Energy expenditure and withdrawal of sedation in severe head-injured patients.


OBJECTIVES:To determine the outcome of oxygen consumption (VO2) and energy expenditure after cessation of sedation in severe head-injured patients and to assess its usefulness as a predictor of neurologic severity. DESIGN:Prospective, descriptive study. SETTING:Neurosurgical intensive care unit (ICU) in a university hospital. PATIENTS:Fifteen severe head-injured patients with tracheostomies and who were mechanically ventilated and sedated at the time of the study. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:VO2 and energy expenditure were measured, using indirect calorimetry during and after discontinuation of sedation. After the measurement period, the patients were divided into two groups. Group 1 included patients who were completely weaned from sedation; group 2 included patients who had to be sedated again using predetermined criteria. In both groups, energy expenditure was close to basal energy expenditure during sedation, and increased to 150% of basal energy expenditure during the recovery period, with maximum hourly values 80% above basal energy expenditure. In group 1, VO2 and energy expenditure changed from 284 +/- 44 mL/min and 1833 +/- 261 kcal/day during sedation to 390 +/- 85 mL/min and 2512 +/- 486 kcal/day for the period without sedation. During this period, there was a significant correlation between VO2 and mean arterial pressure. For the recovery period, there was no difference in mean or maximum VO2 between the two groups of patients. At 24 and 48 hrs after cessation of sedation, VO2 and energy expenditure decrease to 30% above basal energy expenditure. These changes may be due to the recovery of muscular activity, weaning from mechanical ventilation, or an increase in the amount of circulating catecholamines. CONCLUSION:In severe head-injured patients, during the first 12 hrs after the discontinuation of sedation, the patients experienced a large increase in VO2, energy expenditure, and mean arterial pressure. Although these changes have no prognostic value in our study, they have potential deleterious effects in head-injured patients. Methods that blunt these changes which have proven efficacious in anesthesia may be effective for intensive care patients.


Crit Care Med


Critical care medicine


Bruder N,Lassegue D,Pelissier D,Graziani N,François G




Has Abstract


1994-07-01 00:00:00












  • Trends and Outcomes in Sepsis Hospitalizations With and Without Atrial Fibrillation: A Nationwide Inpatient Analysis.

    abstract:OBJECTIVES:Atrial fibrillation is frequently seen in sepsis-related hospitalizations. However, large-scale contemporary data from the United States comparing outcomes among sepsis-related hospitalizations with versus without atrial fibrillation are limited. The aim of our study was to assess the frequency of atrial fib...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Desai R,Hanna B,Singh S,Omar A,Deshmukh A,Kumar G,Foreman MG,Sachdeva R

    更新日期:2019-08-01 00:00:00

  • Recombinant human erythropoietin pretreatment attenuates acute renal tubular injury against ischemia-reperfusion by restoring transient receptor potential channel-6 expression and function in collecting ducts.

    abstract:OBJECTIVE:Acute renal tubular injury is a serious complication in the postoperative period, which is associated with high mortality and increased ICU stay. We aimed to demonstrate the protective effect of rhEPO against acute tubular injury induced by ischemia-reperfusion and to explore the mechanism of canonical transi...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Shen S,Jin Y,Li W,Liu X,Zhang T,Xia W,Wang Y,Ma K

    更新日期:2014-10-01 00:00:00

  • The effects of the rate of postresuscitation rewarming following hypothermia on outcomes of cardiopulmonary resuscitation in a rat model.

    abstract:OBJECTIVE:To investigate the optimal rewarming rate following therapeutic hypothermia in a rate model of cardiopulmonary resuscitation. Both clinical and laboratory studies have demonstrated that mild therapeutic hypothermia following cardiopulmonary resuscitation improves myocardial and neurologic outcomes of cardiac ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Lu X,Ma L,Sun S,Xu J,Zhu C,Tang W

    更新日期:2014-02-01 00:00:00

  • Taking values seriously: Ethical challenges in organ donation and transplantation for critical care professionals.

