Thermogenic and metabolic response to amino acid solution in brain dead patients

Çankayalı, İlkin; Demırağ, Kubilay; Kocabas, S.; Moral, Ali Reşat

doi:10.1016/s0261-5614(03)80174-7

Cited by 3 publications

(10 citation statements)

References 10 publications

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“…The inflammatory state and its relationship with EE is best described in obesity in both animal studies with an increase in EE associated with the increase in inflammation [128,129]. Nutritional support representing protein intake and route of nutritional intake had an indeterminate relationship with EE [22,50,57,69,77,80,90,130]. This factor requires additional consideration for it evaluation strategy in future studies of energy expenditure.…”

Section: Discussionmentioning

confidence: 99%

Systematic review of factors associated with energy expenditure in the critically ill

Mtaweh

Aguero

Campbell

et al. 2019

Clinical Nutrition ESPEN

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Background and aims: Indirect calorimetry is the reference standard for energy expenditure measurement. Predictive formulae that replace it are inaccurate. Our aim was to review the patient and clinical factors associated with energy expenditure in critically ill patients. Methods: We conducted a systematic review of the literature. Eligible studies were those reporting an evaluation of factors and energy expenditure. Energy expenditure and factor associations with p-values were extracted from each study, and each factor was classified as either significantly, indeterminantly, or not associated with energy expenditure. Regression coefficients were summarized as measures of central tendency and spread. Metanalysis was performed on correlations. Results: The search strategy yielded 8521 unique articles, 307 underwent full text review, and 103 articles were included. Most studies were in adults. There were 95 factors with 352 evaluations. Minute volume, weight, age, % body surface area burn, sedation, post burn day, and caloric intake were significantly associated with energy expenditure. Heart rate, fraction of inspired oxygen, respiratory rate, respiratory disease diagnosis, positive end expiratory pressure, intensive care unit days, C-reactive protein, and size were not associated with energy expenditure. Multiple factors (n ¼ 37) were identified with an unclear relationship with energy expenditure and require further evaluation. Conclusions: An important interval step in the development of accurate formulae for energy expenditure estimation is a better understanding of relationships between patient and clinical factors and energy expenditure. The review highlights the limitations of currently available data, and identifies important factors that are not included in current prediction formulae of the critically ill.

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Section: Discussionmentioning

confidence: 99%

Systematic review of factors associated with energy expenditure in the critically ill

Mtaweh

Aguero

Campbell

et al. 2019

Clinical Nutrition ESPEN

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“…16 Reduced REE and cardiac output after traumatic brain injury were also observed in patients treated with experimental hypothermia 27 and among normothermic organ donors receiving parenteral alimentation. 17 Euthermia was maintained by OPO protocols, and the REE of our donors was higher than predicted. Recent studies in critically ill patients indicate that the Harris-Benedict equation yields underestimates of actual energy expenditure, 28,29 findings similar to our data.…”

Section: Discussionmentioning

confidence: 75%

“…However, despite the continuing high circulating catecholamine and cytokine levels following brain death, indirect calorimetry shows lower REE (25%–80%) than predicted by traditional formulas, presumably because of hypothermia, absent brain metabolism, and flaccid musculature. 14,16,17 Although REE among donors does not increase during intravenous infusion of amino acids, 17 the effects of enteral feeding on REE are unknown.…”

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confidence: 99%

Randomized Trial to Evaluate Nutritional Status and Absorption of Enteral Feeding after Brain Death

