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Guillain-barré-syndrome (GBS) is a hypercatabolic but not hypermetabolic disease
NUTRITION AND THE CRITICALLY ILL: NUTRITIONAL ASSESSMENT
P.101 ConWwus measurement of indirect calorimetry scwerdyburnedpatm M. Kbhkwa A. Hi&de, H. Sugimofo, T. Yoshioka and T. Sugimoto
in
high fat group against 6 days in the standard group (no signiit diierence). Conclusion: In this study high fat, low carbohydrate feeding was shown to reduce COP excretion and RQ, but failed to reduce paC& during weaning from the ventilator.
Depemmmt of Traumatology Osaka University Medica/ School, Osaka,
JF The putpose of this study is to evaluate reliability on short-time
P.103 Guillain-BarrHyndrome but not hypermetabolic disease
measurements of indirect calorimetry which has been performed for less than one hour in many studies to assess metabolic and nutritional state of severely burned patients. In 5 severely bumed patients (25-79 years old, Burn Index 35-65) with intratracheal intubation, indirect calorimetry were continuously measured by breath-by-breathmethod throughout24 hours for 10 to79daysfrom the first day after burn injury. Using computerized respirometer and gas analyser (RM-300 and MG-360, Minato Medical Co., Osaka, Japan), we obtained oxygen consumption @02), carbon dioxide production #CO,) and respiratory quotient (RQ) every 5 minutes. We calculated averages of vOZ and RQ in an each hour rjo,, IX&,,,) after eliminating artifacts due to intratracheal suction and other procedures for burn wound treatment, and averages of \iOand RClh, in an each day CjO,,,, !+I,). Reliability of \iO, and RQ in aday were estimated by coefficients of variation (Cv) of \io,,,, and R&, in an each day. We also measured hourly body temperature and daily urinary urea nitrogen (UUN) excretion in all the patients. MeanCVof\iO~~,was15 ? 5%, andmeanCVof RQhwrwas 11 If 3% inall patients. Resting Energy Expenditure (%REE) calculated from i/O*dav and Rh was 130-180% throughout the duration measured in all the patients. They did not show initial peak such as flow phase. From the variation of \iO*hwr and RQhou,,we might happen to calculate energy substrate consumed with errors of 50-200 g/day in sugar, 20-80 g/day in lipid. These errors have important problems on clinical nutrition in severely burned patients. We conclude that short time measurement (less than one hour) of indirect calorimetry is not enough to assess clinical nutrition properly and to investigate energy metabolism in severely burned patients.
W. Dtumi, M. Lechner, G. Grimm and 8. SchneeweiB 1. Med. Univ. Clinic, University of Vienna, Austria The term ‘hypercatabolism’ usually indicates ‘hypermetabolism’ in disease states as trauma, infections. Treating patients with Guillain-Barr&Syndrome (GBS) however, we noted a striking discrepancy between energy expenditure and nitrogen loss. To improve nutriiional support we thus investigated energy expenditure and nitrogen metabolism in GBS. Patients and methods: 8 patients with GBS (5F, 3M, mean age 43 yrs) were investigated during respiratory support and parenteral/enteral nutrition (mean observation period 2Od). N-intake, N-loss (BUN-corrected ureageneration rate t obligatory N-losses (31 mg/kg/d)) and an estimate of N-balance were evaluated. In 6 patients energy expenditure was measured by indirect calorimetry (MMC Horizon). Resutts~ N-loss was 19.2 + 1.3 S/d, N-intake (inspite of energetically adequate nutriiional support) 10.8 ?r 0.8 g/d, and thus, N-balance was -8.4 + 0.7 s/d. Mean measured energy expenditure was 1555 + 106 k&d (1.02 ? 0.06 kcal/min0,73m2) and within the normal (calculated) range of 1561 + 96 kca!fd and 1.03+ 0.04 kcal/min/l.73m2). Values are Mean + SEM. Treabnent day Cum
N-b&ma
5 43.W
20 76 10 13 M).6i4 92.7i9 130.1+19 179?37
25 216f26
Mb! 273.9+22
Conclusions: GBS is a hypercatabolic but not hypermetabolic disease. Muscular inactivity and functional denervation activate protein catabolism but do not stimulate energy expenditure.
