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PP003-MON RELATIONSHIPS BETWEEN BIOELECTRICAL PHASE ANGLE, ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION (APACHE II) AND SIMPLIFIED ACUTE PHYSIOLOGY SCORES (SAPS II) IN INTENSIVE CARE UNIT (ICU) PATIENTS
Critical Care II
139
energy requirements did not differ between groups: 1892±365 kcal/d. Cumulated D3 energy balance was 3905±1314 (ns); on D8 3698±2363 (SPN group) vs. 5995±3450 kcal (EN group) (p < 0.0001). Energy target was achieved with SPN (mean 100±16% vs. 73±27%; p < 0.0001) but not with EN alone. Mean Insulin delivery was 33±48 IU/D (EN) vs. 32±38 IU/D (SPN). Altogether 21,911 glycemia were performed, 11,305 during intervention (ns): glycemic profile was similar until D3: during intervention there were more episodes of hyperglycemia in SPN group patients, but no increase of the AUC D4 8: EN group 1107±263 mmol versus SPN group 1106±279 mmol/l (ns). Conclusion: While SPN covered energy requirements, it did not worsen glycemic control as reflected by the similar area under the curve of all glycemia D4 to D8, showing that this technique is safe with a nurse driven glucose protocol. Disclosure of Interest: S. Graf: None Declared, M. Berger Grant/Research Support from: FreseniusKabi, Consultant of: Baxter, A. Clerc: None Declared, V. Brancato: None Declared, C. Heidegger: None Declared, C. Pichard Consultant of: Baxter.
PP002-MON NEW INDIRECT CALORIMETERS IN INTENSIVE CARE UNIT (ICU): WHICH ONE IS SUITABLE? S. Graf1 , V.L. Karsegard1 , A. Clerc1 , V. Viatte1 , L. Genton1 , C. Pichard1 . 1 Clinical Nutrition, University Hospital Geneva, Geneva, Switzerland Rationale: Indirect calorimetry is the gold standard to measure resting energy expenditure (REE) in ICU patients. The popular 30 years old Deltatrac II® (Datex) indirect calorimeter (IC) is no more commercialised, but other manufacturers have developed new IC. This study aims at comparing two new IC, CCM Express® (Medgraphics) and QUARK® (Cosmed) with the Deltatrac II® to assess their potential use in ICU patients. Methods: ICU patients on mechanical ventilation (Evita ager), with <9 cm H2 O of positive end-expiratory XL® (Dr¨ pressure (PEEP), fraction of inspired oxygen <60% (FiO2 ), were measured 20 minutes, in triplicate by three IC devices simultaneously connected to the ventilator. Patients’ characteristics were recorded, as well as O2 consumption (VO2 ), CO2 production (VCO2 ), respiratory quotient (RQ), REE and FiO2 . Data are presented as mean±SD and compared by ANOVA with Dunnett’s post hoc test and Bland Altman tests. Results: Forty patients (22%, 60±17 yrs, BMI 25.4±7.6 kg/m2 , SAPS II 53±16) were included. FiO2 was 27±6% and PEEP was 6±1 cm H2 O. For the Deltatrac II® VO2 was 227±61 ml/min, VCO2 189±52 ml/min and REE 1562±412 kcal/d. The ANOVA test showed that VO2, VCO2 and REE differed significantly between devices (p = 0.031, p = 0.02, p = 0.04 respectively). The p values of the Dunnett’s post hoc test (vs. Deltatrac II® ) are reported in the table. VO2 ml/min
p
QUARK® 223±70 0.963 CCM Express® 261±77 0.056
VCO2 ml/min
p
179±58 0.672 225±63* 0.013
REE kcal
p
1478±521 0.661 1835±534* 0.027
For REE, Bland Altman test showed a mean difference ±2SD of 25.2±441 kcal Deltatrac II® vs QUARK® , and 273±532 kcal Deltatrac II® vs CCM express® . Conclusion: QUARK® would best replace Deltatrac II® than CCM express® , but it suffers a REE offset of 441 kcal (±2SD), which is not acceptable for clinical practice. Further improvements of new IC are needed before recommending their routine use in ICU patients. Disclosure of Interest: None Declared.
