Introduction Standard calculations for the evaluation of indirect calorimetry (IC) are based on two-dimensional nonlinear systems of equations. For a more sophisticated evaluation metabolic models can be used, which are described by complex systems of equations. Since the solutions are multidimensional, a concrete result must be selected by means of constraints, using optimizing procedures. These multidimensional optimizations are critical concerning processing time and reproducibility of minimum detection. Methods In order to simulate the status of metabolism of ICU patients on the basis of IC data, a complex model of metabolism was developed. The model was described by a system of equations consisting of 13 equations and 25 variables. The final result is selected out of the nine-dimensional space of solutions by optimization, considering a total of 69 constraints. Two optimizing procedures (Simplex algorithm [1] SPX, Powell procedure [2] POW) were modified, and analysed referring to processing time (PT), variance and reproducibility (VK, VC) of results. Test data as well as long-term IC measurements in ICU patients were evaluated. Modifications including ‘meta procedures’, which multiply restart the ‘core’ of the optimization (SPX) or find an optimal starting point for the core by a deformation of optimal sets of IC data with already known solutions, were necessary. VC and VK were tested for four representative parameters of the metabolic simulation (enzymes pyruvate dehydrogenase PDH, citrate synthase CS, ketoglutarate decarboxylase KDC, malate dehydrogenase MDH) by means of seven sets of calculated IC data. Penalty values as a measure of the quality of the simulation and processing time (Pentium 120 MHz) were determined using real data of a ventilated patient. Results Both optimization procedures showed a high reproducibility and a low variance (all but one VK/VC values below 10%); there were no differences between Simplex and Powell algorithm (see Table 1). Evaluating real data, we found a lower frequency of outliers (nonevaluable data) for SPX (3.7% vs. 5.7%), while processing time was shorter for POW (1.95 ± 0.87 vs. 8.88 ± 3.06 min; both P < 0.05; n = 800). Table 1. Variance (VK) and reproducibility (VC) for the Simplex algorithm (SPX) and the Powell procedure (POW) for four different enzymes (PDH, CS, KDC, MDH) VC VK SPX POW SPX POW PDH 3.5% ± 1.7% 2.1% ± 1.7% 5.1% ± 1.7% 2.8% ± 2.3% CS 3.6% ± 1.6% 1.4% ± 1.4% 10.1% ± 2.1% 4.7% ± 5.8% KDC 0.1% ± 0.0% 0.0% ± 0.0% 1.5% ± 0.0% 0.0% ± 0.0% MDH 1.5% ± 0.7% 0.5% ± 0.4% 3.0% ± 1.3% 2.5% ± 1.5% Conclusion The evaluation of IC data using a model for the simulation of metabolism was successful even in clinical situations, where standard procedures usually fail. Multidimensional nonlinear systems of equations, as used for this simulation, are a considerable extension of available tools for the interpretation of IC data, if a powerful optimizing procedure is used. Both of the analysed procedures have shown to be suitable to reduce the nine-dimensional space of solutions of the system of equations to a concrete result, and can be applied to online metabolic simulations, if fast PC hardware is available.
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