Continuous Indirect Calorimetry in Critically Injured Patients Reveals Significant Daily Variability and Delayed, Sustained Hypermetabolism

Georgia Vasileiou, Michelle B. Mulder, Sinong Qian, Rahul Iyengar, Lindsey M. Gass, Jonathan Parks, Edward Lineen, Patricia Byers, Daniel Dante Yeh

Research output: Contribution to journalArticle

Abstract

Background: Previous studies have used using Indirect Calorimetry (IC) with solitary or sparse measurements of resting energy expenditure (REE). This “snapshot” may not capture the dynamic nature of metabolic requirements. Using continuous IC, we describe the variation of REE during the first days in the intensive care unit. Methods: Injured adults (≥18 years) requiring mechanical ventilation from March 2018 to September 2018 were enrolled. IC was initiated within 4 days of admission and continuous REE recorded until 14 days, extubation, or death. Multiple 10-minute periods collected during steady state were used to calculate daily REE maximum, minimum, average, and variability [(REEmax − REEmin/2)/average REE]. Results: We included 55 patients. Median age was 38 [27–58] years, 38 (69%) were male, body mass index was 28 [25–33] kg/m2, and Acute Physiology and Chronic Health Evaluation II was 17 [14–24]. Mechanism of injury was: blunt (n = 38, 69%), penetrating (n = 9, 16%), and burn (n = 8, 15%). Average REE increased gradually from 1,663 kcal [1,435–2,143] to a maximum of 2,080 [1,701–2,336] on day 7, a relative 25% increase, which was sustained through day 14. REE variability ranged 8%–13% and was not reliably predicted by fever, tachycardia, elevated intracranial pressures, hypertension, or hypotension. Conclusion: In critically injured patients, steady-state REE measurements display fluctuations over a 24-hour period and demonstrate a gradual rise over the first few days after injury. Continuous REE, if available, is recommended for more precise matching of energy delivery to metabolic requirements.

Original languageEnglish (US)
JournalJournal of Parenteral and Enteral Nutrition
DOIs
StateAccepted/In press - Jan 1 2019

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Indirect Calorimetry
Energy Metabolism
Intracranial Hypertension
Intracranial Hypotension
Nonpenetrating Wounds
APACHE
Artificial Respiration
Tachycardia
Intensive Care Units
Body Mass Index
Fever

Keywords

  • adult
  • calorimetry
  • outcomes research/quality
  • surgery
  • trauma

ASJC Scopus subject areas

  • Medicine (miscellaneous)
  • Nutrition and Dietetics

Cite this

Continuous Indirect Calorimetry in Critically Injured Patients Reveals Significant Daily Variability and Delayed, Sustained Hypermetabolism. / Vasileiou, Georgia; Mulder, Michelle B.; Qian, Sinong; Iyengar, Rahul; Gass, Lindsey M.; Parks, Jonathan; Lineen, Edward; Byers, Patricia; Yeh, Daniel Dante.

In: Journal of Parenteral and Enteral Nutrition, 01.01.2019.

Research output: Contribution to journalArticle

Vasileiou, Georgia ; Mulder, Michelle B. ; Qian, Sinong ; Iyengar, Rahul ; Gass, Lindsey M. ; Parks, Jonathan ; Lineen, Edward ; Byers, Patricia ; Yeh, Daniel Dante. / Continuous Indirect Calorimetry in Critically Injured Patients Reveals Significant Daily Variability and Delayed, Sustained Hypermetabolism. In: Journal of Parenteral and Enteral Nutrition. 2019.
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abstract = "Background: Previous studies have used using Indirect Calorimetry (IC) with solitary or sparse measurements of resting energy expenditure (REE). This “snapshot” may not capture the dynamic nature of metabolic requirements. Using continuous IC, we describe the variation of REE during the first days in the intensive care unit. Methods: Injured adults (≥18 years) requiring mechanical ventilation from March 2018 to September 2018 were enrolled. IC was initiated within 4 days of admission and continuous REE recorded until 14 days, extubation, or death. Multiple 10-minute periods collected during steady state were used to calculate daily REE maximum, minimum, average, and variability [(REEmax − REEmin/2)/average REE]. Results: We included 55 patients. Median age was 38 [27–58] years, 38 (69{\%}) were male, body mass index was 28 [25–33] kg/m2, and Acute Physiology and Chronic Health Evaluation II was 17 [14–24]. Mechanism of injury was: blunt (n = 38, 69{\%}), penetrating (n = 9, 16{\%}), and burn (n = 8, 15{\%}). Average REE increased gradually from 1,663 kcal [1,435–2,143] to a maximum of 2,080 [1,701–2,336] on day 7, a relative 25{\%} increase, which was sustained through day 14. REE variability ranged 8{\%}–13{\%} and was not reliably predicted by fever, tachycardia, elevated intracranial pressures, hypertension, or hypotension. Conclusion: In critically injured patients, steady-state REE measurements display fluctuations over a 24-hour period and demonstrate a gradual rise over the first few days after injury. Continuous REE, if available, is recommended for more precise matching of energy delivery to metabolic requirements.",
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AU - Vasileiou, Georgia

AU - Mulder, Michelle B.

AU - Qian, Sinong

AU - Iyengar, Rahul

AU - Gass, Lindsey M.

AU - Parks, Jonathan

AU - Lineen, Edward

AU - Byers, Patricia

AU - Yeh, Daniel Dante

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AB - Background: Previous studies have used using Indirect Calorimetry (IC) with solitary or sparse measurements of resting energy expenditure (REE). This “snapshot” may not capture the dynamic nature of metabolic requirements. Using continuous IC, we describe the variation of REE during the first days in the intensive care unit. Methods: Injured adults (≥18 years) requiring mechanical ventilation from March 2018 to September 2018 were enrolled. IC was initiated within 4 days of admission and continuous REE recorded until 14 days, extubation, or death. Multiple 10-minute periods collected during steady state were used to calculate daily REE maximum, minimum, average, and variability [(REEmax − REEmin/2)/average REE]. Results: We included 55 patients. Median age was 38 [27–58] years, 38 (69%) were male, body mass index was 28 [25–33] kg/m2, and Acute Physiology and Chronic Health Evaluation II was 17 [14–24]. Mechanism of injury was: blunt (n = 38, 69%), penetrating (n = 9, 16%), and burn (n = 8, 15%). Average REE increased gradually from 1,663 kcal [1,435–2,143] to a maximum of 2,080 [1,701–2,336] on day 7, a relative 25% increase, which was sustained through day 14. REE variability ranged 8%–13% and was not reliably predicted by fever, tachycardia, elevated intracranial pressures, hypertension, or hypotension. Conclusion: In critically injured patients, steady-state REE measurements display fluctuations over a 24-hour period and demonstrate a gradual rise over the first few days after injury. Continuous REE, if available, is recommended for more precise matching of energy delivery to metabolic requirements.

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