1
|
Jakobsson J, Norén C, Hagel E, Backheden M, Kalman S, Bartha E. Perioperative estimations of oxygen consumption from LiDCO™plus-derived cardiac output and Ca-cvO2 difference: Relationship with measurements by indirect calorimetry in elderly patients undergoing major abdominal surgery. PLoS One 2024; 19:e0272239. [PMID: 39052563 PMCID: PMC11271938 DOI: 10.1371/journal.pone.0272239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 06/10/2024] [Indexed: 07/27/2024] Open
Abstract
BACKGROUND Feasible estimations of perioperative changes in oxygen consumption (VO2) could enable larger studies of its role in postoperative outcomes. Current methods, either by reverse Fick calculations using pulmonary artery catheterisation or metabolic by breathing gas analysis, are often deemed too invasive or technically requiring. In addition, reverse Fick calculations report generally lower values of oxygen consumption. METHODS We investigated the relationship between perioperative estimations of VO2 (EVO2), from LiDCO™plus-derived (LiDCO Ltd, Cambridge, UK) cardiac output and arterial-central venous oxygen content difference (Ca-cvO2), with indirect calorimetry (GVO2) by QuarkRMR (COSMED srl. Italy), using data collected 2017-2018 during a prospective observational study on perioperative oxygen transport in 20 patients >65 years during epidural and general anaesthesia for open pancreatic or liver resection surgery. Eighty-five simultaneous intra- and postoperative measurements at different perioperative stages were analysed for prediction, parallelity and by traditional agreement assessment. RESULTS Unadjusted bias between GVO2 and EVO2 indexed for body surface area was 26 (95% CI 20 to 32) with limits of agreement (1.96SD) of -32 to 85 ml min-1m-2. Correlation adjusted for the bias was moderate, intraclass coefficient(A,1) 0.51(95% CI 0.34 to 0.65) [F (84,84) = 3.07, P<0.001]. There was an overall association between GVO2 and EVO2, in a random coefficient model [GVO2 = 73(95% CI 62 to 83) + 0.45(95% CI 0.29 to 0.61) EVO2 ml min-1m-2, P<0.0001]. GVO2 and EVO2 changed in parallel intra- and postoperatively when normalised to their respective overall means. CONCLUSION Based on this data, estimations from LiDCO™plus-derived cardiac output and Ca-cvO2 are not reliable as a surrogate for perioperative VO2. Results were in line with previous studies comparing Fick-based and metabolic measurements but limited by variability of data and possible underpowering. The parallelity at different perioperative stages and the prediction model can provide useful guidance and methodological tools for future studies on similar methods in larger samples.
Collapse
Affiliation(s)
- Julia Jakobsson
- Division of Anaesthesia and Intensive Care, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Carl Norén
- Department of Anaesthesia and Intensive Care, Nyköping County Hospital, Nyköping, Sweden
| | - Eva Hagel
- Department of Learning, Information, Management and Ethics (LIME), Medical Statistics Unit, Karolinska Institutet, Stockholm, Sweden
| | - Magnus Backheden
- Department of Learning, Information, Management and Ethics (LIME), Medical Statistics Unit, Karolinska Institutet, Stockholm, Sweden
| | - Sigridur Kalman
- Division of Anaesthesia and Intensive Care, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden
| | - Erzsébet Bartha
- Division of Anaesthesia and Intensive Care, Department of Clinical Science, Intervention and Technology (CLINTEC), Karolinska Institutet, Stockholm, Sweden
- Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital Huddinge, Stockholm, Sweden
| |
Collapse
|
2
|
Shinozaki K, Yu PJ, Zhou Q, Cassiere HA, John S, Rolston DM, Garg N, Li T, Johnson J, Saeki K, Goto T, Okuma Y, Miyara SJ, Hayashida K, Aoki T, Wong VK, Molmenti EP, Lampe JW, Becker LB. Low respiratory quotient correlates with high mortality in patients undergoing mechanical ventilation. Am J Emerg Med 2024; 78:182-187. [PMID: 38301368 DOI: 10.1016/j.ajem.2024.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Accepted: 01/06/2024] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE Oxygen consumption (VO2), carbon dioxide generation (VCO2), and respiratory quotient (RQ), which is the ratio of VO2 to VCO2, are critical indicators of human metabolism. To seek a link between the patient's metabolism and pathophysiology of critical illness, we investigated the correlation of these values with mortality in critical care patients. METHODS This was a prospective, observational study conducted at a suburban, quaternary care teaching hospital. Age 18 years or older healthy volunteers and patients who underwent mechanical ventilation were enrolled. A high-fidelity automation device, which accuracy is equivalent to the gold standard Douglas Bag technique, was used to measure VO2, VCO2, and RQ at a wide range of fraction of inspired oxygen (FIO2). RESULTS We included a total of 21 subjects including 8 post-cardiothoracic surgery patients, 7 intensive care patients, 3 patients from the emergency room, and 3 healthy volunteers. This study included 10 critical care patients, whose metabolic measurements were performed in the ER and ICU, and 6 died. VO2, VCO2, and RQ of survivors were 282 +/- 95 mL/min, 202 +/- 81 mL/min, and 0.70 +/- 0.10, and those of non-survivors were 240 +/- 87 mL/min, 140 +/- 66 mL/min, and 0.57 +/- 0.08 (p = 0.34, p = 0.10, and p < 0.01), respectively. The difference of RQ was statistically significant (p < 0.01) and it remained significant when the subjects with FIO2 < 0.5 were excluded (p < 0.05). CONCLUSIONS Low RQ correlated with high mortality, which may potentially indicate a decompensation of the oxygen metabolism in critically ill patients.
