Tissue fuel and weight loss after injury.

Kinney, John M.; Duke, Joshua; Long, Calvin L.; Gump, Frank E.

doi:10.1136/jcp.s3-4.1.65

Cited by 157 publications

(44 citation statements)

References 17 publications

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“…1 Plank et al 2 have found that resting energy expenditure (REE) in adults with severe sepsis resulting from peritonitis increases up to 49% above normal and remains high for at least 3 weeks from the onset of disease. Hypermetabolism in these patients is associated with lipolysis and catabolism despite increased caloric intake.…”

Section: Discussionmentioning

confidence: 99%

Energy Metabolism of Infants and Children with Systemic Inflammatory Response Syndrome and Sepsis

Turi¹,

Petros²,

Eaton³

et al. 2001

Annals of Surgery

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ObjectiveTo evaluate whether critically ill children with systemic inflammatory response syndrome (SIRS) or sepsis have altered resting energy expenditure (REE) and substrate utilization. Summary Background DataStudies in adults with sepsis have shown increased energy expenditure and mobilization of endogenous fat. In infants and children, energy metabolism and substrate utilization during sepsis have not been characterized. MethodsMetabolic studies were performed in 21 critically ill children with SIRS or sepsis. Twenty-one stable control children, matched for weight, were also studied. Seven patients required inotropic support and 17 received mechanical ventilation. Fifteen patients with SIRS had evidence of bacterial, fungal, or viral infection and were considered septic. Respiratory gas exchange was measured by computerized indirect calorimetry for 1 to 2 hours continuously. ResultsThe REE of patients with SIRS or sepsis was not different from that of controls. Similarly, there were no differences in carbon dioxide production and oxygen consumption. Resting energy metabolism was not different between patients with SIRS and patients with sepsis. In addition, the presence of low platelet count or inotropic support did not affect resting energy metabolism. The median respiratory quotient of patients with SIRS or sepsis was 0.88 (range 0.75-1.12), indicating mixed utilization of fat and carbohydrate; this was not significantly different from that of controls. The Pediatric Risk of Mortality Score was not significantly correlated with REE or respiratory quotient. ConclusionsThe energy requirements of children with SIRS or sepsis are not increased. Their resting metabolism is based on both carbohydrate and fat utilization. The authors speculate that these children divert the energy for growth into recovery processes.Studies in adults have shown that the metabolic response to trauma and sepsis is characterized by hypermetabolism and increased tissue catabolism.1 Plank et al 2 have found that resting energy expenditure (REE) in adults with severe sepsis resulting from peritonitis increases up to 49% above normal and remains high for at least 3 weeks from the onset of disease. Hypermetabolism in these patients is associated with lipolysis and catabolism despite increased caloric intake.1,2 The energy requirement of adult patients with critical illness or those undergoing severe stress is thought to be increased by 30% above normal.3 Van Lanschot et al 4 have shown that energy expenditure measured by indirect calorimetry in these patients is greater than energy expenditure predicted on the basis of body size and age.There is little information on the metabolic response to critical illness in infancy and childhood. Preliminary studies 5,6 have not demonstrated a hypermetabolic response similar to that described in adults.2,4 Chwals et al 5 measured REE by indirect calorimetry in critically ill ventilated infants and young children and showed that the measured

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Section: Discussionmentioning

confidence: 99%

Energy Metabolism of Infants and Children with Systemic Inflammatory Response Syndrome and Sepsis

Turi¹,

Petros²,

Eaton³

et al. 2001

Annals of Surgery

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“…Predicted energy expenditures (PEE) were then calculated for each patient by multiplying individual BEE by 1.2 (an activity factor for bedrest) and then by 1.6 (an injury factor for major trauma): 11 Although this method of predicting energy expenditure may yield high values compared to other reports, 2 it is used here because it is a documented standard. Therefore, an assessment of its accuracy is warranted.…”

Section: Methodsmentioning

confidence: 99%

“…Initially, elevations in urinary nitrogen losses and in energy expenditures are observed in patients without SCI. 1,2 Resolution of this hypermetabolism, with or without aggressive nutrition support, usually ensues within 1 ± 3 weeks. Nitrogen balance (NB) then normalizes (to zero) or becomes positive.…”

Section: Introductionmentioning

confidence: 99%

The metabolic response to spinal cord injury

1997

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The metabolic response to trauma, including neurotrauma in general, has been studied extensively, but the acute metabolic response to spinal cord injury (SCI) has not. Therefore, 12 patients with SCI are presented in whom intensive nutrition assessment and management were instituted immediately after injury. Nitrogen balance (NB), predicted energy expenditure (PEE), and actual energy expenditure (MEE) were calculated or measured in each patient. A persistent negative NB was observed in all but one of the 12 patients. The single patient who did not exhibit persistent negative NB (no positive NB from week 2 to week 4 in the face of appropriate feeding) had an incomplete myelopathy, thus implying that the degree of motor dysfunction correlates with the obligatory nature of the negative NB. The negative NB observed in several of the patients did not occur until the second or third post-injury week. In addition, calculations of PEE by successively multiplying the Harris-Benedict equation by an activity factor of 1.2 and then by a stress factor of 1.6, resulted in excessive feeding (as assessed by metabolic cart measurements; ie indirect calorimetry) in the majority of the patients. In all of the 11 patients with persistent negative NBs, protein administration in the amount of 2 g/k of ideal body weight and aggressive caloric delivery did not alter the negative pattern of the NBs. Therefore, it is concluded that the negative NB following SCI is obligatory. Furthermore, the extent of SCI (extent of myelopathy or of neurological injury) correlates with the obligatory nature of the negative NB. In addition, the results from using the above method for estimating caloric requirements and the delayed manifestation of the negative NB may cause an additional tendency to acutely overfeed SCI patients. Therefore, eliminating the activity factor of 1.2 (due to the diminished activity arising from paralysis) and a diminution of the stress factor is recommended for initial PEE calculations. Serial metabolic cart (indirect calorimetry) measurements are recommended to accurately assess the patient's subsequent metabolic requirements.

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“…During the perioperative period, metabolism usually increases by 10% [14]. Attempts to identify the factors which, during the perioperative period, cause an intensification of stress reactions resulted in reports in which the researchers indicated that even 12-hour starvation before surgery brings about metabolic changes that prolong the period of convalescence after non-complicated surgical procedures [15,16].…”

Section: Introductionmentioning

confidence: 99%