Hergenroeder

Ward

et al. 2013

Prog Transpl

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Context Catecholamines and inflammatory mediators, with elevated levels after brain death, are associated with reduced function and survival of transplanted organs. Enteral nutrition reduces tissue damage and may benefit organs. Objective To evaluate the effects of immunomodulating enteral nutrition in organ donors. Design Prospective, randomized, open-label study. Setting Intensive care unit. Patients Thirty-six brain-dead organ donors. Interventions Donors were randomized to receive enteral nutrition containing omega-3 polyunsaturated fatty acid, antioxidants, and glutamine or standard care (fasting). Donors received hormonal replacement therapy of corticosteroid, levothyroxine, dextrose, and insulin. Main Outcome Measures Gastrointestinal assimilation (measured by 13carbon-labeled uracil breath analysis), quantity of organs recovered, resting energy expenditure, urine level of urea nitrogen, and serum levels of albumin, prealbumin, interleukin 6, tumor necrosis factor-α, and C-reactive protein were evaluated. Results Thirteen patients (36%) assimilated 13C-labeled uracil. Resting energy expenditure was significantly higher than predicted between 10 and 14 hours after baseline in 33 donors (P = .007). Other measures were not conclusively different between fed and fasting groups. No adverse events occurred that were related to the enteral feeding. Conclusions About 30% of donors metabolized 13C-labeled uracil, although no difference in oxidation rate was found between fasting and fed donors. Corticosteroid administration lowers plasma levels of interleukin 6 and most likely contributes to greater than predicted resting energy expenditure. Thus energy needs may not be met during fasting if hormones are given. Consequences of this possible energy deficit warrant further study.

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“…The metabolic unit was calibrated for VO 2 measurements with two calibration cylinders containing 21% and 12% O 2 . The calibration for VCO 2 measurements was conducted with calibration gases containing 5% and 0% CO 2 , respectively [10][11][12][13]. The metabolic computer continuously recorded the breath-to-breath volume (Vt), RR, the ventilation per minute volume (MV) as well as the inhaled and exhaled gases (O 2 and CO 2 ).…”

Section: Resting Energy Expenditurementioning

confidence: 99%

“…Clinical trials investigating the changes of REE in brain-dead patients are controversial. Several studies have found a reduction in REE in brain-dead patients, probably due to hypothermia, even though brain damage causes an increase in REE when compared to BMR [ 9 , 10 ].…”

Section: Introductionmentioning

confidence: 99%

Relationships Between Resting Energy Expenditure and Transcranial Doppler Measurements in Patients With and Without Brain Death

Kiourtzieva¹,

Grosomanidis²,

Amaniti³

et al. 2022

Cureus

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IntroductionBrain metabolism deteriorates during brain death, suggesting that cerebral metabolic measurements could serve as a prognostic factor. The application of transcranial Doppler can be useful in evaluating patients evolving to brain death. Resting energy expenditure is lower than expected in patients with brain death, and this is caused by the decrease in cerebral blood flow and consequently lower oxygen supply. The primary aim of this retrospective study is to investigate the early metabolic changes in patients with clinical criteria of brain death and examine if these changes are related to a gradual decrease in blood flow velocities in the middle cerebral artery. MethodsAll consecutive patients from 1st June 2018 to 30th April 2022, admitted to the ICU with brain injury and a GCS ≤ 8, were included retrospectively in the study. Patients were allocated into two groups: Group A, patients without clinical signs of brain death (n = 32), and Group B, patients with brain death (n = 34). In each group, three sets of metabolic measurements were performed concomitantly with cerebral blood flow velocities using transcranial Doppler (a) upon admission to the ICU, (b) once hemodynamic stabilization was obtained, and (c) 48 hours after their hemodynamic stabilization or when brain death was confirmed by clinical criteria. Resting energy expenditure (REE) measurements were performed using a metabolic computer. Cerebral blood flow velocities were measured after a period of 30 min using a 2-MHZ 2D ultrasound probe. ResultsBrain-dead patients had a significant decrease in their metabolic parameters as the cerebral blood flow velocities recorded with the transcranial Doppler deteriorated, (

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Thermogenic and metabolic response to amino acid solution in brain dead patients

Cited by 3 publications

References 10 publications

Systematic review of factors associated with energy expenditure in the critically ill

Systematic review of factors associated with energy expenditure in the critically ill

Randomized Trial to Evaluate Nutritional Status and Absorption of Enteral Feeding after Brain Death

Relationships Between Resting Energy Expenditure and Transcranial Doppler Measurements in Patients With and Without Brain Death

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