Collapse
Affiliation(s)
- Koichiro Shinozaki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States of America; Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States of America; Department of Emergency Medicine, Kindai University Faculty of Medicine, Osaka, Japan.
| | - Pey-Jen Yu
- Department of Cardiothoracic Surgery, North Shore University Hospital, Manhasset, NY, United States of America
| | - Qiuping Zhou
- Division of Critical Care Medicine of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, NY, United States of America
| | - Hugh A Cassiere
- Division of Critical Care Medicine, Department of Medicine, North Shore University Hospital, Manhasset, NY, United States of America
| | - Stanley John
- Department of Respiratory Therapy, Critical Care Serviceline, Northshore University Hospital, Manhasset, NY, United States of America
| | - Daniel M Rolston
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States of America; Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States of America
| | - Nidhi Garg
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States of America; Department of Emergency Medicine, South Shore University Hospital, Bay Shore, NY, United States of America
| | - Timmy Li
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States of America
| | - Jennifer Johnson
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States of America
| | - Kota Saeki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Nihon Kohden Innovation Center, Cambridge, MA, United States of America
| | | | - Yu Okuma
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Santiago J Miyara
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Department of Anesthesiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Kei Hayashida
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Tomoaki Aoki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Vanessa K Wong
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America
| | - Ernesto P Molmenti
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Department of Surgery, Medicine, and Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joshua W Lampe
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; ZOLL Medical, Chelmsford, MA, USA
| | - Lance B Becker
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, United States of America; Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, New York, NY, United States of America; Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, United States of America
| |
Collapse
|
3
|
Wang Y, Han C, Wang X. Advances in surgical treatment of hidradenitis suppurative. Zhejiang Da Xue Xue Bao Yi Xue Ban 2023; 52:795-801. [PMID: 37986703 PMCID: PMC10764190 DOI: 10.3724/zdxbyxb-2023-0326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Accepted: 10/16/2023] [Indexed: 11/22/2023]
Abstract
Hidradenitis suppurative is a chronic, refractory and recurrent dermatological disease. The disease should be managed by targeted surgical intervention on the basis of medical treatment. Currently, the surgical treatment methods include local treatments like incision and drainage, unroofing, laser therapy, intense pulsed light therapy, photodynamic therapy, as well as complete lesion resection such as skin-tissue saving excision with electrosurgical peeling and extended excision. The clearance range, therapeutic effect, postoperative complications, and recurrence risk vary among the different treatment methods. Local treatments cause less damage, but have high recurrence rates, and are mainly for mild to moderate hidradenitis suppurative patients. Complete lesion resections have relatively low recurrence rates, but may bring more surgical injuries, and postoperative reconstructions are needed, which are mainly for moderate to severe hidradenitis suppurative patients. In this article, the surgical treatment principles and various surgical treatment methods of hidradenitis suppurative are reviewed, to provide a reference for the diagnosis and treatment of this disease in clinical practice.
