Long-term measurements of energy expenditure in severe burn injury.pdf

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Long-term measurements of energy expenditure in severe burn injury.pdf

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Long-term measurements of energy expenditure in severe burn injury

World J. Surg. 23, 115–122, 1999 WORLD Journal of SURGERY ? 1999 by the Socie?te? Internationale de Chirurgie Long-term Measurements of Energy Expenditure in Severe Burn Injury Ramin Khorram-Sefat, M.D.,1,2 Walter Behrendt, M.D.,2 Astrid Heiden, Ph.D.,3 Rolf Hettich, M.D.1 1Department of Burns and Plastic Surgery, University of Technology Aachen, Pauwelsstrasse, D-52057 Aachen, Germany 2Department of Anesthesiology, University of Technology Aachen, Pauwelsstrasse, D-52057 Aachen, Germany 3Institute of Statistics, University of Technology Aachen, Pauwelsstrasse, D-52057 Aachen, Germany Abstract. The objective of this study was to evaluate resting energy expenditure (REE) in spontaneously breathing and artificially ventilated burn patients during the entire intensive care period. In 27 patients with 51 6 20% body surface area burned (BSAB) the REE was determined via indirect calorimetry. Three groups were formed according to the mortality prognosis index of Zawacki et al. In groups A, B, and C the predicted mortality rates were 20%, 20% to 80%, and 80%, respectively. The frequency of acute respiratory distress syndrome (ARDS), sepsis, renal failure, and mortality increased from group A toward group C. The REE test revealed wide individual variation and was usually overestimated by all tested formulas. The mean REE was comparable in groups A, B, and C during the first 20 days (49 6 16% vs. 59 6 21% vs. 57 6 18% above the REE calculated by the Harris-Benedict equation, or HBEE). The REE of patients in groups A and B declined after this period, whereas the long-term ventilated patients in the prognostically unfavorable group C showed a high REE up to the 45th day, usually accompanied by severe organ dysfunction and major metabolic disorders. During this time a nutritional regimen meeting the actual REE could not be achieved. In the clinical situation when indirect calorimetry is not available, REE can be stated to be 50% to 60% above HBEE in patients with 20% BSAB for at