Castañón-González JA, Satué-Rodríguez J, Camacho-Juárez JS, Carrillo-Rosales F, León-Gutiérrez MA, Miranda-Ruiz R

Language: Spanish
References: 17
Page: 583-588
PDF size: 462.77 Kb.

ABSTRACT

Objective: To identify variations during measurements of resting energy expenditure (REE), oxygen consumption (VO₂) and CO₂ production (VCO₂) by indirect calorimetry (IC) in patients with pressure-controlled ventilation and different levels of positive end expiratory pressure (PEEP).
Design: Prospective and comparative study.
Setting: Intensive care unit (ICU) of a university-affiliated hospital.
Measurements and Main Results: REE, VO2, and VCO2 were measured by IC in nine patients with pressure- controlled ventilation and different levels of PEEP. Paired t Wilcoxon and coeficient of variation tests for all measurements were carried out. Decrease in REE, VCO₂, and VO₂ was observed with increments in PEEP, these changes related with a concomitant reduction in VE. Coefficient of variation during IC was above 6%, and was lower in three patients who maintained the same VE throughout the study.
Conclusions: Measurement of REE by IC is reliable at various levels of PEEP, and it improves if VE remains constant throughout measurement. Respiratory quotient (RQ) in this setting is not accurate.

REFERENCES

1. Giner M, Laviano A, Mequid M, Gleason JR. In 1995 a correlation between malnutrition and poor outcome in critically ill patients still exists. Nutrition 1996;12:23-29.

2. Gallagher-Allred CR, Voss AC, Finn SC, McCamish. Malnutrition and clinical outcomes: the case for medical nutrition therapy. J Am Diet Assoc 1996;96:361-366.

3. Christman JW, Lancaster LH, Blackwell TS. Nuclear factor kB: a pivotal role in the systemic inflammatory response syndrome and new target for therapy. Intens Care Med 1998;24:1131-1138.

4. Takala J, Keinanen O, Vaisanen P, Kari A. Measurement of gas exchange in intensive care: laboratory and clinical validation of a new device. Crit Care Med 1989;17:1041-1047.

5. Ronco JJ, Phang TP. Validation of an indirect calorimeter to measure oxygen consumption in critical ill patients. J Crit Care 1991;6:36-41.

6. Tissot S, Delafose B, Bertrand O, et al. Clinical validation of Deltatrac monitoring system in mechanically ventilated patients. Intens Care Med 1995;21:149-153.

7. Phang P, Rich T, Ronco J. A validation and comparison study of two metabolic monitors. J Parenter Enter Nutr 1990;14:259-261.

8. Makita, Nunn J, Royston B. Evaluation of metabolic measuring instruments for use in critically ill patients. Crit Care Med 1990;18:638-644.

9. Westenskow D, Cutler C, Wallace W. Instrumentation for monitoring gas exchange and metabolic rate in critical ill patients. Crit Care Med 1984;12:183-187.

10. Eccles R, Swinamer D, Jones R, King E. Validation of a compact system for measuring gas exchange. Crit Care Med 1986;64:807-811.

11. Damask M, Weisman C, Askanazi J, et al. A systematic method for validation of gas exchange measurements, Anesthesiology 1982;57;213-218.

12. Braun U, Zundel J, Freiboth K, et al. Evaluation of methods for indirect calorimetry with a ventilated lung model. Intens Care Med 1989;15:196-202.

13. Smithies M, Roynston K, Makita K, et al. Comparison of oxygen consumption measurements: indirect calorimetry vs the reversed Fick method. Crit Care Med 1991;19:1401-1406.

14. Nunn, Makita K, Royston B. Validation of oxygen consumption measurements during artificial ventilation. J Appl Physiol 1989;67:2129.

15. Svensson K, Sonander H, Stenqvist O. Validation of a system for measurement of metabolic gas exchange during anesthesia with controlled ventilation in an oxygen consuming lung model. Br J Anesth 1990;64:311-19.

16. Nelson L, Anderson H, García H. Clinical validation of a new metabolic minotr suitable for use in critically ill patients. Crit Care Med 1987;15:951957.

17. Feenstra B, Holland W, van Lanschot J, Bruining H. Design and validation of an automatic metabolic monitor. Intens Care Med 1985;11:9599.