Yoğun bakım hastalarında metabolik monitör ile ölçülen enerji tüketiminin standart denklemlerle karşılaştırılması

Year 2021, Volume: 46 Issue: 2, 589 - 600, 30.06.2021

Emre Karakoç , Onur Taktakoğlu , Murat Erdogan

https://doi.org/10.17826/cumj.865721

Abstract

Amaç: Bu çalışmda yoğun bakım hastalarında enerji tüketimini etkileyen parametreleri ve enerji tüketiminin hesaplanması için en güvenilir formüllerin belirlenmesi amaçlanmıştır.
Gereç ve Yöntem: Bu prospektif çalışma Çukurova Üniversitesi Hastanesi İç Hastalıkları Anabilim Dalı yoğun bakım ünitesinde yapıldı. Çalışmaya, hemodinamik ve solunum stabilitesi olan, mekanik ventilatörde 24 saatten fazla izlenen 18 yaş üstü toplam 71 hasta dahil edildi. Formüllerden elde edilen hesaplanan enerji tüketim değerlerinin, indirekt kalorimetre ile ölçülen enerji tüketim değerleri ile korelasyonunu inceledik.
Bulgular: Çalışma 71 hasta üzerinde gerçekleştirildi. Hastaların ortalama enerji tüketimi 2078 ± 794 kcal ve kilogram başına ortalama enerji ihtiyacı 31.64 ± 13.82 kcal olarak bulundu. İndirekt kalorimetre ölçümleri Swinamer formülü ile en güçlü korelasyonu gösterdi.
Sonuç: İndirekt kalorimetri, enerji tüketiminin belirlenmesinde sadece "altın standart" değil, "ulaşılabilir altın standart" haline geldi. Yoğun bakım hastalarında beslenmenin doğru şekilde sürdürülmesi için indirekt kalorimetre yönteminin kullanılmasını öneriyoruz. İndirekt kalorimetrenin kullanılamadığı veya 24 saat beklemenin istenmediği koşullar altında; 2 saatlik bir ölçümün sonuçlarına göre veya güvenilir tahmin denklemlerine göre besleme başlatılabilir.

Keywords

Beslenme desteği, indirekt kalorimetre, yetersiz beslenme, yoğun bakım ünitesi

Comparison of energy consumptions measured by metabolic monitor with standard equations in intensive care patients

Abstract

Purpose: The aim of this study was to determine parameters affecting the energy consumption in intensive care patients, and the most reliable formulas for calculation of energy consumption.
Materials and Methods: This prospective study was carried out in the intensive care unit of the Internal Medicine Department of Çukurova University Hospital. Total 71 patients above 18 years of age, with hemodynamical and respirational stability, and being followed up on a mechanical ventilator for more than 24 hours, were included to this study. We analyzed the correlation of calculated energy consumption values obtained from formulas, with the energy consumption values measured by indirect calorimeter.
Results: The study was executed on 71 patients. The mean energy consumption of the patients was 2078±794 kcal and the mean energy need per kilogram was found as 31.64±13.82 kcal. Indirect calorimeter measurements showed the strongest correlation with Swinamer formula.
Conclusion: Indirect calorimetry has become not only a "gold standard" but an "achievable gold standard" in determining energy consumption. We recommend that the indirect calorimeter method should be used in intensive care patients to maintain nutrition properly. Under conditions where indirect calorimeter cannot be used, or it is not desirable to wait for 24 hours; feeding can be started according to the results of a 2-hour measurement, or reliable predictive equations.