P.104 Influence of a new amino acid (AA) - solution with increased amount of essential and branched-chain AA on protein catabolism in acute renal (ARF) - and multiple organ failure (MOF)
P.102 Hiih fat, low carbohydrate, enteral feeding in patients weaning from the ventilator 8. van ckn Bq and W.C. J. Hop Respiratory intensive Care Unit, Universify Hospital Rotterdam, Nethedands
(GBS) is a hypcncatabollc
The
H. Kierdorf, P. Sfehle. W. Behrendf, 0. Brand, P. F&t, H. Me/zerand H.G. Sieberth Dept. of k&ma/ Medicine and Anaesthesiokqy, RW73 Aachen, Inst. No/, Chem. and EW, University Hohenheim, R&D, pfrmmer Kabi, Edangen, Germany
Previous studies have suggested that high fat, low carbohydrate feeding couM be beneficial in patients with respiratory failure by reducing COP production. We compared in a randomized controlled study the effects of a high fat, low carbohydrate enteral nutrition with a standard iSocaloric feed on CO* production and paCO* in patients on mechanical ventilation. In a do&a-blind fashion 32 patients were randomized: 15 patients receiving high fat (fat 55%, carbohydrate 28% energy) and 17 patients standard feed (fat 30%. carbohydrate 53%). The nutrition was administered in an amount equal to 1.5 times basal metabolic rate. O2 consumption, CO? production, RQand arterial bloodgases were obtained during mechanical ventilation and periods of weaning from the ventilator. The study was completed when the patients could breath spontaneously for 3 hours. Resu&~ During mechanical ventilation the mean CO? production of the patisnts on high fat feeding was 0.200 Umin against 0.220 Umin at the standard feed; this difference was not significant However a significant difference was found in RQ: 0.92 in the high fat group against 1 .OOin the standard grcn~p (p < 0.05). During weaning significant differences were fwnd in CO, excretion and RQ: high fat group mean COn excretion 0.180 Umin and RQ 0.73 against standard group 0.230 Umin and 0.85 @values:
ARF and MOF are typically associated with increased protein catabolism according to imbalances of intracellular PA and specific alterations of plasma AA. In a prospective randomized study we examinsdtlwinfluence of anew AA-solution(EAA4696, BCPA2846, PheandMetmduced)onnitrogen metabolism and concentrations of AA in patients with ARF. 20 anuric patients with ARF and at least one additional organ failure were studied for a period of 7 days after onset of continuous haemofiitratii. Ail mceived TPN including 1-59 AA, 4-59 glucose and 1 g lipid/kg.kg.d (28 non-protein kcal). Patient in random A received the new AA-solution, patients in random B the conventional AA-solution (26% EAS, 11% BCAA). Results: There was no difference in the two groups according to averaged daily nitrogen loss (group A: 21.5 + 7 g/d, group 9: 20.4 + 9 s/d), nitrm balance(-5.9~5vs-5.1+9g/d)andtheconcentrationofshortlifeplasme proteins. Plasma concentrations of BCAA, within the lower limit in allpatients before starting the examination, increased in group A while the concsntration in group B was constant or decreasing, often leaving the bwer limit. Sieving coefficient of continuous haemofiltratbn reached 0.7-0.8 for AA. Conclu&n: The new AA-solution appears to avoid the decrease of BCAA-concentrations in patients with ARF end MOF. Niirogen catabolism 57
P.101 ConWwus measurement of indirect calorimetry scwerdyburnedpatm M. Kbhkwa A. Hi&de, H. Sugimofo, T. Yoshioka and T. Sugimoto
in
high fat group against 6 days in the standard group (no signiit diierence). Conclusion: In this study high fat, low carbohydrate feeding was shown to reduce COP excretion and RQ, but failed to reduce paC& during weaning from the ventilator.
Depemmmt of Traumatology Osaka University Medica/ School, Osaka,
JF The putpose of this study is to evaluate reliability on short-time
P.103 Guillain-BarrHyndrome but not hypermetabolic disease
measurements of indirect calorimetry which has been performed for less than one hour in many studies to assess metabolic and nutritional state of severely burned patients. In 5 severely bumed patients (25-79 years old, Burn Index 35-65) with intratracheal intubation, indirect calorimetry were continuously measured by breath-by-breathmethod throughout24 hours for 10 to79daysfrom the first day after burn injury. Using computerized respirometer and gas analyser (RM-300 and MG-360, Minato Medical Co., Osaka, Japan), we obtained oxygen consumption @02), carbon dioxide production #CO,) and respiratory quotient (RQ) every 5 minutes. We calculated averages of vOZ and RQ in an each hour rjo,, IX&,,,) after eliminating artifacts due to intratracheal suction and other procedures for burn wound treatment, and averages of \iOand RClh, in an each day CjO,,,, !+I,). Reliability of \iO, and RQ in aday were estimated by coefficients of variation (Cv) of \io,,,, and R&, in an each day. We also measured hourly body temperature and daily urinary urea nitrogen (UUN) excretion in all the patients. MeanCVof\iO~~,was15 ? 5%, andmeanCVof RQhwrwas 11 If 3% inall patients. Resting Energy Expenditure (%REE) calculated from i/O*dav and Rh was 130-180% throughout the duration measured in all the patients. They did not show initial peak such as flow phase. From the variation of \iO*hwr and RQhou,,we might happen to calculate energy substrate consumed with errors of 50-200 g/day in sugar, 20-80 g/day in lipid. These errors have important problems on clinical nutrition in severely burned patients. We conclude that short time measurement (less than one hour) of indirect calorimetry is not enough to assess clinical nutrition properly and to investigate energy metabolism in severely burned patients.
