Estimating energy expenditure.
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Calorimetry, Indirect↗
Biomedical subjects
J M Raurich
Publications and source records attributed to J M Raurich.
Metabolic rate in severe head trauma.
BACKGROUND: The metabolic rate of patients suffering severe head trauma (HT) is not well defined, and large variations of resting energy expenditure (REE) have been reported, suggesting an important nonuniformity of REE distribution in HT patients. The purpose of this clinical study was to assess the metabolic rate in mechanically ventilated patients suffering from severe isolated HT, or HT associated with other injuries, in the absence of gross motor activity. METHODS: Eighty HT patients undergoing mechanical ventilation were studied between 48 and 72 hours after injury. Three groups of patients were studied in the following clinical settings: (group A) isolated HT, not receiving morphine (n = 34); (group B) isolated HT, receiving an intravenous perfusion of morphine (n = 26) to control gross motor activity; and (group C) HT associated with other serious injuries, receiving intravenous morphine (n = 20) to induce sedation and analgesia. REE was measured with the open-Douglas-bag method. RESULTS: No significant differences among the three groups were found in the metabolic rate expressed as the percentage of measured REE from predicted REE and REE expressed in terms of body weight. The mean percent measured REE was 123 +/- 16, and REE expressed in terms of body weight was 30 +/- 5 kcal/kg per day. Severe hypermetabolism was diagnosed if mean percent measured REE was greater than 130 and was present in 25 of 80 (31%) patients. CONCLUSIONS: Severe HT treated with or without morphine was characterized by a moderate state of hypermetabolism after the first days of trauma, but an important proportion of HT patients showed considerably elevated metabolic rates.
Adult↗
[Effect of changes in body weight on rest energy expenditure in critically ill patients].
AIM: Critically ill patients may present rapid and significant variations in body weight in excess of 20%, attributed to acute changes in the volume of extracellular water. These changes should not alter the level of metabolic activity, as the extracellular compartment is metabolically inactive. The purpose of this study has been to verify whether or not the rapid changes in body weight presented by critically ill patients over short periods of time alter the at-rest energy expenditure (GER in its Spanish acronym). PATIENTS: Out of a group of 55 critically ill patients whose GER had been repeatedly measured, 15 were chosen as two of their GER measurements complied with the following clinical conditions: a difference in body weight of more than 5%, a time difference of less than 10 days between both measurements, a variation of less than 20% in the calorie intake, a difference in axillary temperature of less than 1 degree centigrade (degree C) and the same sedation and/or analgesia. All of the patients presented acute kidney failure. Their GER was measured with a system based on the bell spirometer (Calorimet). RESULTS: The variation in body weight was 7.3 +/- 2.12 kg. The difference between the GER with high and low body weight was, in absolute terms, 154 +/- 162 kcal/day (p = 0.003) and, in terms of body weight, -0.6 +/- 1.9 kcal/kg/day (p = 0.21). A statistically significant (r = 0.77 and p > 0.001) linear relationship was observed between the variations in body weight and the GER expressed as a percentage [[symbol: see text] GER (%) = -1.77 + [symbol: see text] peso (%)]. CONCLUSION: The variation in body weight presented by critically ill patients over short periods of time is associated with changes in the GER.
Body Weight↗
[Energy consumption in patients with Crohn's disease. An evolutionary study during hospitalization].
In Crohn's disease, weight loss and malnutrition are very frequently occurring problems. One explanation of these findings could be an increased energy expenditure. Eleven patients were studied, of which six were women and five were men, during a hospital stay for an active episode of Crohn's disease. In three patients the small intestine was affected, in five the colon, and in the last three both the ileum and the colon were affected. Van Hees' activity index on admittance was 196 +/- 52 (132-265). The energy expenditure at rest (ECR) on admittance, was 11% higher than that found in the normal population (p: n.s.). The energy expenditure decreased weekly, in a statistically significant way, during hospitalization. No significant relationship was found between the Van Hees activity index and any of the parameters used to evaluate the energy needs. Those patients whose body weight was less than 90% of the ideal body weight, presented pathologically elevated energy needs when the energy expenditure was expressed in kcal/kg (p = 0.003). Fever was the only analyzed parameter which showed a significant correlation with the changes in energy expenditure: measured by the oxygen consumption index (p = 0.003) and by the percentage of REE (p = 0.006).
Adolescent↗
[CO2 production and thermogenesis induced by enteral and parenteral nutrition].
UNLABELLED: The objectives of this study were to quantify, in critically ill patients, the thermogenesis induced by artificial nutrition (AN), when the caloric supply restores the energetic losses, and to evaluate the effects of the AN suppression on the production of CO2 (VCO2). MATERIAL AND METHODS: 20 patients were studied, 14 with mechanical ventilation and 6 with spontaneous respiration, divided into two groups, depending on whether the AN was enteral (EN) or parenteral (PN). The VCO2 and the consumption of oxygen (VO2) were measured by means of the Douglas bag. The resting energy expenditure during the AN (REET) and 2 hours after discontinuing the AN (REE) were measured. The thermogenesis induced by the nutrition (TIN) was defined as the difference between REET and REE, expressed as a percentage of the caloric supply. RESULTS: After discontinuing the AN, there were no statistically significant differences between EN and PN patients in the VCO2 decreases (p = 0.60) and the VO2 decreases (p = 0.78), and in the TIN percentage referred to the caloric supply (p = 0.82). After discontinuing the caloric supply, which was 1.12 times the REET, the VCO2 decreased 5 +/- 4.9% (Confidence interval (CI) of 95%, from 3% to 7%), the VO2 decreased 2 +/- 6.1% (CI of -0.36% to 5.32%), and the TIN represented 3 +/- 4.5% of the caloric supply (CI of 0.72% to 4.95%). CONCLUSIONS: The results of this study indicate that the thermogenesis induced by artificial nutrition, when restores the energetic losses, is equivalent to 3% of the caloric supply. The discontinuation of the artificial nutrition induced a VCO2 decrease of 5% and thus this measure would probably not be useful for decreasing the ventilatory demand.
Adolescent↗