Collapse
Affiliation(s)
- Yiran Wang
- Department of Burns & Wound Care, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
| | - Chunmao Han
- Department of Burns & Wound Care, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China
| | - Xingang Wang
- Department of Burns & Wound Care, the Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou 310009, China.
| |
Collapse
|
4
|
Shinozaki K, Yu PJ, Zhou Q, Cassiere HA, John S, Rolston DM, Garg N, Li T, Johnson J, Saeki K, Goto T, Okuma Y, Miyara SJ, Hayashida K, Aoki T, Wong VK, Molmenti EP, Lampe JW, Becker LB. Continuous and repeat metabolic measurements compared between post-cardiothoracic surgery and critical care patients. BMC Pulm Med 2023; 23:390. [PMID: 37840131 PMCID: PMC10577926 DOI: 10.1186/s12890-023-02657-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Accepted: 09/13/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVE Using a system, which accuracy is equivalent to the gold standard Douglas Bag (DB) technique for measuring oxygen consumption (VO2), carbon dioxide generation (VCO2), and respiratory quotient (RQ), we aimed to continuously measure these metabolic indicators and compare the values between post-cardiothoracic surgery and critical care patients. METHODS This was a prospective, observational study conducted at a suburban, quaternary care teaching hospital. Age 18 years or older patients who underwent mechanical ventilation were enrolled. RESULTS We included 4 post-surgery and 6 critical care patients. Of those, 3 critical care patients died. The longest measurement reached to 12 h and 15 min and 50 cycles of repeat measurements were performed. VO2 of the post-surgery patients were 234 ± 14, 262 ± 27, 212 ± 16, and 192 ± 20 mL/min, and those of critical care patients were 122 ± 20, 189 ± 9, 191 ± 7, 191 ± 24, 212 ± 12, and 135 ± 21 mL/min, respectively. The value of VO2 was more variable in the post-surgery patients and the range of each patient was 44, 126, 71, and 67, respectively. SOFA scores were higher in non-survivors and there were negative correlations of RQ with SOFA. CONCLUSIONS We developed an accurate system that enables continuous and repeat measurements of VO2, VCO2, and RQ. Critical care patients may have less activity in metabolism represented by less variable values of VO2 and VCO2 over time as compared to those of post-cardiothoracic surgery patients. Additionally, an alteration of these values may mean a systemic distinction of the metabolism of critically ill patients.
Collapse
Affiliation(s)
- Koichiro Shinozaki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA.
- Department of Emergency Medicine, Kindai University Faculty of Medicine, Osaka-Sayama, Osaka, Japan.
| | - Pey-Jen Yu
- Department of Cardiothoracic Surgery, North Shore University Hospital, Manhasset, NY, USA
| | - Qiuping Zhou
- Division of Critical Care Medicine of Emergency Medicine, Long Island Jewish Medical Center, New Hyde Park, NY, USA
| | - Hugh A Cassiere
- Division of Critical Care Medicine, Department of Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - Stanley John
- Division of Critical Care Medicine, Department of Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - Daniel M Rolston
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - Nidhi Garg
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Emergency Medicine, South Shore University Hospital, Bay Shore, NY, USA
| | - Timmy Li
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Jennifer Johnson
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA
| | - Kota Saeki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Nihon Kohden Innovation Center, Cambridge, MA, USA
| | | | - Yu Okuma
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Santiago J Miyara
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Kei Hayashida
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Tomoaki Aoki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Vanessa K Wong
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Ernesto P Molmenti
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Surgery, Medicine, and Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Joshua W Lampe
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- ZOLL Medical, Chelmsford, MA, USA
| | - Lance B Becker
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Emergency Medicine, North Shore University Hospital, Manhasset, NY, USA
| |
Collapse
|
5
|
Messina A, Calabrò L, Pugliese L, Lulja A, Sopuch A, Rosalba D, Morenghi E, Hernandez G, Monnet X, Cecconi M. Fluid challenge in critically ill patients receiving haemodynamic monitoring: a systematic review and comparison of two decades. Crit Care 2022; 26:186. [PMID: 35729632 PMCID: PMC9210670 DOI: 10.1186/s13054-022-04056-3] [Citation(s) in RCA: 23] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/07/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Introduction
Fluid challenges are widely adopted in critically ill patients to reverse haemodynamic instability. We reviewed the literature to appraise fluid challenge characteristics in intensive care unit (ICU) patients receiving haemodynamic monitoring and considered two decades: 2000–2010 and 2011–2021.
Methods
We assessed research studies and collected data regarding study setting, patient population, fluid challenge characteristics, and monitoring. MEDLINE, Embase, and Cochrane search engines were used. A fluid challenge was defined as an infusion of a definite quantity of fluid (expressed as a volume in mL or ml/kg) in a fixed time (expressed in minutes), whose outcome was defined as a change in predefined haemodynamic variables above a predetermined threshold.
