ABSTRACT
BACKGROUND: Hypermetabolism has been described in stress states such as trauma, sepsis, acute respiratory distress syndrome, and severe burn injuries. We hypothesize that patients with Coronavirus disease 2019 (COVID-19) may develop a hypermetabolic state, which may be a major contributing factor to the extraordinary ventilatory and oxygenation demands in patients with COVID-19. METHOD: Resting energy expenditure (REE), carbon dioxide production (VCO2 ), and oxygen consumption (VO2 ) were measured by indirect calorimetry on 7 critically ill patients with COVID-19. RESULTS: The median measured REE was 4044 kcal/d, which was 235.7% ± 51.7% of predicted. The median VCO2 was 452 mL/min (range, 295-582 mL/min), and the median VO2 was 585 mL/min (range, 416-798 mL/min). CONCLUSION: Critically ill patients with COVID-19 are in an extreme hypermetabolic state. This may explain the high failure rates for mechanical ventilation for these patients and highlights the potential need for increased nutrition requirements for such patients.
Subject(s)
Basal Metabolism , COVID-19/metabolism , Carbon Dioxide/metabolism , Critical Illness , Oxygen Consumption , Rest , Adult , COVID-19/virology , Calorimetry, Indirect/methods , Energy Metabolism , Humans , Nutritional Requirements , Respiration, Artificial , Respiratory Distress Syndrome , SARS-CoV-2ABSTRACT
BACKGROUND: We have observed that critically ill patients with COVID-19 are in an extreme hypermetabolic state. This may be a major contributing factor to the extraordinary ventilatory and oxygenation demands seen in these patients. We aimed to quantify the extent of the hypermetabolic state and report the clinical effect of the use of hypothermia to decrease the metabolic demand in these patients. METHODS: Mild hypothermia was applied on four critically ill patients with COVID-19 for 48 h. Metabolic rates, carbon dioxide production and oxygen consumption were measured by indirect calorimetry. RESULTS: The average resting energy expenditure (REE) was 299% of predicted. Mild hypothermia decreased the REE on average of 27.0% with resultant declines in CO2 production (VCO2) and oxygen consumption (VO2) by 29.2% and 25.7%, respectively. This decrease in VCO2 and VO2 was clinically manifested as improvements in hypercapnia (average of 19.1% decrease in pCO2 levels) and oxygenation (average of 50.4% increase in pO2). CONCLUSION: Our case series demonstrates the extent of hypermetabolism in COVID-19 critical illness and suggests that mild hypothermia reduces the metabolic rate, improves hypercapnia and hypoxia in critically ill patients with COVID-19.