Keywords

Nutritional support, indirect calorimetry, malnutrition, intensive care unit

References

• 1. Cerra, F., et al. Applied nutrition in ICU patients. A consensus statement of the American College of Chest Physicians. Chest 111, 769-778 (1997).
• 2. Pirat, A., et al. Comparison of Measured Versus Predicted Energy Requirements in Critically Ill Cancer Patients. Respiratory care 54, 487-494 (2009).
• 3. Heyland, D., Dhaliwal, R., Day, A., Jain, M. & Drover, J. Validation of the Canadian clinical practice guidelines for nutrition support in mechanically ventilated, critically ill adult patients: Results of a prospective observational study. Critical care medicine 32, 2260-2266 (2004).
• 4. Heyland, D.K. NUTRITIONAL SUPPORT IN THE CRITICALLY ILL PATIENT: A Critical Review of the Evidence. Critical Care Clinics 14, 423-440 (1998).
• 5. Klein, S., et al. Nutrition support in clinical practice: review of published data and recommendations for future research directions. Summary of a conference sponsored by the National Institutes of Health, American Society for Parenteral and Enteral Nutrition, and American Society for Clinical Nutrition. The American journal of clinical nutrition 66, 683-706 (1997).
• 6. Wong, P.W., Enriquez, A. & Barrera, R. Nutritional support in critically ill patients with cancer. Crit Care Clin 17, 743-767 (2001).
• 7. Klein, C.J., Stanek, G.S. & Wiles, C.E. Overfeeding Macronutrients to Critically Ill Adults: Metabolic Complications. Journal of the American Dietetic Association 98, 795-806 (1998).
• 8. Mechanick, J.I. & Brett, E.M. Nutrition and the chronically critically ill patient. Current opinion in clinical nutrition and metabolic care 8, 33-39 (2005).
• 9. Fung, E.B. Estimating energy expenditure in critically ill adults and children. AACN Clin Issues 11, 480-497 (2000).
• 10. Walker, R.N. & Heuberger, R.A. Predictive equations for energy needs for the critically ill. Respir Care 54, 509-521 (2009).
• 11. Faisy, C., Guerot, E., Diehl, J.L., Labrousse, J. & Fagon, J.Y. Assessment of resting energy expenditure in mechanically ventilated patients. The American journal of clinical nutrition 78, 241-249 (2003).
• 12. Frankenfield, D., Smith, J.S. & Cooney, R.N. Validation of 2 approaches to predicting resting metabolic rate in critically ill patients. JPEN. Journal of parenteral and enteral nutrition 28, 259-264 (2004).
• 13. Robinson, J.D., Lupkiewicz, S.M., Palenik, L., Lopez, L.M. & Ariet, M. Determination of ideal body weight for drug dosage calculations. American journal of hospital pharmacy 40, 1016-1019 (1983).
• 14. NHBLI. NHBLI Clinical Guidelines on the Identification , Evaulation and Treatment of Overweight and Obesity in Adults, (2001).
• 15. Prentice, A.M. & Jebb, S.A. Beyond body mass index. Obesity reviews : an official journal of the International Association for the Study of Obesity 2, 141-147 (2001).
• 16. Pai, M.P. & Paloucek, F.P. The origin of the "ideal" body weight equations. The Annals of pharmacotherapy 34, 1066-1069 (2000).
• 17. Singer, P., et al. ESPEN Guidelines on Parenteral Nutrition: intensive care. Clinical nutrition (Edinburgh, Scotland) 28, 387-400 (2009).
• 18. Bland, J.M. & Altman, D.G. Measuring agreement in method comparison studies. Statistical methods in medical research 8, 135-160 (1999).
• 19. Swinamer, D.L., Phang, P.T., Jones, R.L., Grace, M. & King, E.G. Twenty-four hour energy expenditure in critically ill patients. Crit Care Med 15, 637-643 (1987).
• 20. Bursztein, S., Saphar, P., Singer, P. & Elwyn, D.H. A mathematical analysis of indirect calorimetry measurements in acutely ill patients. The American journal of clinical nutrition 50, 227-230 (1989).
• 21. van Lanschot, J.J., Feenstra, B.W., Vermeij, C.G. & Bruining, H.A. Calculation versus measurement of total energy expenditure. Crit Care Med 14, 981-985 (1986).
• 22. Graf, S. Evaluation of three indirect calorimetry devices in mechanically ventilated patients: Which device compares best with the Deltatrac II®? A prospective observational study. Clinical nutrition v. 34, pp. 6-65-2015 v.2034 no.2011 (2015).
• 23. Sundstrom, M., Tjader, I., Rooyackers, O. & Wernerman, J. Indirect calorimetry in mechanically ventilated patients. A systematic comparison of three instruments. Clinical nutrition (Edinburgh, Scotland) 32, 118-121 (2013).
• 24. Cheng, C.H., et al. Measured versus estimated energy expenditure in mechanically ventilated critically ill patients. Clinical nutrition (Edinburgh, Scotland) 21, 165-172 (2002).
