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Citation
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Byerly S, Vasileiou G, Qian S, Mantero A, Lee E, Parks J, Mulder M, Pust DG, Rattan R, Lineen E, Byers P, Namias N, Yeh DD. JPEN J. Parenter. Enteral. Nutr. 2020; ePub(ePub): ePub. |
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Abstract
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BACKGROUND: Classic experiments demonstrating hypermetabolism after major trauma were performed in a different era of critical care. We aim to describe the modern post-traumatic metabolic response in trauma intensive care unit (TICU).
MATERIALS & METHODS: This prospective, observational study (03/18-02/19) enrolled mechanically-ventilated adults(age≥18) in the TICU. Multiple daily resting energy expenditure (REE) measurements were recorded. Basal energy expenditure (BEE) was calculated by the Harris-Benedict equation. Hypometabolism was defined as average daily REE<0.85*BEE and hypermetabolism defined as average daily REE>1.15*BEE. Demographics, interventions, and clinical outcomes were abstracted. Descriptive statistics and multivariable logistical regression models evaluating demographics with the outcome variable of hypermetabolism for the first three days ("sustained hypermetabolism") were performed along with group-based trajectory modeling (GBTM).
RESULTS: Fifty-five patients were analyzed: median age was 38[28-56] years, 38(69%) were male, BMI was 28[26-32]kg/m2 , and Injury Severity Score was 27[19-34] with [38(71%) blunt, 8(15%)penetrating, 7(13%) burn] injury mechanism. Overall, 19(35%) had hypermetabolism on day 1 ("immediate hypermetabolism") and 11 (21%) had sustained hypermetabolism for the first 3 days. Logistic regression analysis identified penetrating mechanism (AOR:16.4, 95%CI:1.9-199.6, p =.015), burn mechanism (AOR:11.1, 95%CI:1.3-116.8, p =.029), and maximum temperature (AOR:4.2, 95%CI:1.3∼ 20.3, p =.041) as independent predictors of sustained hypermetabolism. GBTM identified four nutritional phenotypes with two hyperconsumptive phenotypes associated with increased risk of malnutrition at discharge.
CONCLUSION: Only a minority of injured patients is hypermetabolic in the first week after injury. Elevated temperature, penetrating mechanism, and burn mechanism are independently associated with sustained hypermetabolism. Hyperconsumptive phenotype patients are more likely to develop malnutrition during hospitalization. This article is protected by copyright. All rights reserved.
Language: en |