W. Dtumi, M. Lechner, G. Grimm and 8. SchneeweiB 1. Med. Univ. Clinic, University of Vienna, Austria The term ‘hypercatabolism’ usually indicates ‘hypermetabolism’ in disease states as trauma, infections. Treating patients with Guillain-Barr&Syndrome (GBS) however, we noted a striking discrepancy between energy expenditure and nitrogen loss. To improve nutriiional support we thus investigated energy expenditure and nitrogen metabolism in GBS. Patients and methods: 8 patients with GBS (5F, 3M, mean age 43 yrs) were investigated during respiratory support and parenteral/enteral nutrition (mean observation period 2Od). N-intake, N-loss (BUN-corrected ureageneration rate t obligatory N-losses (31 mg/kg/d)) and an estimate of N-balance were evaluated. In 6 patients energy expenditure was measured by indirect calorimetry (MMC Horizon). Resutts~ N-loss was 19.2 + 1.3 S/d, N-intake (inspite of energetically adequate nutriiional support) 10.8 ?r 0.8 g/d, and thus, N-balance was -8.4 + 0.7 s/d. Mean measured energy expenditure was 1555 + 106 k&d (1.02 ? 0.06 kcal/min0,73m2) and within the normal (calculated) range of 1561 + 96 kca!fd and 1.03+ 0.04 kcal/min/l.73m2). Values are Mean + SEM. Treabnent day Cum
N-b&ma
5 43.W
20 76 10 13 M).6i4 92.7i9 130.1+19 179?37
25 216f26
Mb! 273.9+22
Conclusions: GBS is a hypercatabolic but not hypermetabolic disease. Muscular inactivity and functional denervation activate protein catabolism but do not stimulate energy expenditure.
P.104 Influence of a new amino acid (AA) - solution with increased amount of essential and branched-chain AA on protein catabolism in acute renal (ARF) - and multiple organ failure (MOF)
P.102 Hiih fat, low carbohydrate, enteral feeding in patients weaning from the ventilator 8. van ckn Bq and W.C. J. Hop Respiratory intensive Care Unit, Universify Hospital Rotterdam, Nethedands
(GBS) is a hypcncatabollc
The
H. Kierdorf, P. Sfehle. W. Behrendf, 0. Brand, P. F&t, H. Me/zerand H.G. Sieberth Dept. of k&ma/ Medicine and Anaesthesiokqy, RW73 Aachen, Inst. No/, Chem. and EW, University Hohenheim, R&D, pfrmmer Kabi, Edangen, Germany
Previous studies have suggested that high fat, low carbohydrate feeding couM be beneficial in patients with respiratory failure by reducing COP production. We compared in a randomized controlled study the effects of a high fat, low carbohydrate enteral nutrition with a standard iSocaloric feed on CO* production and paCO* in patients on mechanical ventilation. In a do&a-blind fashion 32 patients were randomized: 15 patients receiving high fat (fat 55%, carbohydrate 28% energy) and 17 patients standard feed (fat 30%. carbohydrate 53%). The nutrition was administered in an amount equal to 1.5 times basal metabolic rate. O2 consumption, CO? production, RQand arterial bloodgases were obtained during mechanical ventilation and periods of weaning from the ventilator. The study was completed when the patients could breath spontaneously for 3 hours. Resu&~ During mechanical ventilation the mean CO? production of the patisnts on high fat feeding was 0.200 Umin against 0.220 Umin at the standard feed; this difference was not significant However a significant difference was found in RQ: 0.92 in the high fat group against 1 .OOin the standard grcn~p (p < 0.05). During weaning significant differences were fwnd in CO, excretion and RQ: high fat group mean COn excretion 0.180 Umin and RQ 0.73 against standard group 0.230 Umin and 0.85 @values:
ARF and MOF are typically associated with increased protein catabolism according to imbalances of intracellular PA and specific alterations of plasma AA. In a prospective randomized study we examinsdtlwinfluence of anew AA-solution(EAA4696, BCPA2846, PheandMetmduced)onnitrogen metabolism and concentrations of AA in patients with ARF. 20 anuric patients with ARF and at least one additional organ failure were studied for a period of 7 days after onset of continuous haemofiitratii. Ail mceived TPN including 1-59 AA, 4-59 glucose and 1 g lipid/kg.kg.d (28 non-protein kcal). Patient in random A received the new AA-solution, patients in random B the conventional AA-solution (26% EAS, 11% BCAA). Results: There was no difference in the two groups according to averaged daily nitrogen loss (group A: 21.5 + 7 g/d, group 9: 20.4 + 9 s/d), nitrm balance(-5.9~5vs-5.1+9g/d)andtheconcentrationofshortlifeplasme proteins. Plasma concentrations of BCAA, within the lower limit in allpatients before starting the examination, increased in group A while the concsntration in group B was constant or decreasing, often leaving the bwer limit. Sieving coefficient of continuous haemofiltratbn reached 0.7-0.8 for AA. Conclu&n: The new AA-solution appears to avoid the decrease of BCAA-concentrations in patients with ARF end MOF. Niirogen catabolism 57