ABSTRACT
Objective:To evaluate the predictive effect of the 24 h energy expenditure value obtained by indirect calorimetry (IC) on the prognosis of patients with multiple traumatic mechanical ventilation.Methods:A total of 140 patients with multiple traumatic mechanical ventilation who were hospitalized in the ICU of General Hospital of Ningxia Medical University from December 1st, 2016 to August 31st, 2018 were selected as research objects. The general information such as sex, age, Height, weight, and clinical diagnosis were recorded. The IC method was used to measure the patient's 24 h energy expenditure, and the ratio of 24 h energy expenditure to the actual body weight of the patients was calculated the energy expenditure of 24 h energy expenditure per kilogram of body weight. The patient’s mechanical ventilation time and length of stay in ICU were statistically analyzed. The outcome indexes were 28-day mortality and the incidence of hospital-acquired infection. The receiver operating characteristic curve (ROC) was used to analyze the predictive value of 24 h energy expenditure and 24 h energy expenditure per kilogram of body weight.Results:The mechanical ventilation time was positively correlated with 24 h energy expenditure and 24 h energy expenditure per kilogram of body weight ( r=0.470, r=0.247, both P<0.01). The length of sty in ICU was positively correlated with the 24 h energy expenditure of patients with multiple trauma( r=0.276, P<0.05). The area under the ROC curve (AUC) of the 24 h energy expenditure and 24 h energy expenditure per kilogram of body weight for the 28 d mortality and the incidence of hospital-acquired infection were 0.647, 0.663, 0.832, 0.646, with the 24 h energy expenditure per kilogram of body weight greater than 30.4 kcal/(kg·d) as the best critical value for judging 28 d mortality. The sensitivity was 66.5%, specificity was 77.0%, and the 24 h energy expenditure consumption greater than 2 083 kcal/d was used as the optimal critical value for judging the susceptibility to acquire hospital infection, with a sensitivity of 80.0% and specificity of 80.7%. Conclusions:The mechanical ventilation time and length of stay in ICU are closely related to energy expenditure in patients with multiple trauma. The 24 h EE per kilogram of body weight and 24 h energy expenditure have a certain predictive effect on the prognosis of patients with multiple trauma.
ABSTRACT
Objective To compare the measured resting energy expenditure (MREE) in patients with sepsis calculated using respiratory indirect calorimetry and Harris-Benedict (HB) coefficient method,and to investigate the influence of different energy target on the prognosis of patients with sepsis.Methods This was a prospective comparative study.60 patients with sepsis who were suitable for nutrition support and respiratory indirect calorimetry in the Intensive Care Unit (ICU) of the General Hospital of Ningxia Medical University from January to October 2015 were selected.(1) MREE was measured simultaneously with respiratory indirect calorimetry and HB coefficient (Harris-Benedict equation × stress coefficient) in the 60 patients on the 0,3rd,7th,and 14th days of nutrition support.The MREE calculated with the two methods were compared to detect difference.(2) The septic patients were randomly divided into two groups according to the random number table:respiratory indirect calorimetry group (n =30),in which the nutrition support was given according to the MREE measured using respiratory indirect calorimetry as the energy target;HB coefficient method group (n =30),in which the nutrition support energy target was the MREE measured using HB coefficient method.The clinical data of the patients in both groups were recorded and compared,which included the baseline characteristics,nutrition-related complications,and prognostic indicators.Results (1) Within 2 weeks during nutrition support,the dynamic MREE in the respiratory indirect calorimetry group was significantly higher than that in the HB coefficient method group (P ＜0.05).There was no significant difference in MREE on the 0,3rd,7th,and 14th days of nutrition support measured by respiratory indirect calorimetry (P ＞ 0.05).(2) There were no significant differences between the two groups in incidence of liver function damage and abnormal blood glucose within 2 weeks of nutrition support (both P ＞ 0.05).Compared with the HB coefficient method group,the length of ICU stay and 28-day mortality were significantly lower in the respiratory indirect calorimetry group [193.5 (172.2,289.7) h vs.247.5 (194.7,393.2),Z=-2.061,P=0.039;3.3％ vs.23.3％,x2 =5.129,P=0.023],but there was no significant difference between the two groups in mechanical ventilation time (P ＞ 0.05).Conclusions The MREE of septic patients may be considerably high and with little fluctuation in a short period.Respiratory indirect calorimetry may be more suitable to guide the energy intake target in septic patients.