压力支持通气的重症监护病房患者实测与计算的能量消耗对比

Measured versus calculated energy expenditure in pressure support ventilated ICU patients.

作者信息

Casati A, Colombo S, Leggieri C, Muttini S, Capocasa T, Gallioli G

机构信息

IRCCS H San Raffaele, University of Milan, Department of Anesthesia and Intensive Care.

出版信息

Minerva Anestesiol. 1996 May;62(5):165-70.

PMID:8937040

Abstract

OBJECTIVE

To evaluate the usefulness of the modified Harris-Benedict formula predicting Energy Expenditure (EE) in pressure support ventilated, critically ill patient.

SETTING

The intensive care unit (ICU) of a teaching hospital.

PATIENTS

Fiftyfive patients admitted to ICU for acute respiratory failure, requiring mechanical ventilation.

MEASUREMENTS AND RESULTS

After 12 hours at rest, EE was measured using indirect calorimetry (Datex-Deltatrac, with method exclusions - ICEE), and calculated using modified Harris-Benedict formula (MHBEE) (with correction for "hospital activity" and "stress factor") to calculate the bias between calculated and measured EE. Patients were divided into three groups on the basis of nutritional stress: A) non surgical/non septic patients (n = 10), B) complicated surgical patients (n = 21), C) severe infectious/multiple trauma patients (n = 24). In each group, a good correlation between calculated and measured EE was found [A) r = 0.809, p = 0.0046; B) r = 0.753 p = 0.0001; C) r = 0.711, p = 0.0001]. The bias (+/- SEM) was: A 175.1 (+/- 82) kcal/day, B 324.5 (+/- 64.5) kcal/day, C 366.7 (+/- 62.9) kcal/day. The mean difference value seems to be increased in the more stressed patients but these differences did not reach statistical significance (p = 0.23). A single correction factor for the original Harris-Benedict formula (OHBEE) was also calculated (ICEE/OHBEE) on each studied group: A) 1.20 (+/- 0.04), B) 1.28 (+/- 0.03), C) 1.50 (+/- 0.04) (p = 0.0001).

CONCLUSIONS

The use of both "stress" and "activity" correction factors seems to be excessive in pressure support ventilated ICU patients. A single correction factor, proportional to the intensity of the illness, should be used in mechanically ventilated patients. Compared to the original Harris-Benedict formula, we found an EE increment of about 20%, 30%, and 50% respectively in non-septic/non-complicated, surgical complicated, and multiple trauma/septic patients.

摘要

目的

评估改良的哈里斯- Benedict公式预测压力支持通气的危重症患者能量消耗（EE）的有效性。

设置

一家教学医院的重症监护病房（ICU）。

患者

55例因急性呼吸衰竭入住ICU并需要机械通气的患者。

测量与结果

休息12小时后，使用间接测热法（Datex-Deltatrac，排除ICEE方法）测量EE，并使用改良的哈里斯- Benedict公式（MHBEE）（校正“医院活动”和“应激因素”）计算EE，以计算计算值与测量值之间的偏差。根据营养应激情况将患者分为三组：A）非手术/非脓毒症患者（n = 10），B）复杂手术患者（n = 21），C）严重感染/多发创伤患者（n = 24）。在每组中，计算值与测量值之间均发现良好的相关性[A）r = 0.809，p = 0.0046；B）r = 0.753，p = 0.0001；C）r = 0.711，p = 0.0001]。偏差（±SEM）为：A组175.1（±82）kcal/天，B组324.5（±64.5）kcal/天，C组366.7（±62.9）kcal/天。应激程度较高的患者平均差值似乎有所增加，但这些差异未达到统计学意义（p = 0.23）。还对每个研究组计算了原始哈里斯- Benedict公式（OHBEE）的单一校正因子（ICEE/OHBEE）：A）1.20（±0.04），B）1.28（±0.03），C）1.50（±0.04）（p = 0.0001）。