Results
We included 124 studies, 32 (25.8%) published in 2000–2010 and 92 (74.2%) in 2011–2021, overall enrolling 6,086 patients, who presented sepsis/septic shock in 50.6% of cases. The fluid challenge usually consisted of 500 mL (76.6%) of crystalloids (56.6%) infused with a rate of 25 mL/min. Fluid responsiveness was usually defined by a cardiac output/index (CO/CI) increase ≥ 15% (70.9%). The infusion time was quicker (15 min vs 30 min), and crystalloids were more frequent in the 2011–2021 compared to the 2000–2010 period.
Conclusions
In the literature, fluid challenges are usually performed by infusing 500 mL of crystalloids bolus in less than 20 min. A positive fluid challenge response, reported in 52% of ICU patients, is generally defined by a CO/CI increase ≥ 15%. Compared to the 2000–2010 decade, in 2011–2021 the infusion time of the fluid challenge was shorter, and crystalloids were more frequently used.
Collapse
|
6
|
Shinozaki K, Yu PJ, Zhou Q, Cassiere HA, Stanley J, Rolston DM, Garg N, Li T, Johnson J, Saeki K, Goto T, Okuma Y, Miyara SJ, Hayashida K, Aoki T, Wong V, Molmenti EP, Lampe JW, Becker LB. An Automation System Equivalent to the Douglas Bag Technique Enables Continuous and Repeat Metabolic Measurements in Patients Undergoing Mechanical Ventilation. Clin Ther 2022; 44:1471-1479. [DOI: 10.1016/j.clinthera.2022.09.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 09/05/2022] [Indexed: 11/27/2022]
|
7
|
Cordoza M, Chan LN, Bridges E, Thompson H. Methods for Estimating Energy Expenditure in Critically Ill Adults. AACN Adv Crit Care 2021; 31:254-264. [PMID: 32866253 DOI: 10.4037/aacnacc2020110] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
Energy expenditure (EE) is the sum of metabolic activity within the body at a given time and comprises basal EE, diet-induced thermogenesis, and physical activity. In the intensive care unit, EE is most often assessed to determine a patient's caloric requirements. Energy expenditure also may be useful to understand disease states and the metabolic impact of interventions. Several methods for estimating EE are relevant for clinical use, including indirect calorimetry, predictive equations, exhaled carbon dioxide volume, and the Fick method. Indirect calorimetry is the preferred method for evaluating EE and is considered the gold standard for estimating EE in hospitalized patients. However, use of indirect calorimetry is not always practical or possible. Therefore, other methods of estimating EE must be considered. In this review, methods of evaluating EE in critically ill adults are examined and the benefits and limitations of each method are discussed, with practical considerations for use.
Collapse
Affiliation(s)
- Makayla Cordoza
- Makayla Cordoza is Postdoctoral Fellow, Division of Sleep and Chronobiology, Perelman School of Medicine, University of Pennsylvania, 1013 Blockley Hall, 423 Guardian Drive, Philadelphia, PA 19104
| | - Lingtak-Neander Chan
- Lingtak-Neander Chan is Professor, Department of Pharmacy, School of Pharmacy, University of Washington, Seattle, Washington
| | - Elizabeth Bridges
- Elizabeth Bridges is Professor, University of Washington, Seattle, Washington
| | - Hilaire Thompson
- Hilaire Thompson is Professor, Department of Biobehavioral Nursing and Health Informatics, School of Nursing, University of Washington, Seattle, Washington
| |
Collapse
|
8
|
Shinozaki K, Okuma Y, Saeki K, Miyara SJ, Aoki T, Molmenti EP, Yin T, Kim J, Lampe JW, Becker LB. A method for measuring the molecular ratio of inhalation to exhalation and effect of inspired oxygen levels on oxygen consumption. Sci Rep 2021; 11:12815. [PMID: 34140533 PMCID: PMC8211831 DOI: 10.1038/s41598-021-91246-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/17/2021] [Indexed: 01/15/2023] Open
Abstract
