sought to validate a method of volumeless breath-by-breath RQ measurement based on real-time analysis of inspired and alveolar concentrations of O2, CO2, and N2 alone. We derived our volumeless method from a modified three-compartment lung model and tested the validity of the model by comparing it with a standard volumetric open-circuit method. Data from 1,736 breaths from 25 healthy adult volunteers for a total of 78 epochs were collected. Inspired, end-tidal, and mixed expired gas compositions were analyzed by Raman spectroscopy, and RQ values from 0.6 to 2.4 were obtained. Linear regression of the volumeless breath-by-breath method against the open-circuit method yielded a line with a slope of 1.002 (95% confidence interval 0.928 to 1.076) and an intercept of 0.066 (95% confidence interval -0.008 to 0.146) with an R2 of 0.91 (P < 0.001). We analyzed agreement by several methods and used mathematical modeling to predict precision with variations in epoch length and breath volume, which were verified by Monte Carlo techniques. We demonstrated that RQ can be measured reliably and easily using this volumeless breath-by-breath technique.