Abstract
A possible relationship between hypermetabolism (energy expenditure expressed as percentage above the estimated basal metabolic rate) and clinical outcome was investigated in 29 artificially ventilated patients with infection and multiple organ failure following abdominal surgery. The average energy expenditure and hypermetabolism were 126±19 kJ (30±5 kcal)/kg/24h and 36±12%, respectively. Survivors of the intensive care period (n=20) had a 15% higher hypermetabolism (41±11 vs 26±8%,p<0.01) than patients who died in the intensive care unit (n=9). Six of the patients died after intensive care. On comparing hypermetabolism in survivors (n=14) and non-survivors (n=15) of the period of hospitalization, no significant difference was discernible. The results demonstrate that patients with multiple organ failure have a moderate hypermetabolism and suggest that the hypermetabolism is comparatively reduced in patients with a fatal outcome during intensive care.
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Carlsson M, Nordenström J, Hedenstierna G (1984) Clinical implications of continuous measurement of energy expenditure in mechanically ventilated patients. Clin Nutr 3:103–110
Soop M, Forsberg E, Thörne A, Alvestrand A (1989) Energy expenditure in postoperative multiple organ failure with acute renal failure. Clin Nephrol 31:139–145
Lanschot JJB van, Feenstra BW, Looijen R, Vermeij CG, Bruining HA (1987) Total parenteral nutrition in critically ill surgical patients: fixed vs tailored caloric replacement. Intensive Care Med 13:46–51
Bursztein S, Teitelman U, De Myttenaere S, Michelson M, Dahan E, Gepstein R, Edelman D, Melamed Y (1978) Reduced oxygen consumption in catabolic states with mechanical ventilation. Crit Care Med 6:162–166
Shikora SA, Bistrian BR, Borlase BC, Blackburn GL, Stone MD, Benotti PN (1990) Work of breathing: reliable predictor of weaning and extubation. Crit Care Med 18:157–162
Robertson CS, Clifton GL, Grossman RG (1984) Oxygen utilization and cardiovascular function in head injured patients. Neurosurgery 15:307–314
Swinamer DL, Phang PT, Jones RL, Grace M, King EG (1988) Effect of routine administration of analgesia on energy expenditure in critically ill patients. Chest 93:4–10
Wilson RF, Christensen CC, LeBlanc LP (1972) Oxygen consumption in critically-ill surgical patients. Ann Surg 176:801–804
Lanschot JJB van, Feenstra BWA, Vermeij CG, Bruining HA (1988) Outcome prediction in critically ill patients by means of oxygen consumption index and simplified acute physiology score. Intensive Care Med 14:44–49
Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829
Carlsson M, Forsberg E, Thörne A, Nordenström J, Hedenstierna G (1985) Evaluation of an apparatus for continuous monitoring of gas exchange in mechanically ventilated patients. Int J Clin Monit Comput 1:211–220
Fleisch A (1951) Le métabolisme basal standard et sa détermination au moyen du “Metabolcalculator”. Helv Med Acta 18:23–44
Geigy Scientific Tables (1984) Metropolitan height and mass tables. In: Lentner C (ed) Physical chemistry blood and somatometric data. Ciba Geigy, pp 326
Baker JP, Detsky AS, Stewart S, Whitwell J, Errol BM, Jeejeebhoy KN (1984) Randomized trial of total parenteral nutrition in critically ill patients: Metabolic effects of varying glucose-lipid ratios as the energy source. Gastroenterology 87:53–59
Swinamer DL, Grace MG, hamilton SM, Jones RL, Roberts P, King EG (1990) Predictive equation for assessing energy expenditure in mechanically ventilated critically ill patients. Crit Care Med 18:657–661
Wilmore DW, Long JM, Mason AD, Skreen RW, Pruitt BA (1974) Cathecholamines: mediator of the hypermetabolic response to thermal injury. Ann Surg 180:653–669
Wilmore DW (1977) The metabolic management of the critically ill. Plenum, New York, pp 29
Soop M, Forsberg E, Thörne A, Cederblad G, Bergström J, Forsberg A-M, Hultman E (1989) Muscle alkali-soluble protein, carnitine, water and electrolytes in patients with persistent postoperative infection. Clin Nutr 8:151–160
Bergström J, Alvestrand A, Fürst P, Hultman E, Widstam-Attorps U (1983) Muscle intracellular electrolytes in patients with chronic uremia. Kidney Int 24:S153-S160
Muldowney FP (1963) The value of muscle biopsy in the diagnosis of clinical alterations in total body water, body potassium and body sodium. Ann NY Acad Sci 110:654–660
Muldowney FP (1963) Clinical disturbances in serum sodium and potassium in relation to alteration in total exchangeable sodium, exchangeable potassium and total body water. Am J Med 35:768–780
Shaw SN, Elwyn DH, Askanazi J, Iles M, Schwartz Y, Kinney JM (1983) Effects of increasing nitrogen intake on nitrogen balance and energy expenditure in nutritionally depleted adult patients receiving parenteral nutrition. Am J Clin Nutr 37:930–940
Greig PD, Elwyn DH, Askanazi J, Kinney JM (1987) Parenteral nutrition in septic patients: effect of increasing nitrogen intake. Am J Clin Nutr 46:1040–1047
Soop M, Forsberg E, Thörne A, Bergström J (1990) Muscle and plasma amino-acid pattern in severely depleted surgical patients. Clin Nutr 9:206–213
Weissman C, Kemper M, Damask MC, Askanazi J, Hyman AI, Kinney JM (1984) Effect of routine intensive care interactions on metabolic rate. Chest 86:815–818
Stoner HB, Little RA, Frayn KN, Elebute AE, Tresadern J, Gross E (1983) The effect of sepsis on the oxidation of carbohydrate and fat. Br J Surg 70:32–35
Liaw KY (1985) Effect of injury, sepsis and parenteral nutrition on high energy phosphates in human liver and muscle. JPEN 9:28–33
Bihari D, Smithies M, Gimson A, Tinker J (1987) The effects of vasodilation on oxygen delivery and uptake in critically ill patients. N Engl J Med 317:397–403
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Forsberg, E., Soop, M. & Thörne, A. Energy expenditure and outcome in patients with multiple organ failure following abdominal surgery. Intensive Care Med 17, 403–409 (1991). https://doi.org/10.1007/BF01720678
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DOI: https://doi.org/10.1007/BF01720678