Yu Pey-Jen, Cassiere Hugh, Bocchieri Karl, DeRosa Sarah, Yar Shiraz, Hartman Alan
Division of Cardiovascular and Thoracic Surgery, North Shore University Hospital, Northwell Health, 300 Community Drive, 1DSU, Manhasset, NY, 11030, USA.
Metabol Open. 2020 Jul 26;7:100046. doi: 10.1016/j.metop.2020.100046. eCollection 2020 Sep.
We have observed that critically ill patients with COVID-19 are in an extreme hypermetabolic state. This may be a major contributing factor to the extraordinary ventilatory and oxygenation demands seen in these patients. We aimed to quantify the extent of the hypermetabolic state and report the clinical effect of the use of hypothermia to decrease the metabolic demand in these patients.
Mild hypothermia was applied on four critically ill patients with COVID-19 for 48 h. Metabolic rates, carbon dioxide production and oxygen consumption were measured by indirect calorimetry.
The average resting energy expenditure (REE) was 299% of predicted. Mild hypothermia decreased the REE on average of 27.0% with resultant declines in CO production (VCO) and oxygen consumption (VO) by 29.2% and 25.7%, respectively. This decrease in VCO and VO was clinically manifested as improvements in hypercapnia (average of 19.1% decrease in pCO levels) and oxygenation (average of 50.4% increase in pO).
Our case series demonstrates the extent of hypermetabolism in COVID-19 critical illness and suggests that mild hypothermia reduces the metabolic rate, improves hypercapnia and hypoxia in critically ill patients with COVID-19.
我们观察到，新型冠状病毒肺炎（COVID-19）危重症患者处于极度高代谢状态。这可能是这些患者出现异常通气和氧合需求的主要促成因素。我们旨在量化高代谢状态的程度，并报告使用低温疗法降低这些患者代谢需求的临床效果。
对4例COVID-19危重症患者实施轻度低温治疗48小时。通过间接测热法测量代谢率、二氧化碳产生量和耗氧量。
平均静息能量消耗（REE）为预测值的299%。轻度低温使REE平均降低27.0%，二氧化碳产生量（VCO）和耗氧量（VO）分别下降29.2%和25.7%。VCO和VO的这种降低在临床上表现为高碳酸血症改善（pCO水平平均降低19.1%）和氧合改善（pO平均升高50.4%）。
我们的病例系列证明了COVID-19危重症患者的高代谢程度，并表明轻度低温可降低COVID-19危重症患者的代谢率，改善高碳酸血症和低氧血症。