    abstract::Last year, >28,000 people received organ transplants from >14,000 donors in the United States. Unfortunately, the wait list now tops 91,000, with the gap between recipient needs and available donor organs at around 60,000. This has motivated a host of efforts to increase organ supply, including driver's license and do...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Aulisio MP,Devita M,Luebke D

    更新日期:2007-02-01 00:00:00

  • FTY720 (s)-phosphonate preserves sphingosine 1-phosphate receptor 1 expression and exhibits superior barrier protection to FTY720 in acute lung injury.

    abstract:OBJECTIVE:Effective therapies are needed to reverse the increased vascular permeability that characterizes acute inflammatory diseases such as acute lung injury. FTY720 is a pharmaceutical analog of the potent barrier-enhancing phospholipid, sphingosine 1-phosphate. Because both FTY720 and sphingosine 1-phosphate have ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Wang L,Sammani S,Moreno-Vinasco L,Letsiou E,Wang T,Camp SM,Bittman R,Garcia JG,Dudek SM

    更新日期:2014-03-01 00:00:00

  • Consequences of bed rest.

    abstract::Bed rest is frequently prescribed for critically ill patients because it is assumed to be beneficial for preventing complications, for conserving scarce metabolic resources, and for providing patient comfort. Furthermore, higher levels of physical activity in critically ill patients have been assumed to be impractical...

    journal_title:Critical care medicine

    pub_type: 杂志文章,评审


    authors: Brower RG

    更新日期:2009-10-01 00:00:00

  • Opportunities to Improve Antibiotic Appropriateness in U.S. ICUs: A Multicenter Evaluation.

    abstract:OBJECTIVES:To use a standardized tool for a multicenter assessment of antibiotic appropriateness in ICUs and identify local antibiotic stewardship improvement opportunities. DESIGN:Pilot point prevalence conducted on October 5, 2016; point prevalence survey conducted on March 1, 2017. SETTING:ICUs in 12 U.S. acute ca...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Trivedi KK,Bartash R,Letourneau AR,Abbo L,Fleisher J,Gagliardo C,Kelley S,Nori P,Rieg GK,Silver P,Srinivasan A,Vargas J,Ostrowsky B,Partnership for Quality Care (PQC) Inpatient Antimicrobial Stewardship Working Group.

    更新日期:2020-07-01 00:00:00

  • Cycling empirical antimicrobial agents to prevent emergence of antimicrobial-resistant Gram-negative bacteria among intensive care unit patients.

    abstract:OBJECTIVE:To determine the impact of the rotation of antimicrobial agents on the rates of infection, intestinal colonization, and acquisition with antimicrobial-resistant Gram-negative bacteria. DESIGN:Pre- and postintervention design. SETTING:A 19-bed, medical intensive care unit. PATIENTS:Individuals admitted to t...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Warren DK,Hill HA,Merz LR,Kollef MH,Hayden MK,Fraser VJ,Fridkin SK

    更新日期:2004-12-01 00:00:00

  • A multicenter, prospective validation of disseminated intravascular coagulation diagnostic criteria for critically ill patients: comparing current criteria.

    abstract:OBJECTIVES:To validate scoring algorithm criteria established by the Japanese Association for Acute Medicine (JAAM) for disseminated intravascular coagulation (DIC) and to evaluate its diagnostic property by comparing the two leading scoring systems for DIC, from the Japanese Ministry of Health and Welfare (JMHW) and I...

    journal_title:Critical care medicine

    pub_type: 杂志文章,多中心研究


    authors: Gando S,Iba T,Eguchi Y,Ohtomo Y,Okamoto K,Koseki K,Mayumi T,Murata A,Ikeda T,Ishikura H,Ueyama M,Ogura H,Kushimoto S,Saitoh D,Endo S,Shimazaki S,Japanese Association for Acute Medicine Disseminated Intravascular Coagulati

