MECCIAS trial: Metabolic consequences of continuous veno-venous hemofiltration on indirect calorimetry
| Autor: | Herbert Spapen, Manu L N G Malbrain, Joop Jonckheer, E. De Waele, J. Demol, Katrien Lanckmans |
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| Přispěvatelé: | Faculty of Medicine and Pharmacy, Intensive Care, Pneumology, Faculty of Engineering, Pharmaceutical and Pharmacological Sciences, Clinical Biology, Supporting clinical sciences, Internal Medicine Specializations, Department of Bio-engineering Sciences |
| Rok vydání: | 2020 |
| Předmět: |
Male
0301 basic medicine medicine.medical_specialty Continuous Renal Replacement Therapy Critical Illness Rest medicine.medical_treatment 030209 endocrinology & metabolism Calorimetry Carbon dioxide production Sodium Chloride Critical Care and Intensive Care Medicine Citric Acid 03 medical and health sciences 0302 clinical medicine Internal medicine Hemofiltration Co2 removal medicine Humans Resting energy expenditure Renal replacement therapy Aged Aged 80 and over 030109 nutrition & dietetics Nutrition and Dietetics business.industry Critically ill Blood gas analyzer Calorimetry Indirect Carbon Dioxide Cardiology Female Basal Metabolism Nutrition Therapy Blood Gas Analysis Energy Metabolism business |
| Zdroj: | Clinical Nutrition. 39:3797-3803 |
| ISSN: | 0261-5614 |
| DOI: | 10.1016/j.clnu.2020.04.017 |
| Popis: | Summary Background and aims: Caloric prescription based on resting energy expenditure (REE) measured with indirect calorimetry (IC) improves outcome and is the gold standard in nutritional therapy of critically ill patients. Until now continuous renal replacement therapy (CRRT) precluded the use of IC due to several mechanisms. We investigated the impact of CRRT on VCO2, VO2 and REE to facilitate indirect calorimetry during CRRT. Methods In 10 critically ill ventilated patient in need of continuous veno-venous hemofiltration (CVVH) using citrate predilution we performed IC in 4 different states: baseline, high dose, baseline with NaCl predilution and without CVVH. CO2 content of effluent fluid was measured by a point of care blood gas analyzer. Carbon dioxide production (VCO2) measured with IC was adapted by adding the CO2 flow of effluent and deducing CO2 flow in postdilution fluid to calculate a true VCO2. True REE was calculated with the Weir equation using the true VCO2. Results CO2 removal in effluent during baseline, high dose and NaCl predilution was respectively 24 mL/min, 38 mL/min and 23 mL/min. Together with the CO2 delivery by the postdilution fluid this led to an adaptation of REE respectively by 34 kcal/d or 2% (p = 0,002), 44 kcal/d or 3% (p = 0,002) and 33 kcal/d or 2% (p = 0,002). Compared to the true REE during baseline of 1935 ± 921 kcal/d, true REE during high dose was 1723 ± 752 kcal/d (p = 0.65), during NaCl predilution it was 1604 ± 633 kcal/d (p = 0.014) and without CRRT it was 1713 ± 704 kcal/d (p = 0.193). Conclusions CO2 alterations due to CVVH are clinically of no importance so no correction factor of REE is needed with or without CVVH. IC must be performed during CVVH as CVVH seems to alter metabolism. These changes may be mainly explained by the use of citrate predilution. |
| Databáze: | OpenAIRE |
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