宾夕法尼亚州立大学方程与间接测热法在创伤性脑损伤患者营养评估中的比较。
Penn State equation versus indirect calorimetry for nutritional assessment in patients with traumatic brain injury.
机构信息
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi).
From the Faculty of Medicine, McGill University, Montréal, Que. (Wu, Iqbal, Razek, Deckelbaum, Grushka, McKendy, Wong, Marcoux, Khwaja); the Division of Nephrology, McGill University Health Centre, Montréal, Que. (Iqbal); the Department of Respiratory Therapy, McGill University Health Centre, Montréal, Que. (Giroux); the Department of Critical Care Medicine, McGill University Health Centre, Montréal, Que. (Alam, Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Division of General and Trauma Surgery, McGill University Health Centre, Montréal, Que. (Razek, Deckelbaum, Grushka, McKendy, Wong, Khwaja); the Department of Neurology and Neurosurgery, McGill University Health Centre, Montréal, Que. (Marcoux); and the Research Institute, McGill University Health Centre, Montréal, Que. (Campisi)
出版信息
Can J Surg. 2022 May 11;65(3):E320-E325. doi: 10.1503/cjs.022420. Print 2022 May-Jun.
BACKGROUND
Nutritional assessment can be challenging in patients with traumatic brain injury (TBI), and indirect calorimetry may be a more suitable method than predictive equations. We compared the Penn State equation versus the gold standard of indirect calorimetry for the nutritional assessment of patients with TBI, and quantified the difference between nutritional requirements and actual patient intake.
METHODS
This single-centre, prospective cohort study included patients with moderate (Glasgow Coma Scale score 9-12) and severe (Glasgow Coma Scale score 3-8) TBI admitted to the Montreal General Hospital intensive care unit (ICU) between June 2018 and March 2019. Penn State equation estimates and indirect calorimetry measurements were collected, and actual intake was drawn from medical records. We compared the 2 assessment methods using a Spearman correlation coefficient.
RESULTS
Twenty-three patients with TBI (moderate in 7 and severe in 16) were included in the study. Overall, there was a moderate positive correlation between the Penn State equation estimate and indirect calorimetry readings (correlation coefficient 0.457, = 0.03); however, the correlation was weaker in severe TBI (correlation coefficient 0.174, = 0.5) than in moderate TBI (correlation coefficient 0.929, = 0.003). When compared to indirect calorimetry assessment, patients received 5.4% ( = 0.5) of required intake on the first day and 43.9% ( = 0.8) of required daily intake throughout their ICU stay.
CONCLUSION
Patients with moderate or severe TBI in the ICU received less than 50% of their nutritional requirements. The difference between the Penn State equation and indirect calorimetry assessments was most noticeable for patients with severe TBI, which indicates that indirect calorimetry may be a more suitable tool for assessment of nutritional needs in this population.
背景
创伤性脑损伤（TBI）患者的营养评估可能具有挑战性，间接热量测定法可能比预测方程更合适。我们比较了宾夕法尼亚州立大学方程与间接热量测定法的金标准，以评估 TBI 患者的营养状况，并量化了营养需求与实际患者摄入量之间的差异。
方法
这项单中心前瞻性队列研究纳入了 2018 年 6 月至 2019 年 3 月期间入住蒙特利尔综合医院重症监护病房（ICU）的中度（格拉斯哥昏迷量表评分为 9-12）和重度（格拉斯哥昏迷量表评分为 3-8）TBI 患者。收集了宾夕法尼亚州立大学方程估计值和间接热量测定值，并从病历中提取了实际摄入量。我们使用斯皮尔曼相关系数比较了这两种评估方法。
结果
研究纳入了 23 例 TBI 患者（7 例为中度，16 例为重度）。总体而言，宾夕法尼亚州立大学方程估计值与间接热量测定读数之间存在中度正相关（相关系数 0.457， = 0.03）；然而，在重度 TBI 中相关性较弱（相关系数 0.174， = 0.5），而在中度 TBI 中相关性较强（相关系数 0.929， = 0.003）。与间接热量测定评估相比，患者在 ICU 期间的第一天接受了所需摄入量的 5.4%（ = 0.5），在整个 ICU 期间接受了 43.9%（ = 0.8）的所需每日摄入量。
结论
入住 ICU 的中度或重度 TBI 患者的营养需求不足 50%。宾夕法尼亚州立大学方程与间接热量测定评估之间的差异在重度 TBI 患者中最为明显，这表明间接热量测定法可能是评估该人群营养需求的更合适工具。
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