Skip to main content
Download PDF

Energy expenditure and outcome in patients with multiple organ failure following abdominal surgery

Intensive Care Medicine volume 17, pages 403–409 (1991)Cite this article

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.

References

  1. Carlsson M, Nordenström J, Hedenstierna G (1984) Clinical implications of continuous measurement of energy expenditure in mechanically ventilated patients. Clin Nutr 3:103–110

    Google Scholar 

  2. 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

    Google Scholar 

  3. 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

    Google Scholar 

  4. 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

    Google Scholar 

  5. 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

    Google Scholar 

  6. Robertson CS, Clifton GL, Grossman RG (1984) Oxygen utilization and cardiovascular function in head injured patients. Neurosurgery 15:307–314

    Google Scholar 

  7. 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

    Google Scholar 

  8. Wilson RF, Christensen CC, LeBlanc LP (1972) Oxygen consumption in critically-ill surgical patients. Ann Surg 176:801–804

    Google Scholar 

  9. 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

    Google Scholar 

  10. Knaus WA, Draper EA, Wagner DP, Zimmerman JE (1985) APACHE II: a severity of disease classification system. Crit Care Med 13:818–829

    Google Scholar 

  11. 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

    Google Scholar 

  12. Fleisch A (1951) Le métabolisme basal standard et sa détermination au moyen du “Metabolcalculator”. Helv Med Acta 18:23–44

    Google Scholar 

  13. Geigy Scientific Tables (1984) Metropolitan height and mass tables. In: Lentner C (ed) Physical chemistry blood and somatometric data. Ciba Geigy, pp 326

  14. 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

    Google Scholar 

  15. 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

    Google Scholar 

  16. 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

    Google Scholar 

  17. Wilmore DW (1977) The metabolic management of the critically ill. Plenum, New York, pp 29

    Google Scholar 

  18. 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

    Google Scholar 

  19. 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

    Google Scholar 

  20. 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

    Google Scholar 

  21. 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

    Google Scholar 

  22. 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

    Google Scholar 

  23. 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

    Google Scholar 

  24. 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

    Google Scholar 

  25. 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

    Google Scholar 

  26. 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

    Google Scholar 

  27. Liaw KY (1985) Effect of injury, sepsis and parenteral nutrition on high energy phosphates in human liver and muscle. JPEN 9:28–33

    Google Scholar 

  28. 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

    Google Scholar 

Download references

Author information

Affiliations

  1. Departments of Anaesthesiology, Huddinge University Hospital, Karolinska Institute, Huddinge, S-141 86, Stockholm, Sweden

    E. Forsberg & M. Soop

  2. Departments of Surgery, Huddinge University Hospital, Karolinska Institute, Huddinge, Stockholm, Sweden

    A. Thörne

Authors
  1. E. Forsberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. M. Soop
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. Thörne
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and Permissions

About this article

Cite this article

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

Download citation

  • Received:

  • Accepted:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01720678

Key words

  • Indirect calorimetry
  • Infection
  • Intensive care
  • Multiple organ failure
  • Patient outcome assessment
  • Prognosis