Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716 RP, Ede, The Netherlands.
Department of Intensive Care Medicine, Diakonessenhuis Utrecht, Bosboomstraat 1, 3582 KE, Utrecht, The Netherlands.
Crit Care. 2020 Feb 3;24(1):32. doi: 10.1186/s13054-020-2744-7.
Both overfeeding and underfeeding of intensive care unit (ICU) patients are associated with worse outcomes. A reliable estimation of the energy expenditure (EE) of ICU patients may help to avoid these phenomena. Several factors that influence EE have been studied previously. However, the effect of neuromuscular blocking agents on EE, which conceptually would lower EE, has not been extensively investigated.
We studied a cohort of adult critically ill patients requiring invasive mechanical ventilation and treatment with continuous infusion of cisatracurium for at least 12 h. The study aimed to quantify the effect of cisatracurium infusion on EE (primary endpoint). EE was estimated based on ventilator-derived VCO (EE in kcal/day = VCO × 8.19). A subgroup analysis of septic and non-septic patients was performed. Furthermore, the effects of body temperature and sepsis on EE were evaluated. A secondary endpoint was hypercaloric feeding (> 110% of EE) after cisatracurium infusion.
In total, 122 patients were included. Mean EE before cisatracurium infusion was 1974 kcal/day and 1888 kcal/day after cisatracurium infusion. Multivariable analysis showed a significantly lower EE after cisatracurium infusion (MD - 132.0 kcal (95% CI - 212.0 to - 52.0; p = 0.001) in all patients. This difference was statistically significant in both sepsis and non-sepsis patients (p = 0.036 and p = 0.011). Non-sepsis patients had lower EE than sepsis patients (MD - 120.6 kcal; 95% CI - 200.5 to - 40.8, p = 0.003). Body temperature and EE were positively correlated (Spearman's rho = 0.486, p < 0.001). Hypercaloric feeding was observed in 7 patients.
Our data suggest that continuous infusion of cisatracurium in mechanically ventilated ICU patients is associated with a significant reduction in EE, although the magnitude of the effect is small. Sepsis and higher body temperature are associated with increased EE. Cisatracurium infusion is associated with overfeeding in only a minority of patients and therefore, in most patients, no reductions in caloric prescription are necessary.
重症监护病房（ICU）患者过度喂养和喂养不足均与不良结局相关。对 ICU 患者能量消耗（EE）进行可靠估计可能有助于避免这些现象。之前已经研究了许多影响 EE 的因素。然而，概念上会降低 EE 的神经肌肉阻滞剂对 EE 的影响尚未得到广泛研究。
我们研究了一组需要机械通气且至少接受 12 小时顺阿曲库铵持续输注治疗的成年危重症患者。该研究旨在量化顺阿曲库铵输注对 EE（主要终点）的影响。根据呼吸机衍生的 VCO（EE 以千卡/天表示=VCO×8.19）估算 EE。对脓毒症和非脓毒症患者进行了亚组分析。此外，还评估了体温和脓毒症对 EE 的影响。次要终点是顺阿曲库铵输注后给予高营养喂养（>110%的 EE）。
共纳入 122 例患者。顺阿曲库铵输注前的平均 EE 为 1974 千卡/天，输注后的 EE 为 1888 千卡/天。多变量分析显示，顺阿曲库铵输注后 EE 显著降低（MD-132.0 千卡（95%CI-212.0 至-52.0；p=0.001）。在所有患者、脓毒症和非脓毒症患者中，这种差异均具有统计学意义（p=0.036 和 p=0.011）。非脓毒症患者的 EE 低于脓毒症患者（MD-120.6 千卡；95%CI-200.5 至-40.8，p=0.003）。体温和 EE 呈正相关（Spearman 相关系数=0.486，p<0.001）。有 7 例患者接受了高营养喂养。
我们的数据表明，在机械通气的 ICU 患者中持续输注顺阿曲库铵与 EE 显著降低相关，尽管影响的幅度较小。脓毒症和较高的体温与 EE 增加相关。只有少数患者在顺阿曲库铵输注后出现过度喂养，因此，在大多数患者中，无需减少热量处方。
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