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Kan, Mee-Nin; Chang, Han-Hsin; Sheu, Woei-Fen; Cheng, Chun-Wen; Lee, Bor‐Jen; Huang, Yi‐Chia

doi:10.1186/cc2366

Cited by 47 publications

(12 citation statements)

References 30 publications

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“…Respiratory quotient fluctuates with feeding, nutritional status, and anaerobiosis (43, 44), factors not considered here. The unadjusted Harris-Benedict equation has been shown previously to be unreliable in predicting energy expenditure in critically ill patients (39), which in part may be due to variation in ventilator settings (15, 45, 46), metabolic stress (47, 48), and fasting status (44) in prior studies.…”

Section: Discussionmentioning

confidence: 99%

Estimating Dead-Space Fraction for Secondary Analyses of Acute Respiratory Distress Syndrome Clinical Trials

Beitler

Thompson

Matthay

et al. 2015

Critical Care Medicine

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Objective Pulmonary dead-space fraction is one of few lung-specific independent predictors of mortality from acute respiratory distress syndrome (ARDS). However, it is not measured routinely in clinical trials and thus altogether ignored in secondary analyses that shape future research directions and clinical practice. This study sought to validate an estimate of dead-space fraction for use in secondary analyses of clinical trials. Design Analysis of patient-level data pooled from ARDS clinical trials. Four approaches to estimate dead-space fraction were evaluated: three required estimating metabolic rate; one estimated dead-space fraction directly. Setting U.S. academic teaching hospitals. Patients Data from 210 patients across three clinical trials were used to compare performance of estimating equations with measured dead-space fraction. A second cohort of 3,135 patients from six clinical trials without measured dead-space fraction was used to confirm whether estimates independently predicted mortality. Interventions None. Measurements and Main Results Dead-space fraction estimated using the unadjusted Harris-Benedict equation for energy expenditure was unbiased (mean ± SD Harris-Benedict 0.59 ± 0.13; measured 0.60 ± 0.12). This estimate predicted measured dead-space fraction to within ± 0.10 in 70% of patients and ± 0.20 in 95% of patients. Measured dead-space fraction independently predicted mortality (OR 1.36 per 0.05 increase in dead-space fraction, 95% CI 1.10–1.68; p < .01). The Harris-Benedict estimate closely approximated this association with mortality in the same cohort (OR 1.55, 95% CI 1.21–1.98; p < .01) and remained independently predictive of death in the larger ARDSNet cohort. Other estimates predicted measured dead-space fraction or its association with mortality less well. Conclusions Dead-space fraction should be measured in future ARDS clinical trials to facilitate incorporation into secondary analyses. For analyses where dead-space fraction was not measured, the Harris-Benedict estimate can be used to estimate dead-space fraction and adjust for its association with mortality.

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Section: Discussionmentioning

confidence: 99%

Estimating Dead-Space Fraction for Secondary Analyses of Acute Respiratory Distress Syndrome Clinical Trials

Beitler

Thompson

Matthay

et al. 2015

Critical Care Medicine

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“…The patients included in the study were divided into three groups: underfed, who received less than 90% of the necessary nutrition; appropriate feeding, receiving nutrition with an error of plus or minus 10%; and overfed patients, who received more than 110% of the necessary. Following the study, a significant improvement in hemodynamic status was reported in patients whose nutrition was individualized and related to their needs, reducing both the time of mechanical ventilation and the time in the ICU [ 55 ].…”