    更新日期:2006-03-01 00:00:00

  • Nosocomial endocarditis in the intensive care unit: an analysis of 22 cases.

    abstract:OBJECTIVES:To review the intensive care unit experience of patients with admitted or acquired nosocomial endocarditis (NE) defined according to the Duke criteria. DESIGN:Prospective, cohort study. SETTING:University teaching hospital. PATIENTS:We reviewed the records of 22 patients documented with NE during a 6-yr p...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Gouëllo JP,Asfar P,Brenet O,Kouatchet A,Berthelot G,Alquier P

    更新日期:2000-02-01 00:00:00

  • Randomized ICU trials do not demonstrate an association between interventions that reduce delirium duration and short-term mortality: a systematic review and meta-analysis.

    abstract:OBJECTIVES:We reviewed randomized trials of adult ICU patients of interventions hypothesized to reduce delirium burden to determine whether interventions that are more effective at reducing delirium duration are associated with a reduction in short-term mortality. DATA SOURCES:We searched CINHAHL, EMBASE, MEDLINE, and...

    journal_title:Critical care medicine

    pub_type: 杂志文章,meta分析,评审


    authors: Al-Qadheeb NS,Balk EM,Fraser GL,Skrobik Y,Riker RR,Kress JP,Whitehead S,Devlin JW

    更新日期:2014-06-01 00:00:00

  • Hypophosphatemia and Reye's syndrome.

    abstract::Hypophosphatemia may occur in Reye's syndrome. We retrospectively studied 42 patients with Reye's syndrome to determine the frequency and degree of hypophosphatemia, to identify possible causes, and to determine whether hypophosphatemia was related to the severity of disease or mortality. Nineteen (46%) patients were ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Carroll JL,Kanter RK

    更新日期:1985-06-01 00:00:00

  • Contribution of various metabolites to the "unmeasured" anions in critically ill patients with metabolic acidosis.

    abstract:OBJECTIVE:The physicochemical approach, described by Stewart to investigate the acid-base balance, includes the strong ion gap (SIG), a quantitative measure of "unmeasured" anions, which strongly correlates to the corrected anion gap. The chemical nature of these anions is for the most part unknown. We hypothesized tha...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Moviat M,Terpstra AM,Ruitenbeek W,Kluijtmans LA,Pickkers P,van der Hoeven JG

    更新日期:2008-03-01 00:00:00

  • Decreased splanchnic perfusion measured by duplex ultrasound in humans undergoing small volume hemorrhage.

    abstract:OBJECTIVES:To quantitate duplex Doppler measurements of splanchnic perfusion to determine if these measurements are reproducible in euvolemic humans and if such measurements are sensitive to mild degrees of systemic hypovolemia. DESIGN:Prospective, nonrandomized, controlled trial. SETTING:Clinical research center. P...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章


    authors: Dalton JM,Gore DC,Makhoul RG,Fisher MR,DeMaria EJ

    更新日期:1995-03-01 00:00:00

  • Effects of mannitol on cerebral circulation after transient complete cerebral ischemia in dogs.

    abstract::The effects of hypertonic mannitol on postischemic cerebral circulation were studied in 20 dogs. Mannitol, 2 g/kg iv, was infused into ten dogs during a 2-h period starting 1.5 h after 6 min of complete cerebral ischemia. One hour postischemia, regional cerebral blood flow (rCBF) was 36% in the control group (ten dogs...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Arai T,Tsukahara I,Nitta K,Watanabe T

    更新日期:1986-07-01 00:00:00

  • Continuous breathing circuit flow and tracheal tube cuff leak: sources of error during pediatric indirect calorimetry.

    abstract:OBJECTIVE:To determine whether continuous gas flow in the breathing circuit or an airleak around the tracheal tube cuff will introduce errors into the measurement of oxygen consumption (VO2) with indirect calorimetry. DESIGN:Nonrandomized, controlled trial. SETTING:Experimental laboratory. SUBJECTS:Ten healthy, anes...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Räsänen J

