Persistent hypermetabolism and longitudinal energy expenditure in critically ill patients with COVID-19

Whittle, John; Molinger, Jeroen; MacLeod, David B.; Haines, Krista; Wischmeyer, Paul E.; Sung, Anthony D.; Fudim, Marat; Boerger, Lindsie; Lessig, Kathryn; Lumbard, Jessica; Murray, Leslie C.; Steves, Sue; Parikh, Jhana; Ribet, Jacob; Hollidge, Melanie

doi:10.1186/s13054-020-03286-7

Cited by 101 publications

(121 citation statements)

References 6 publications

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“…Some authors define a hyperinflammatory state as a C-reactive protein concentration greater than 150 mg/L, ferritin concentration of greater than 1500 μg/L, or D-dimer concentration greater than 2500 mg/L [ 29 , 30 ]. Two of those criteria were present in our case, supporting a severe case of COVID-19 in the inflammatory phase [ 3 , 27 , 31 , 32 ]. In this stage of the disease, the physiologic effects of controlled hypothermia may play a role in improving gas exchange, being more intense in hyperthermic subjects [ 20 ].…”

Section: Discussionsupporting

confidence: 81%

“…Preliminary data shows that energy expenditure is still high after the second week of severe COVID-19 cases, and a hyperinflammatory profile is associated with worse outcomes [ 27 , 28 ]. Some authors define a hyperinflammatory state as a C-reactive protein concentration greater than 150 mg/L, ferritin concentration of greater than 1500 μg/L, or D-dimer concentration greater than 2500 mg/L [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Successful use of mild therapeutic hypothermia as compassionate treatment for severe refractory hypoxemia in COVID-19

Cruces

Cores²,

Casanova

et al. 2021

Journal of Critical Care

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Section: Discussionsupporting

confidence: 81%

Section: Discussionmentioning

confidence: 99%

Successful use of mild therapeutic hypothermia as compassionate treatment for severe refractory hypoxemia in COVID-19

Cruces

Cores²,

Casanova

et al. 2021

Journal of Critical Care

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“…Luckily, our patient experienced no symptoms of acute infection, and she was able to correctly follow her usual drug therapy. While higher energy consumption is described in the literature [ 3 ] during severe COVID, data in milder form are lacking. Our patient never showed a hypercatabolic state, as she didn't show any neurological impairment or biochemical sign of metabolic decompensation (both ammonium and glutamine were normal) even following her usual, low protein, diet.…”

Section: Discussionmentioning

confidence: 99%

SARS CoV2 infection in a young subject affected by arginosuccinate synthase deficiency: A case report of epilepsy worsening

Vitturi

Lenzini

Francini-Pesenti

et al. 2021

Molecular Genetics and Metabolism Reports

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Summary We describe a case of a 21 years old woman affected by Citrullinemia type 1- Arginosuccinate Synthase deficiency (ASSD)-who underwent a SARS CoV2 infection during the first phase of pandemic burst in Italy. She had no symptoms of infection nor a metabolic crisis. After recovery from SARS CoV2, she experienced a worsening in their epilepsy despite therapy, with one/two crisis a week.

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“…Clinical data on the course of EE during the recovery or convalescence phase of critical illness is scarce and usually derived from studies with small sample size. When available, measured REE is still significantly elevated several weeks after ICU admission, as has been shown in burns, trauma, and sepsis patients, including very recently in COVID-19 [ 50 – 52 ]. However, in serial measurements in twelve patients during the post-ICU hospitalization period, Ridley et al showed significant individual variability in measured EE [ 11 ].…”

Section: Energy Expenditurementioning

confidence: 93%

Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations

2021

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The use of indirect calorimetry is strongly recommended to guide nutrition therapy in critically ill patients, preventing the detrimental effects of under- and overfeeding. However, the course of energy expenditure is complex, and clinical studies on indirect calorimetry during critical illness and convalescence are scarce. Energy expenditure is influenced by many individual and iatrogenic factors and different metabolic phases of critical illness and convalescence. In the first days, energy production from endogenous sources appears to be increased due to a catabolic state and is likely near-sufficient to meet energy requirements. Full nutrition support in this phase may lead to overfeeding as exogenous nutrition cannot abolish this endogenous energy production, and mitochondria are unable to process the excess substrate. However, energy expenditure is reported to increase hereafter and is still shown to be elevated 3 weeks after ICU admission, when endogenous energy production is reduced, and exogenous nutrition support is indispensable. Indirect calorimetry is the gold standard for bedside calculation of energy expenditure. However, the superiority of IC-guided nutritional therapy has not yet been unequivocally proven in clinical trials and many practical aspects and pitfalls should be taken into account when measuring energy expenditure in critically ill patients. Furthermore, the contribution of endogenously produced energy cannot be measured. Nevertheless, routine use of indirect calorimetry to aid personalized nutrition has strong potential to improve nutritional status and consequently, the long-term outcome of critically ill patients.

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Persistent hypermetabolism and longitudinal energy expenditure in critically ill patients with COVID-19

Cited by 101 publications

References 6 publications

Successful use of mild therapeutic hypothermia as compassionate treatment for severe refractory hypoxemia in COVID-19

Successful use of mild therapeutic hypothermia as compassionate treatment for severe refractory hypoxemia in COVID-19

SARS CoV2 infection in a young subject affected by arginosuccinate synthase deficiency: A case report of epilepsy worsening

Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations

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