Energy metabolism of thoracic surgical patients in the early postoperative period - Effect of posture

Study objective: To determine the effect of elective thoracic surgery on energy metabolism and gas exchange and to evaluate whether the 30 degrees sitting position would affect these variables. Design: Prospective, unblinded, controlled study. Setting: Surgical ICU in a university hospital. Patients: Twenty-two adult patients undergoing elective pulmonary resection. Interventions: Posture change from supine to 30 degrees sitting position. Measurements and results: Oxygen consumption (VO2), carbon dioxide production (VCO2), respiratory quotient (RQ), and energy expenditure (EE) were measured by means of computerized indirect calorimetry before and after surgery. Heart rate and respiratory frequency were measured continuously during gas exchange measurement. Blood gases were analyzed with an automated blood gas analyzer. Preoperatively, altering position did not affect energy metabolism, gas exchange, and cardiopulmonary variables, Postoperatively, the measured EE was 116% of the expected value. Mean EE and Vover dotO(2) values for each position were higher than the preoperative values for the corresponding postures (p<0.05 for each position), while VCO2 increased only in the supine position (p<0.05). Mean percent increases in EE, Vover dotO(2), and VCO2 were significantly lower in the 30 degrees sitting position than in the supine position (EE: 7.9+/-2.7% vs 14.4+/-2.3%; p<0.001; Vover dotO(2): 9.0+/-3.0% vs 16.4+/-2.6%; p<0.001; VCO2: 3.2+/-2.1% vs 6.5+/-1.4%; p<0.05). Arterial oxygen tension and all the physiologic indexes of gas exchange for each position were worse than the preoperative values for the corresponding postures (p<0.05 for each position). Mean arterial pressure, heart rate, and respiratory frequency for each position were higher than the preoperative values for the corresponding postures (p<0.05 for each position). No changes in mean values of these variables occurred between the two positions postoperatively. Conclusions: The early postoperative period of patients undergoing elective thoracic surgery is characterized by a condition of impaired gas exchange and by a hypermetabolic state. Hypermetabolism can be partly mitigated by assuming the 30 degrees sitting position.