    更新日期:1992-09-01 00:00:00

  • Toll-like receptor 2 plays a critical role in cardiac dysfunction during polymicrobial sepsis.

    abstract:OBJECTIVE:To determine the role of toll-like receptor 2 in cardiac dysfunction during polymicrobial sepsis. DESIGN:Controlled animal study. SETTING:University hospital research laboratory. SUBJECTS:Male C57BL/6, wild-type, toll-like receptor 2-/-. INTERVENTION:Polymicrobial peritonitis, a clinically relevant model ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Zou L,Feng Y,Chen YJ,Si R,Shen S,Zhou Q,Ichinose F,Scherrer-Crosbie M,Chao W

    更新日期:2010-05-01 00:00:00

  • Intrahospital transport of critically ill patients.

    abstract::Severe complications sometimes occur in critically ill patients during intrahospital transport. Possible causes may be inadequate ventilation, insufficient monitoring, interrupted application of vasoactive drugs, or disconnections and accidental extubation. We constructed a transport unit equipped with a respirator; c...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Link J,Krause H,Wagner W,Papadopoulos G

    更新日期:1990-12-01 00:00:00

  • Long-term health-related quality of life in survivors of sepsis. Short Form 36: a valid and reliable measure of health-related quality of life.

    abstract:OBJECTIVE:To describe the long-term health-related quality of life (HRQL) of survivors of sepsis and to evaluate the reliability and validity of the medical outcomes study Short Form-36 (SF-36) in this population. STUDY DESIGN:Cross-sectional survey. SETTING:University intensive care unit. PATIENTS:Surviving patient...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Heyland DK,Hopman W,Coo H,Tranmer J,McColl MA

    更新日期:2000-11-01 00:00:00

  • Effects of temperature on bleeding time and clotting time in normal male and female volunteers.

    abstract:OBJECTIVE:This study was done to assess the effects of temperature on bleeding time and clotting time in normal male and female volunteers. DESIGN:Open study utilizing normal volunteers. SETTING:University research laboratory. SUBJECTS:Fifty-four healthy male and female volunteers, ranging in age from 19 to 35 yrs, ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Valeri CR,MacGregor H,Cassidy G,Tinney R,Pompei F

    更新日期:1995-04-01 00:00:00

  • Association of hypomagnesemia and mortality in acutely ill medical patients.

    abstract:OBJECTIVE:To test the hypothesis that the mortality rate of acutely ill patients admitted to a medical ward or medical ICU is higher for those patients who present with hypomagnesemia than for those patients who do not present with hypomagnesemia. DESIGN:Prospective, observational study. SETTING:Emergency Department ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Rubeiz GJ,Thill-Baharozian M,Hardie D,Carlson RW

    更新日期:1993-02-01 00:00:00

  • Ligands of the receptor for advanced glycation end products, including high-mobility group box 1, limit bacterial dissemination during Escherichia coli peritonitis.

    abstract:OBJECTIVE:The receptor for advanced glycation end products mediates a variety of inflammatory responses. Soluble receptor for advanced glycation end products has been suggested to function as a decoy abrogating cellular activation. High-mobility group box 1 is a high-affinity binding ligand for the receptor for advance...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: van Zoelen MA,Achouiti A,Schmidt AM,Yang H,Florquin S,Tracey KJ,van der Poll T

    更新日期:2010-06-01 00:00:00

  • Survival and functional outcome in pediatric traumatic brain injury: a retrospective review and analysis of predictive factors.

    abstract:OBJECTIVE:The aim of this study was to evaluate the relationship of patient care variables to survival and functional outcome in the pediatric population with traumatic brain injury. DESIGN:Retrospective chart review. SETTING:A 16-bed pediatric critical care unit in an academic community children's hospital. PATIENT...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Hackbarth RM,Rzeszutko KM,Sturm G,Donders J,Kuldanek AS,Sanfilippo DJ

