Pérez-Cruz E, Meléndez-Mier G, Castillo-García N

Language: Spanish
References: 16
Page: 345-351
PDF size: 82.06 Kb.

ABSTRACT

Objective: The A H1N1 influenza has caused several pandemics, the last in 2009. The aim of this study was to evaluate the metabolic behavior and suggest a suitable protein in critically ill patients infected for A H1N1 influenza virus.
Methods and patients: Prospective, longitudinal and descriptive study which included patients with atypical pneumonia virus AH1N1 influenza admitted to the Intensive Care Unit for Adults in may 2009 to February 2010. Demographic variables were obtained, Quetelet index (QI), nutritional risk index (NRI) and Subjective Global Assessment (SGA) were measured. We calculated energy and protein requirements initially by Harris-Benedict equation. Nitrogen balance and urinary nitrogen losses (UN) were determined in urine for 24 h. The injury was evaluated with APACHE II and SOFA.
Results: A total de 29 patients (52% female and 48% male). The mean age was 37 ± 7,5 years, APACHE II on admission 33,1 ± 3,6 and SOFA 12,1 ± 0,94. The mean QI was 29,1 ± 4,7 and NRI 80,9 ± 4,7. The percentage of average normal weight patients was 95,7 ± 2,3. The calculated nutritional requirements were 25 Kcal/Kg per day. Nitrogen losses were at admission, 72 hours and at discharge from intensive care 16 g, 28,6 and 22,2 g respectively. The protein requirements in the catabolism phase were 2,3 g protein/kg/day.
Conclusion: Patients with influenza A H1N1 have high levels or urinary nitrogen excretion, so the estimate of protein requirements must be higher.

REFERENCES

1. Fischer J. Metabolic and Inflammatory Responses to Trauma and Infeccion. En: Fisher J, editor. Mastery in Surgery. Fifth ed: Lippincott; 2006.

2. Goldstein SA, Elwyn DH. The effects of injury and sepsis on fuel utilization. Annu Rev Nutr 1989;9:445-473.

3. Salud. Sd. Situación Actual de la Epidemia. Secretaria de Salud; 2011. Disponible en: http://portal.salud.gob.mx/sites/salud/descargas/pdf/influenza/situacion_actual_epidemia_310510.pdf.

4. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. APACHE II: a severity of disease classification system. Crit Care Med 1985;13(10):818-829.

5. Ferreira FL, Bota DP, Bross A, Melot C, Vincent JL. Serial evaluation of the SOFA score to predict outcome in critically ill patients. JAMA 2001;286(14):1754-1758.

6. Quetelet A, editor. Physique Sociale ou essai sur le developpement des facultés de l'homme. Premier ed. Brussels: Academie Royale de Belgique; 1869.

7. Keys A, Fidanza F, Karvonen MJ, Kimura N, Taylor HL. Indices of relative weight and obesity. J Chronic Dis 1972;25(6):329-343.

8. Buzby GP, Mullen JL, Matthews DC, Hobbs CL, Rosato EF. Prognostic nutritional index in gastrointestinal surgery. Am J Surg 1980;139(1):160-167.

9. Detsky AS, McLaughlin JR, Baker JP, Johnston N, Whittaker S, Mendelson RA, et al. What is subjective global assessment of nutritional status? JPEN J Parenter Enteral Nutr 1987;11(1):8-13.

10. Uaui R. Diet, nutrition and the prevention of chronic diseases. Geneva: World Health organization 2003.

11. Murray MW, DW. Nutrition support in the criticalli ill patient. In: Murray M, editor. Critical care medicine: perioperative management. First ed. Philadelphia: Lippincott Williams & Wilkins; 2002. p. 177-181.

12. Harris JB, FG, editor. A biometric study of basal metabolism in man. First ed. Washington DC: Carnegie Institution of Washington D.C.; 1919.

13. Long CL, Birkhahn RH, Geiger JW, Blakemore WS. Contribution of skeletal muscle protein in elevated rates of whole body protein catabolism in trauma patients. Am J Clin Nutr 1981;34(6):1087-1093.

14. Jeffery N. Taubenberger and Morens D. The Pathology of Influenza Virus Infections. Annu Rev Pathol 2008;3:499-522.

15. Barnard DL. Animmals models for the study of influenza pathogenesis anb therapy. Antiviral Res 2009;82(2):110-122.

16. James WP. Protein synthesis and breakdown and amino acid catabolism in protein-calorie malnutrition. Proc Nutr Soc 1972;31:225.