Indirect calorimetry in critically ill patients: Clinical applications and practical advice

被引:66
作者
Brandi, LS
Bertolini, R
Calafa, M
机构
关键词
indirect calorimetry; energy metabolism; oxygen consumption; carbon dioxide; production; artificial nutrition; critical illness; TOTAL PARENTERAL-NUTRITION; CARBON-DIOXIDE PRODUCTION; MULTIPLE ORGAN FAILURE; RESTING METABOLIC-RATE; MECHANICALLY VENTILATED PATIENTS; GAS-EXCHANGE MEASUREMENTS; TOTAL-ENERGY-EXPENDITURE; OXYGEN-CONSUMPTION; SURGICAL PATIENTS; ACUTE PHYSIOLOGY;
D O I
10.1016/S0899-9007(97)83059-6
中图分类号
R15 [营养卫生、食品卫生]; TS201 [基础科学];
学科分类号
100403 ;
摘要
Indirect calorimetry is the method by which metabolic rate and substrate utilization are estimated in human beings starting from respiratory gas exchange measurements and urinary nitrogen excretion. This method is based on some models and assumptions that must be known and taker, into consideration to correctly interpret the results obtained. Recent advances in technology and the availability of precise and portable metabolic carts have made this technique practical at the bedside even in critically ill patients. It must be considered that, particularly in the ICU, there may be several sources of error and many technical difficulties in applying this methodology. Taking into account the relevant clinical studies related to the outcomes of critically ill patient, this article defines when the assessment of energy expenditure by indirect calorimetry may provide useful and valid information. Review of the literature suggests that the clinical application of indirect calorimetry in critically ill patients, although promising, requires further evaluation. Currently, the potential useful clinical applications of indirect calorimetry in this category of patients can be summarized as follows: (1) assessment of energy expenditure in patients who fail to adequately respond to the estimated nutritional needs; (2) assessment of energy expenditure in patients with single- or multiple-organ dysfunction who need prolonged ICU care and artificial nutritional support; (3) assessment of the effects induced by artificial nutrition on the cardiocirculatory and respiratory systems in mechanically ventilated patients with acute respiratory failure; and (4) monitoring of VO2 during weaning from mechanical ventilation. (C)Elsevier Science Inc. 1997.
引用
收藏
页码:349 / 358
页数:10
相关论文
共 70 条
[1]   OXYGEN COST OF BREATHING AND DIAPHRAGMATIC PRESSURE-TIME INDEX - MEASUREMENT IN PATIENTS WITH COPD DURING WEANING WITH PRESSURE SUPPORT VENTILATION [J].
ANNAT, GJ ;
VIALE, JP ;
DEREYMEZ, CP ;
BOUFFARD, YM ;
DELAFOSSE, BX ;
MOTIN, JP .
CHEST, 1990, 98 (02) :411-414
[2]   COMPARISON OF NUTRITIONAL INDEXES AND OUTCOME IN CRITICALLY ILL PATIENTS [J].
APELGREN, KN ;
ROMBEAU, JL ;
TWOMEY, PL ;
MILLER, RA .
CRITICAL CARE MEDICINE, 1982, 10 (05) :305-307
[3]   RESPIRATORY CHANGES INDUCED BY THE LARGE GLUCOSE LOADS OF TOTAL PARENTERAL-NUTRITION [J].
ASKANAZI, J ;
ROSENBAUM, SH ;
HYMAN, AI ;
SILVERBERG, PA ;
MILICEMILI, J ;
KINNEY, JM .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1980, 243 (14) :1444-1447
[4]   ERRORS IN MEASUREMENT OF OXYGEN-UPTAKE DUE TO ANESTHETIC-GASES [J].
AUKBURG, SJ ;
GEER, RT ;
WOLLMAN, H ;
NEUFELD, GR .
ANESTHESIOLOGY, 1985, 62 (01) :54-59
[5]  
BARTLETT RH, 1982, SURGERY, V92, P771
[6]   METABOLIC AND NUTRITIONAL ASPECTS OF WEANING FROM MECHANICAL VENTILATION [J].
BENOTTI, PN ;
BISTRIAN, B .
CRITICAL CARE MEDICINE, 1989, 17 (02) :181-185
[7]  
BRACCO D, 1995, CHEST, V104, P1406
[8]   ENERGY-EXPENDITURE AND GAS-EXCHANGE MEASUREMENTS IN POSTOPERATIVE-PATIENTS - THERMODILUTION VERSUS INDIRECT CALORIMETRY [J].
BRANDI, LS ;
GRANA, M ;
MAZZANTI, T ;
GIUNTA, F ;
NATALI, A ;
FERRANNINI, E .
CRITICAL CARE MEDICINE, 1992, 20 (09) :1273-1283
[9]   INSULIN-RESISTANCE OF STRESS - SITES AND MECHANISMS [J].
BRANDI, LS ;
SANTORO, D ;
NATALI, A ;
ALTOMONTE, F ;
BALDI, S ;
FRASCERRA, S ;
FERRANNINI, E .
CLINICAL SCIENCE, 1993, 85 (05) :525-535
[10]   Energy metabolism of thoracic surgical patients in the early postoperative period - Effect of posture [J].
Brandi, LS ;
Bertolini, R ;
Janni, A ;
Gioia, A ;
Angeletti, CA .
CHEST, 1996, 109 (03) :630-637