Using a new method for measuring the molecular ratio (R) of inhalation to exhalation, we investigated the effect of high fraction of inspired oxygen (FIO2) on oxygen consumption (VO2), carbon dioxide generation (VCO2), and respiratory quotient (RQ) in mechanically ventilated rats. Twelve rats were equally assigned into two groups by anesthetics: intravenous midazolam/fentanyl vs. inhaled isoflurane. R, VO2, VCO2, and RQ were measured at FIO2 0.3 or 1.0. R error was ± 0.003. R was 1.0099 ± 0.0023 with isoflurane and 1.0074 ± 0.0018 with midazolam/fentanyl. R was 1.0081 ± 0.0017 at an FIO2 of 0.3 and 1.0092 ± 0.0029 at an FIO2 of 1.0. There were no differences in VCO2 among the groups. VO2 increased at FIO2 1.0, which was more notable when midazolam/fentanyl was used (isoflurane-FIO2 0.3: 15.4 ± 1.1; isoflurane-FIO2 1.0: 17.2 ± 1.8; midazolam/fentanyl-FIO2 0.3: 15.4 ± 1.1; midazolam/fentanyl-FIO2 1.0: 21.0 ± 2.2 mL/kg/min at STP). The RQ was lower at FIO2 1.0 than FIO2 0.3 (isoflurane-FIO2 0.3: 0.80 ± 0.07; isoflurane-FIO2 1.0: 0.71 ± 0.05; midazolam/fentanyl-FIO2 0.3: 0.79 ± 0.03; midazolam/fentanyl-FIO2 1.0: 0.59 ± 0.04). R was not affected by either anesthetics or FIO2. Inspired 100% O2 increased VO2 and decreased RQ, which might be more remarkable when midazolam/fentanyl was used.
Collapse
Affiliation(s)
- Koichiro Shinozaki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA.
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA.
- Department of Emergency Medicine, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health, 300 Community Dr., Manhasset, NY, 11030, USA.
| | - Yu Okuma
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Kota Saeki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Nihon Kohden Innovation Center, Cambridge, MA, USA
| | - Santiago J Miyara
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Elmezzi Graduate School of Molecular Medicine, Manhasset, NY, USA
| | - Tomoaki Aoki
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Ernesto P Molmenti
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Surgery, Medicine, and Pediatrics, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
| | - Tai Yin
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Junhwan Kim
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
| | - Joshua W Lampe
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- ZOLL Medical, Chelmsford, MA, USA
| | - Lance B Becker
- The Feinstein Institutes for Medical Research, Northwell Health, Manhasset, NY, USA
- Department of Emergency Medicine, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY, USA
- Department of Emergency Medicine, North Shore University Hospital/Long Island Jewish Medical Center, Northwell Health, 300 Community Dr., Manhasset, NY, 11030, USA
| |
Collapse
|
9
|
Medical Nutrition Therapy in Critically Ill Patients Treated on Intensive and Intermediate Care Units: A Literature Review. J Clin Med 2019; 8:jcm8091395. [PMID: 31500087 PMCID: PMC6780491 DOI: 10.3390/jcm8091395] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Revised: 09/01/2019] [Accepted: 09/03/2019] [Indexed: 12/12/2022] Open
Abstract
Medical nutrition therapy in critically ill patients remains challenging, not only because of the pronounced stress response with a higher risk for complications, but also due to their heterogeneity evolving from different phases of illness. The present review aims to address current knowledge and guidelines in order to summarize how they can be best implemented into daily clinical practice. Further studies are urgently needed to answer such important questions as best timing, route, dose, and composition of medical nutrition therapy for critically ill patients and to determine how to assess and to adapt to patients’ individual needs.
Collapse
|
10
|
Indirect Calorimetry in Clinical Practice. J Clin Med 2019; 8:jcm8091387. [PMID: 31491883 PMCID: PMC6780066 DOI: 10.3390/jcm8091387] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 08/28/2019] [Accepted: 08/30/2019] [Indexed: 12/14/2022] Open
Abstract
Indirect calorimetry (IC) is considered as the gold standard to determine energy expenditure, by measuring pulmonary gas exchanges. It is a non-invasive technique that allows clinicians to personalize the prescription of nutrition support to the metabolic needs and promote a better clinical outcome. Recent technical developments allow accurate and easy IC measurements in spontaneously breathing patients as well as in those on mechanical ventilation. The implementation of IC in clinical routine should be promoted in order to optimize the cost–benefit balance of nutrition therapy. This review aims at summarizing the latest innovations of IC as well as the clinical indications, benefits, and limitations.
Collapse
|
11
|
What's New in Shock, November 2017? Shock 2017; 48:501-503. [PMID: 29036030 DOI: 10.1097/shk.0000000000000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|