Energy expenditure and withdrawal of sedation in severe head-injured patients

Resting energy expenditure in non-ventilated, non-sedated patients recovering from serious traumatic brain injury: Comparison of prediction equations with indirect calorimetry values

“…25,26 Biological variation in REE during the first 2 weeks of brain injury have been attributed to the effects of sedation, barbiturate therapy, steroid treatment, mechanical ventilation, diet induced thermogenesis, days since injury, severity of injury, body temperature, abnormal motor activity and/or infection, which can independently serve to increase or decrease measured REE. [3][4][5][6][7][8][9]21,22 To our knowledge, this is the first study investigating factors contributing to measured REE in a larger group of patients recovering from TBI when sedation and ventilation have been discontinued. We demonstrated that the severity of brain injury continues to affect the energy expenditure of patients in the later stages of trauma recovery.…”

“…Mean GCS at the time of measurement was 11 (range [4][5][6][7][8][9][10][11][12][13][14][15]. Approximately 53% of our patient group required supplementary oxygen via percutaneous tracheostomy to maintain oxygen saturations.…”

“…Patients receiving sedatives and or muscle relaxants were found to have a mean measured REE 30% lower than those patients not receiving sedation or in barbiturate coma. [6][7][8] Current guidelines for nutrition in TBI recommend replacing 140% of the REE in non-paralyzed patients and 100% in paralyzed patients by the seventh day of injury. 9 Research to date provides little information regarding REE in head injured patients after 2 weeks, typically when ventilation and sedation has been stopped and patients are in various degrees of consciousness and breathing spontaneously.…”

Hypermetabolism following Moderate to Severe Traumatic Acute Brain Injury: A Systematic Review

“…From this pool of 56 articles, 32 were excluded (Table 2). Following final review, 24 articles remained which comprised the final sample (Bitzani et al, 1999;Borzotta et al, 1994;Bruder et al, 1991Bruder et al, , 1994Bruder et al, , 1998Chiolero et al, 1989b;Clifton et al, 1984Clifton et al, , 1986Dempsey et al, 1985;Dickerson et al, 1990;Esper et al, 2006;Hadfield et al, 1992;Haider et al, 1975;Kolpek et al, 1989;McCall et al, 2003;Moore et al, 1989;Ott et al, 1994;Petersen et al, 1993;Raurich and Ibanez, 1994;Robertson et al, 1984Robertson et al, , 1985Weekes and Elia, 1996;Young et al, 1985Young et al, , 1996.…”

“…(Borzotta et al, 1994;Bruder et al, 1994;Chiolero et al, 1989b;McCall et al, 2003;Robertson et al, 1984Robertson et al, , 1985, or were measured continuously over a 24-h period (Bruder et al, 1991(Bruder et al, , 1998. Weekes and Elia (1996) obtained measurements that were collected over a 24-h period on one occasion and for less than 30 min on the second occasion.…”