Section: Reviewmentioning

confidence: 99%

The influence of metabolic imbalances and oxidative stress on the outcome of critically ill polytrauma patients: a review

et al. 2017

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The critically ill polytrauma patient presents with a series of associated pathophysiologies secondary to the traumatic injuries. The most important include systemic inflammatory response syndrome (SIRS), sepsis, oxidative stress (OS), metabolic disorders, and finally multiple organ dysfunction syndrome (MODS) and death. The poor outcome of these patients is related to the association of the aforementioned pathologies. The nutrition of the critically ill polytrauma patient is a distinct challenge because of the rapid changes in terms of energetic needs associated with hypermetabolism, sepsis, SIRS, and OS. Moreover, it has been proven that inadequate nutrition can prolong the time spent on a mechanical ventilator and the length of stay in an intensive care unit (ICU). A series of mathematical equations can predict the energy expenditure (EE), but they have disadvantages, such as the fact that they cannot predict the EE accurately in the case of patients with hypermetabolism. Indirect calorimetry (IC) is another method used for evaluating and monitoring the energy status of critically ill patients. In this update paper, we present a series of pathophysiological aspects associated with the metabolic disaster affecting the critically ill polytrauma patient. Furthermore, we present different non-invasive monitoring methods that could help the intensive care physician in the adequate management of this type of patient.

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“…No entanto, um aporte calórico adequado pode promover o desmame da VM em pacientes críticos, reduzindo o tempo de internação hospitalar e a ocorrência de infecções 10 .…”

Section: N T R O D U ç ã Ounclassified

“…No estudo realizado por Kan et al 10 , os pacientes que receberam uma alimentação inadequada para suprir a demanda energética dependeram por mais tempo da VM. O presente estudo não encontrou associação estatisticamente significativa entre o percentual de calorias administradas e os tempos de VM (r s =0,130; p=0,321), de permanência em UTI (r s =-0,117; p=0,372) e de internação hospitalar (r s =-0,152; p=0,246).…”

Section: I S C U S S ã Ounclassified

Terapia nutricional enteral em politraumatizados sob ventilação mecânica e oferta energética

2012

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OBJETIVO: O objetivo deste estudo foi avaliar a adequação energética dos pacientes politraumatizados em suporte ventilatório internados na unidade de terapia intensiva de um hospital público de Porto Alegre (RS), por meio da comparação entre as calorias prescritas e as efetivamente administradas, assim como entre as calorias estimadas pela equação de Harris-Benedict e a prescrição energética de cada paciente. MÉTODOS: Estudo de coorte prospectivo de pacientes politraumatizados, simultaneamente sob ventilação mecânica e terapia nutricional enteral. Verificou-se o tempo de permanência sob ventilação mecânica e a oferta energética durante o período de terapia nutricional enteral. A associação entre as variáveis quantitativas foi avaliada através do teste de correlação de Spearman devido à assimetria das variáveis. RESULTADOS: Foram acompanhados 60 pacientes, na faixa etária de 18 a 78 anos, sendo 81,7% do sexo masculino. Os tempos medianos de internação hospitalar, permanência na unidade de terapia intensiva e ventilação mecânica foram de 29, 14 e 6 dias, respectivamente. A média do percentual de dieta administrada foi de 68,6% (DP=18,3%). Da amostra total, 16 (26,7%) pacientes receberam no mínimo 80% de suas necessidades diárias. Não houve associação estatisticamente significativa entre o valor energético total administrado e os tempos de ventilação mecânica (r s=0,130; p=0,321), de unidade de terapia intensiva (r s=-0,117; p=0,372) e de internação hospitalar (r s=-0,152; p=0,246). CONCLUSÃO: Os pacientes incluídos neste estudo não receberam com precisão o aporte energético prescrito, ficando expostos aos riscos da desnutrição e seus desfechos clínicos desfavoráveis.

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Untitled

Cited by 47 publications

References 30 publications

Estimating Dead-Space Fraction for Secondary Analyses of Acute Respiratory Distress Syndrome Clinical Trials

Estimating Dead-Space Fraction for Secondary Analyses of Acute Respiratory Distress Syndrome Clinical Trials

The influence of metabolic imbalances and oxidative stress on the outcome of critically ill polytrauma patients: a review

Terapia nutricional enteral em politraumatizados sob ventilação mecânica e oferta energética

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