    更新日期:2002-07-01 00:00:00

  • Bedside respiratory analysis by pocket computer.

    abstract::A computer program is presented which analyzes acid-base and respiratory variables. This program's advantages include limited data input, hand-held portability, error identification, and succinct analysis statements. It is a useful adjunct to daily care of the critically ill. ...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Lynn LA,Sunderrajan EV

    更新日期:1986-01-01 00:00:00

  • Procalcitonin and cytokine levels: relationship to organ failure and mortality in pediatric septic shock.

    abstract:BACKGROUND:Procalcitonin (PCT), a marker of bacterial sepsis, may also act as a mediator of the inflammatory response to infection, and thus influence outcome. OBJECTIVE:To investigate the relationship between PCT, interleukin (IL)-10, tumor necrosis factor (TNF), organ failure, and mortality in pediatric septic shock...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Hatherill M,Tibby SM,Turner C,Ratnavel N,Murdoch IA

    更新日期:2000-07-01 00:00:00

  • Impaired adenosine-5'-triphosphate release from red blood cells promotes their adhesion to endothelial cells: a mechanism of hypoxemia after transfusion.

    abstract:OBJECTIVE:Transfusion of red blood cells has been linked to disappointing clinical outcomes in the critically ill, but specific mechanisms of organ dysfunction after transfusion remain poorly understood. We tested the hypothesis that red blood cell storage impairs the ability of red blood cells to release adenosine-5'-...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Zhu H,Zennadi R,Xu BX,Eu JP,Torok JA,Telen MJ,McMahon TJ

    更新日期:2011-11-01 00:00:00

  • Human rabies: clinical features, diagnosis, complications, and management.

    abstract::A case of rabies was treated with intensive medical support. This led to a prolongation of life to 25 days. The neurologic progression of the disease was monitored clinically and with serial EEG. This prolonged course enabled us to witness and manage a wide variety of unusual complications including the adult respirat...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Udwadia ZF,Udwadia FE,Katrak SM,Dastur DK,Sekhar M,Lall A,Kumta A,Sane B

    更新日期:1989-08-01 00:00:00

  • Factors affecting team leadership skills and their relationship with quality of cardiopulmonary resuscitation.

    abstract:OBJECTIVE:This study aims to explore the relationship between team-leadership skills and quality of cardiopulmonary resuscitation in an adult cardiac-arrest simulation. Factors affecting team-leadership skills were also assessed. DESIGN:Forty advanced life-support providers leading a cardiac arrest team in a standardi...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Yeung JH,Ong GJ,Davies RP,Gao F,Perkins GD

    更新日期:2012-09-01 00:00:00

  • Medical complications of aneurysmal subarachnoid hemorrhage: a report of the multicenter, cooperative aneurysm study. Participants of the Multicenter Cooperative Aneurysm Study.

    abstract:OBJECTIVES:This report examines the frequency, type, and prognostic factors of medical (nonneurologic) complications after subarachnoid hemorrhage in a large, prospective study. The influences of contemporary neurosurgical, neurological, and critical care practice on mortality and morbidity rates after aneurysmal subar...

    journal_title:Critical care medicine

    pub_type: 临床试验,杂志文章,多中心研究,随机对照试验


    authors: Solenski NJ,Haley EC Jr,Kassell NF,Kongable G,Germanson T,Truskowski L,Torner JC

    更新日期:1995-06-01 00:00:00

  • Lipid peroxidation in experimental septic rats.

    abstract::We previously reported increased lipid peroxide and decreased alpha-tocopherol levels in the blood of critically ill septic patients. To clarify these results, we investigated lipid peroxidation in experimental septic rats and severely traumatized rats. In septic rats, both platelet count and plasma alpha-tocopherol d...

    journal_title:Critical care medicine

    pub_type: 杂志文章


    authors: Takeda K,Shimada Y,Okada T,Amano M,Sakai T,Yoshiya I

    更新日期:1986-08-01 00:00:00