• 25. Maday, K. Energy Estimation in the Critically Ill: A Literature Review. International Journal of Clinical Medicine 1, 39-43 (2013).
• 26. Petros, S. & Engelmann, L. Validity of an abbreviated indirect calorimetry protocol for measurement of resting energy expenditure in mechanically ventilated and spontaneously breathing critically ill patients. Intensive care medicine 27, 1164-1168 (2001).
• 27. Ahmad, A., Duerksen, D.R., Munroe, S. & Bistrian, B.R. An evaluation of resting energy expenditure in hospitalized, severely underweight patients. Nutrition (Burbank, Los Angeles County, Calif.) 15, 384-388 (1999).
• 28. Cutts, M.E., Dowdy, R.P., Ellersieck, M.R. & Edes, T.E. Predicting energy needs in ventilator-dependent critically ill patients: effect of adjusting weight for edema or adiposity. The American journal of clinical nutrition 66, 1250-1256 (1997).
• 29. Flancbaum, L., Choban, P.S., Sambucco, S., Verducci, J. & Burge, J.C. Comparison of indirect calorimetry, the Fick method, and prediction equations in estimating the energy requirements of critically ill patients. The American journal of clinical nutrition 69, 461-466 (1999).
• 30. Kross, E.K., Sena, M., Schmidt, K. & Stapleton, R.D. A comparison of predictive equations of energy expenditure and measured energy expenditure in critically ill patients. J Crit Care 27, 321.e325-321.e312 (2012).
• 31. MacDonald, A. & Hildebrandt, L. Comparison of formulaic equations to determine energy expenditure in the critically ill patient. Nutrition (Burbank, Los Angeles County, Calif.) 19, 233-239 (2003).
• 32. Frankenfield, D.C., et al. Correlation between measured energy expenditure and clinically obtained variables in trauma and sepsis patients. JPEN. Journal of parenteral and enteral nutrition 18, 398-403 (1994).
• 33. Harris, J.A. & Benedict, F.G. A Biometric Study of Human Basal Metabolism. Proc Natl Acad Sci U S A 4, 370-373 (1918).
• 34. Haugen, H., Chan, L.-N. & Li, F. Indirect Calorimetry: A Practical Guide for Clinicians. Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition 22, 377-388 (2007).
• 35. Reid, C.L. Poor agreement between continuous measurements of energy expenditure and routinely used prediction equations in intensive care unit patients. Clinical nutrition (Edinburgh, Scotland) 26, 649-657 (2007).
• 36. Spears, K.E., Kim, H., Behall, K.M. & Conway, J.M. Hand-Held Indirect Calorimeter Offers Advantages Compared with Prediction Equations, in a Group of Overweight Women, to Determine Resting Energy Expenditures and Estimated Total Energy Expenditures during Research Screening. Journal of the American Dietetic Association 109, 836-845 (2009).
• 37. Rodriguez, D.J., Sandoval, W. & Clevenger, F.W. Is measured energy expenditure correlated to injury severity score in major trauma patients? The Journal of surgical research 59, 455-459 (1995).
• 38. Weissman, C., Sardar, A. & Kemper, M. An in vitro evaluation of an instrument designed to measure oxygen consumption and carbon dioxide production during mechanical ventilation. Crit Care Med 22, 1995-1200 (1994).
• 39. Brandi, L.S., et al. Energy expenditure and severity of injury and illness indices in multiple trauma patients. Crit Care Med 27, 2684-2689 (1999).
• 40. Cunningham, J.J. Factors contributing to increased energy expenditure in thermal injury: a review of studies employing indirect calorimetry. JPEN. Journal of parenteral and enteral nutrition 14, 649-656 (1990).
• 41. Bessey, P.Q., Watters, J.M., Aoki, T.T. & Wilmore, D.W. Combined hormonal infusion simulates the metabolic response to injury. Annals of surgery 200, 264-281 (1984).
• 42. Kim, B. Thyroid hormone as a determinant of energy expenditure and the basal metabolic rate. Thyroid : official journal of the American Thyroid Association 18, 141-144 (2008).
• 43. Wang, F., et al. Relationship between thyroid function and ICU mortality: a prospective observation study. Crit Care 16, R11-R11 (2012).
• 44. Rubinson, L., Diette, G.B., Song, X., Brower, R.G. & Krishnan, J.A. Low caloric intake is associated with nosocomial bloodstream infections in patients in the medical intensive care unit. Crit Care Med 32, 350-357 (2004).
• 45. Heyland, D.K., et al. Nutrition support in the critical care setting: current practice in canadian ICUs--opportunities for improvement? JPEN. Journal of parenteral and enteral nutrition 27, 74-83 (2003).