Paediatric Intensive Care Unit, The Royal Brompton Hospital, London, UK.
Pediatr Crit Care Med. 2010 Jul;11(4):496-501. doi: 10.1097/PCC.0b013e3181ce7465.
To determine pre- and postoperative predictors of energy expenditure in children with congenital heart disease requiring open heart surgery; and to compare measured resting energy expenditure with current predictive equations.
Prospective resting energy expenditure data were collected, using indirect calorimetry, for ventilated children admitted consecutively to the pediatric intensive care unit after surgery for congenital heart disease. A 30-min steady-state measurement was performed in suitable patients. Resting energy expenditure was compared to pre- and postoperative clinical variables, and to predicted energy expenditure, using currently used predictive equations.
Pediatric intensive care unit at the Royal Brompton Hospital, London.
Children ventilated in the pediatric intensive care unit post surgery for congenital heart disease.
Measurement of energy expenditure by indirect calorimetry.
Twenty-one mechanically ventilated children (n = 17 boys, 4 girls) were enrolled in the study. Mean +/- sd measured resting energy expenditure was 67.8 +/- 15.4 kcal/kg/day. Most children had inadequate delivery of nutrients compared with actual requirements. Cardiopulmonary bypass had a significant influence on energy expenditure after surgery; in patients who underwent cardiopulmonary bypass during surgery, mean resting energy expenditure was 73.6 +/- 14.45 kcal/kg/day vs. 58.3 +/- 10.29 kcal/kg/day in patients undergoing nonbypass surgery. Children who were malnourished preoperatively had greater resting energy expenditure postoperatively. There was also a significant difference between measured energy expenditure and the Schofield (p = .006), World Health Organization (p = .002), and pediatric intensive care unit-specific formula (p < .0001). However, energy expenditure or a relative energy deficit in the early postoperative period was not associated with severity or duration of organ dysfunction.
Poor nutritional status preoperatively and cardiopulmonary bypass were associated with a greater energy expenditure post cardiac surgery. None of the current predictive equations predicted energy requirements within acceptable clinical accuracy.
确定需要接受心脏直视手术的先天性心脏病儿童的术前和术后能量消耗预测指标；并比较测量的静息能量消耗与当前的预测方程。
使用间接热量测定法连续收集接受先天性心脏病手术后入住儿科重症监护病房的通气儿童的静息能量消耗数据。在合适的患者中进行 30 分钟的稳态测量。将静息能量消耗与术前和术后临床变量以及使用当前使用的预测方程预测的能量消耗进行比较。
伦敦皇家布朗普顿医院儿科重症监护病房。
接受先天性心脏病手术后在儿科重症监护病房通气的儿童。
间接热量测定法测量能量消耗。
研究共纳入 21 例机械通气患儿（17 例男孩，4 例女孩）。平均+/-标准差测量的静息能量消耗为 67.8+/-15.4 kcal/kg/天。大多数儿童的营养供应不足，无法满足实际需求。体外循环对手术后的能量消耗有显著影响；在手术中进行体外循环的患者中，静息能量消耗为 73.6+/-14.45 kcal/kg/天，而在非体外循环手术患者中为 58.3+/-10.29 kcal/kg/天。术前营养不良的儿童术后静息能量消耗更高。测量的能量消耗与 Schofield（p =.006）、世界卫生组织（p =.002）和儿科重症监护病房特定公式（p <.0001）之间也存在显著差异。然而，术后早期的能量消耗或相对能量不足与器官功能障碍的严重程度或持续时间无关。
术前营养状况差和体外循环与心脏手术后能量消耗增加有关。目前的预测方程都不能在可接受的临床精度范围内预测能量需求。