PP003-MON RELATIONSHIPS BETWEEN BIOELECTRICAL PHASE ANGLE, ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION (APACHE II) AND SIMPLIFIED ACUTE PHYSIOLOGY SCORES (SAPS II) IN INTENSIVE CARE UNIT (ICU) PATIENTS S. Graf1 , R. Thibault1 , A. Clerc1 , C.P. Heidegger2 , M.M. Berger3 , C. Pichard1 . 1 Clinical Nutrition, 2 Intensive Care Unit, University Hospital, Geneva, 3 Intensive Care Unit, University Hospital, Lausanne, Switzerland Rationale: BIA derived phase angle has been related to prognostic in hospitalized patients. However, its reliability is questioned in ICU patients, with rapid changes in electrolyte and fluid. This study aims at analyzing the relationship between disease severity scores APACHEII and SAPSII usually used in ICU to predict mortality risk and the phase angle which when low is associated with poor outcome during chronic disease. Methods: All patients admitted in ICU and staying >5 days were included. In the first 48h after admission in ICU, severity scores were calculated. At the 3rd day of their stay 50kHz BIA (Nutriguard-M® ) measurement of phase angle was performed. Anthropometric data and survival in the 1st month were recorded. Variables (median, min-max), were compared (Mann Whitney test) and correlation between phase angle and severity scores were determined (Spearman coefficient). Results: 239 patients (164%, 61±16 yrs, BMI 26.3±4.4 kg/m2 , 134 medical). At day 3, 50kHz phase angle was 4.6±3.9 degree. Phase angle
SAPSII
APACHEII
BMI
Dead (n = 31)
3.2 (1 30)
60 (20 90)
26.8 (17.2 39.1)
Alive (n = 208) P-value (Mann Whitney)
3.9 (1.1 44) 0.012
46 (12 87) 0.008
27 (11 39) 22 (6 43) 0.003
25.3 (16.2 39.4) 0.094
There was neither statistical correlation between phase angle and SAPSII (p = 0.267), APACHEII (p = 0.108), BMI (p = 0.330) nor with surgical or medical ICU patients (p = 0.822), but between phase angle and age (p < 0.0001) or gender (p < 0.0001). Correlation were significant between survival in 1st month and SAPSII (p = 0.007) and APACHEII (p = 0.003). Conclusion: This study confirms the association between severity scores and mortality, as well as 50kHz phase angle with age and gender. 50kHz phase angle at day 3 after ICU admission is significantly different among patients who were alive or dead at 1 month, but is not correlated with severity scores. Disclosure of Interest: None Declared.
139
energy requirements did not differ between groups: 1892±365 kcal/d. Cumulated D3 energy balance was 3905±1314 (ns); on D8 3698±2363 (SPN group) vs. 5995±3450 kcal (EN group) (p < 0.0001). Energy target was achieved with SPN (mean 100±16% vs. 73±27%; p < 0.0001) but not with EN alone. Mean Insulin delivery was 33±48 IU/D (EN) vs. 32±38 IU/D (SPN). Altogether 21,911 glycemia were performed, 11,305 during intervention (ns): glycemic profile was similar until D3: during intervention there were more episodes of hyperglycemia in SPN group patients, but no increase of the AUC D4 8: EN group 1107±263 mmol versus SPN group 1106±279 mmol/l (ns). Conclusion: While SPN covered energy requirements, it did not worsen glycemic control as reflected by the similar area under the curve of all glycemia D4 to D8, showing that this technique is safe with a nurse driven glucose protocol. Disclosure of Interest: S. Graf: None Declared, M. Berger Grant/Research Support from: FreseniusKabi, Consultant of: Baxter, A. Clerc: None Declared, V. Brancato: None Declared, C. Heidegger: None Declared, C. Pichard Consultant of: Baxter.
