Energy expenditure and severity of injury and illness indices in multiple trauma patients

Brandi, L. S.; Santini, L.; Bertolini, R; Malacarne, P; Casagli, Sergio; Baraglia, Anna Maria

doi:10.1097/00003246-199912000-00013

Cited by 61 publications

(40 citation statements)

References 41 publications

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“…43,[63][64][65] Alterations in breathing pattern and V T may introduce error into measurements designed to be made during stable, steady-state conditions. 51,52,66 Interpretation of results must take into account the stability of physiologic variables such as minute ventilation, V T , cardiac output, V /Q , and CO 2 body stores. Certain situations may affect the reliability of the capnogram.…”

Section: Co 2 MV 40 Indicationsmentioning

confidence: 99%

Capnography/Capnometry During Mechanical Ventilation: 2011

2011

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For the purposes of this clinical practice guideline, capnography refers to the evaluation of the CO 2 in the respiratory gases of mechanically ventilated patients. A capnographic device incorporates one of 2 types of sampling techniques: mainstream or sidestream. 1 Mainstream technique inserts a sampling window into the ventilator circuit for measurement of CO 2 , whereas a sidestream analyzer samples gas from the ventilator circuit, and the analysis occurs away from the ventilator circuit. Analyzers utilize infrared, mass or Raman spectra, or a photoacoustic spectra technology. 1,2 Flow measuring devices are utilized in volumetric capnographs. Colorimetric CO 2 detectors are a form of mainstream sampling, but are simplistic. The colorimetric CO 2 detector has a pH-sensitive chemical indicator that undergoes color change with each inspiration and expiration, thus reflecting the change in CO 2 concentration. These devices start at baseline color when minimal CO 2 is present and undergo gradual color change with increasing CO 2 concentration. 3 CO 2 MV 2.0 PROCEDURE Capnography is the continuous analysis and recording of the CO 2 concentration in respiratory gas. Although the Brian K Walsh RRT-NPS FAARC is affiliated with the Respiratory Care

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Section: Co 2 MV 40 Indicationsmentioning

confidence: 99%

Capnography/Capnometry During Mechanical Ventilation: 2011

2011

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“…Ideal BW (IBW) was calculated for a reference body mass index (BMI) at 22.5 kg/m 2 (IBW 22,5 ), and at 25 kg/m 2 (IBW 25 ) or calculated using the Metropolitan Life Insurance tables (IBW MLI ), the Lorentz equation (IBW LO ) (height (cm) À 100 À ((height (cm) À 150)/2.5 for women and/4 for men)) and the Broca equation (IBW BRO ) (height (cm) À 100). We then used the following equations to calculate EE with the different BWs listed above: ESPEN formula [9], HarriseBenedict, Black et al [10], Faisy et al [7], Frankenfield et al [11], Brandi et al [12], Ireton-Jones et al [13], Penn State et al [14] and Swinamer et al [15] (web Appendix Table 4). …”

Section: Methodsmentioning

confidence: 99%

Energy expenditure in mechanically ventilated patients: The weight of body weight!

et al. 2017

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Background & aims: Optimal nutritional care for intensive care unit (ICU) patients requires precise determination of energy expenditure (EE) to avoid deleterious under-or overfeeding. The reference method, indirect calorimetry (IC), is rarely accessible and inconstantly feasible. Various equations for predicting EE based on body weight (BW) are available. This study aims at determining the best prediction strategy unless IC is available. Methods: Mechanically ventilated patients staying !72 h in the ICU were included, except those with contraindications for IC measurements. IC and BW measurements were routinely performed. EE was predicted by the ESPEN formula and other predictive equations using BW (i.e. anamnestic (AN), measured (MES), adjusted for cumulated water balance (ADJ), calculated for a body mass index (BMI) of 22.5). Comparisons were made using Pearson correlation and Bland & Altman plots. Results: 85 patients (57 ± 19 y, 61 men, SAPS II 43 ± 16) were included. Correlations between IC and predicted EE using the ESPEN formula with different BW (BW AN , BW MES , BW ADJ , and BW BMI22.5 ) were 0.44, 0.40, 0.36, and 0.47, respectively. Bland & Altman plots showed wide and inconsistent variations. Predictive equations including body temperature and minute ventilation showed the best correlations, but when using various BWs, differences in predicted EE were observed. Conclusion: No EE predictive equation, regardless of the BW used, gives statistically identical results to IC. If IC cannot be performed, predictive equations including minute ventilation and body temperature should be preferred. BW has a significant impact on estimated EE and the use of measured BW MES or BW BMI 22.5 is associated with the best EE prediction. Clinical trial registration number on ClinicalTrial.gov: NCT02552446. Ethical committee number: CE-14-070.

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“…13,14 Studies of critically ill patients indicate that BMR may be increased by up to 17%. 15 11,20,24,25,38 QCv = h A (Tsur − T hb ) QCv = Heat gained or lost through convection H mkj = Heat transfer coefficient (empirically determined) Approximate values: ∼5 W m −2 K −1 = still air over a surface (natural convection) ∼100 W m 2 K = moderate speed flow of air over a surface (forced convection) ∼3000 W m −2 K −1 = moderate speed flow of water in a pipe (forced convection) A = Surface area of skin Tsur = Temperature of the surroundings (air) T hb = Temperature of the object (human body) Vasodilation: up to 8× increased heat transfer from body core to surface Radiation heat exchange 11,14,19 QR = e A (Tsur 4 − T hb 4 ) e = Emissivity/absorptivity of the object (range 0-1) A = surface area of the object radiating heat = Stefan-Boltzmann constant (5.67 × 10 -8 W M -2 K -4 ) Tsur = temperature of the surroundings T hb = temperature of the human body Evaporative heat loss 19,22,25,26,27,29 QE = L × m QE = heat lost through evaporation L = latent heat of evaporation for water (0.58 kCal g −1 ) m = mass of water evaporated (1 g = 1 mL) Air humidity: multiply by (1 − air humidity %) Body temperature change (black's equation) [36][37][38] T Human Body = (Q Produced ± Q Exchanged ) × M × C T Human Body = change in human body temperature Q Produced = heat produced within the body Q Exchanged = heat exchanged between the body and the environment M = mass of the human body C = Specific heat capacity of the body =58.4 kCal • C −1 (0.83 kCal kg −1 • C −1 × body mass (kg)) during hypothermia steady state (0.74 × BMR) but higher after rewarming (1.16 × BMR). 17 Extra metabolism results from physical activity (engagement of skeletal muscles) and can result in significant heat production ( Table 1).…”

Section: Heat Productionmentioning

confidence: 99%