PP002-MON NEW INDIRECT CALORIMETERS IN INTENSIVE CARE UNIT (ICU): WHICH ONE IS SUITABLE? S. Graf1 , V.L. Karsegard1 , A. Clerc1 , V. Viatte1 , L. Genton1 , C. Pichard1 . 1 Clinical Nutrition, University Hospital Geneva, Geneva, Switzerland Rationale: Indirect calorimetry is the gold standard to measure resting energy expenditure (REE) in ICU patients. The popular 30 years old Deltatrac II® (Datex) indirect calorimeter (IC) is no more commercialised, but other manufacturers have developed new IC. This study aims at comparing two new IC, CCM Express® (Medgraphics) and QUARK® (Cosmed) with the Deltatrac II® to assess their potential use in ICU patients. Methods: ICU patients on mechanical ventilation (Evita ager), with <9 cm H2 O of positive end-expiratory XL® (Dr¨ pressure (PEEP), fraction of inspired oxygen <60% (FiO2 ), were measured 20 minutes, in triplicate by three IC devices simultaneously connected to the ventilator. Patients’ characteristics were recorded, as well as O2 consumption (VO2 ), CO2 production (VCO2 ), respiratory quotient (RQ), REE and FiO2 . Data are presented as mean±SD and compared by ANOVA with Dunnett’s post hoc test and Bland Altman tests. Results: Forty patients (22%, 60±17 yrs, BMI 25.4±7.6 kg/m2 , SAPS II 53±16) were included. FiO2 was 27±6% and PEEP was 6±1 cm H2 O. For the Deltatrac II® VO2 was 227±61 ml/min, VCO2 189±52 ml/min and REE 1562±412 kcal/d. The ANOVA test showed that VO2, VCO2 and REE differed significantly between devices (p = 0.031, p = 0.02, p = 0.04 respectively). The p values of the Dunnett’s post hoc test (vs. Deltatrac II® ) are reported in the table. VO2 ml/min
p
QUARK® 223±70 0.963 CCM Express® 261±77 0.056
VCO2 ml/min
p
179±58 0.672 225±63* 0.013
REE kcal
p
1478±521 0.661 1835±534* 0.027
For REE, Bland Altman test showed a mean difference ±2SD of 25.2±441 kcal Deltatrac II® vs QUARK® , and 273±532 kcal Deltatrac II® vs CCM express® . Conclusion: QUARK® would best replace Deltatrac II® than CCM express® , but it suffers a REE offset of 441 kcal (±2SD), which is not acceptable for clinical practice. Further improvements of new IC are needed before recommending their routine use in ICU patients. Disclosure of Interest: None Declared.
PP003-MON RELATIONSHIPS BETWEEN BIOELECTRICAL PHASE ANGLE, ACUTE PHYSIOLOGY AND CHRONIC HEALTH EVALUATION (APACHE II) AND SIMPLIFIED ACUTE PHYSIOLOGY SCORES (SAPS II) IN INTENSIVE CARE UNIT (ICU) PATIENTS S. Graf1 , R. Thibault1 , A. Clerc1 , C.P. Heidegger2 , M.M. Berger3 , C. Pichard1 . 1 Clinical Nutrition, 2 Intensive Care Unit, University Hospital, Geneva, 3 Intensive Care Unit, University Hospital, Lausanne, Switzerland Rationale: BIA derived phase angle has been related to prognostic in hospitalized patients. However, its reliability is questioned in ICU patients, with rapid changes in electrolyte and fluid. This study aims at analyzing the relationship between disease severity scores APACHEII and SAPSII usually used in ICU to predict mortality risk and the phase angle which when low is associated with poor outcome during chronic disease. Methods: All patients admitted in ICU and staying >5 days were included. In the first 48h after admission in ICU, severity scores were calculated. At the 3rd day of their stay 50kHz BIA (Nutriguard-M® ) measurement of phase angle was performed. Anthropometric data and survival in the 1st month were recorded. Variables (median, min-max), were compared (Mann Whitney test) and correlation between phase angle and severity scores were determined (Spearman coefficient). Results: 239 patients (164%, 61±16 yrs, BMI 26.3±4.4 kg/m2 , 134 medical). At day 3, 50kHz phase angle was 4.6±3.9 degree. Phase angle
SAPSII
APACHEII
BMI
Dead (n = 31)
3.2 (1 30)
60 (20 90)
26.8 (17.2 39.1)
Alive (n = 208) P-value (Mann Whitney)
3.9 (1.1 44) 0.012
46 (12 87) 0.008
27 (11 39) 22 (6 43) 0.003
25.3 (16.2 39.4) 0.094
There was neither statistical correlation between phase angle and SAPSII (p = 0.267), APACHEII (p = 0.108), BMI (p = 0.330) nor with surgical or medical ICU patients (p = 0.822), but between phase angle and age (p < 0.0001) or gender (p < 0.0001). Correlation were significant between survival in 1st month and SAPSII (p = 0.007) and APACHEII (p = 0.003). Conclusion: This study confirms the association between severity scores and mortality, as well as 50kHz phase angle with age and gender. 50kHz phase angle at day 3 after ICU admission is significantly different among patients who were alive or dead at 1 month, but is not correlated with severity scores. Disclosure of Interest: None Declared.