Abstract:
OBJECTIVES:To measure energy expenditure in critically ill children and compare it with the energy expenditure predicted by recommended formulas, and relate the measured energy expenditure to nutritional and clinical indices. DESIGN:A prospective, clinical study. SETTING:Tertiary care pediatric intensive care unit in a university children's hospital. PATIENTS:A total of 37 patients with critical illness who were mechanically ventilated for > or =24 hrs were studied. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Chronic protein-energy malnutrition (CPEM) and acute protein-energy malnutrition were defined by the Waterlow's stages and fat and protein stores were classified as defined by Frisancho, Ryan, and Martinez. Severity of illness was assessed by the Pediatric Risk of Mortality Score, the Therapeutic Intervention Scoring System, and indices of organ failure. Oxygen consumption, carbon dioxide production, and the respiratory quotient were measured by indirect calorimetry, and energy expenditure (MEE) was calculated using the modified Weir formula. Resting energy expenditure (PBMR), predicted energy expenditure, and caloric intake were calculated using recommended formulas. A total of 77 measurements were made in 37 children. MEE was significantly lower than PBMR as estimated by all equations except the Talbot equations. MEE was significantly lower than predicted energy expenditure and the recommended daily allowances. On the first day, the MEE/PBMR ratio was <0.9 in 56.8%, 0.9-1.1 in 21.6%, and >1.1 in 21.6% of patients. MEE did not differ significantly among disease groups or between medical and surgical patients. There was no difference in MEE with or without neuromuscular blockade. MEE was lower in the presence of multiple organ system failure (MOSF) (1019 + 166 kcal/m2 without MOSF vs. 862 + 241 with MOSF; p = .025). A total of 21% had CPEM and 8.1% had acute protein-energy malnutrition. Multivariate stepwise regression analysis showed that the protein intake, midarm muscle area, midarm fat area, the use of vasoactive agents, and sedation correlated with MEE (p < .05). With CPEM, MEE was correlated to the severity of illness (p < .05). Patients at risk for protein stores depletion (midarm muscle areas 1 and 2) had a higher incidence of MOSF compared with nutritionally normal children (p < .05), whereas patients with fat stores depletion (midarm fat area 2) had a higher probability of death (50% vs. 6%, respectively). CONCLUSIONS:Recommended daily allowances and energy expenditure predicted by using a stress-related correction to the resting energy expenditure grossly overestimate MEE. MEE is close to PBMR and in many patients, it is lower than PBMR. MEE that is lower than PBMR is associated with a higher morbidity. Nutritional repletion should thus be based on MEE to avoid the problems of over- or underfeeding.
journal_name
Crit Care Medjournal_title
Critical care medicineauthors
Briassoulis G,Venkataraman S,Thompson AEdoi
10.1097/00003246-200004000-00042subject
Has Abstractpub_date
2000-04-01 00:00:00pages
1166-72issue
4eissn
0090-3493issn
1530-0293journal_volume
28pub_type
杂志文章abstract:OBJECTIVE:To assess survival after cardiac arrest and to determine whether age is an independent determinant of late mortality or poor neurologic outcome. DESIGN:Analyses using results of Brain Resuscitation Clinical Trial I (1979 to 1984) and Brain Resuscitation Clinical Trial II (1984 to 1989), two randomized, doubl...
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
doi:10.1097/00003246-199501000-00007
更新日期:1995-01-01 00:00:00
abstract:OBJECTIVES:We have previously shown that remote ischemic preconditioning reduces acute kidney injury (acute kidney injury) in high-risk patients undergoing cardiopulmonary bypass and that the protective effect is confined to patients who exhibit an increased urinary tissue inhibitor of metalloproteinases-2 and insulin-...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004415
更新日期:2020-08-01 00:00:00
abstract::Cardiac arrest has a poor prognosis, regardless of age group. Children who fail to respond to two standard doses of epinephrine (0.01 mg/kg) rarely survive to hospital discharge, and most die without the return of spontaneous circulation (ROSC). We treated seven consecutive children in cardiac arrest with high dose ep...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198912000-00004
更新日期:1989-12-01 00:00:00
abstract:OBJECTIVE:To study the importance of endothelin-1-induced vasoconstriction in a model of acute and maintained low cardiac output, by investigating regional changes within the mesenteric and particularly the intestinal mucosal circulation. DESIGN:Prospective, controlled animal study. SETTING:University-affiliated rese...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200108000-00019
更新日期:2001-08-01 00:00:00
abstract:OBJECTIVE:The purpose of this study was to evaluate the effect of a neutrophil elastase inhibitor, sivelestat, on lipopolysaccharide-induced acute lung injury through analysis of hemodynamic changes in the pulmonary microcirculation. DESIGN:Randomized animal study. SETTING:Medical school laboratory. SUBJECTS:Twenty-...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/01.ccm.0000172547.54086.ad
更新日期:2005-08-01 00:00:00
abstract::Transfusion-associated circulatory overload is the most frequent serious adverse transfusion reaction, with an incidence close to 1% of transfused patients in the general adult population. Patients in ICUs are probably more at risk of transfusion-associated circulatory overload as they are more frequently transfused a...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003743
更新日期:2019-06-01 00:00:00
abstract:OBJECTIVE:To determine the impact of Acinetobacter baumannii (AB) acquisition in intensive care unit (ICU) patients on mortality and length of stay (LOS). DESIGN:Pairwise matched 1:1 case-control study. SETTING:Medical-surgical ICU in a tertiary health care institution. PATIENTS:During 16 months, all patients admitt...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199909000-00015
更新日期:1999-09-01 00:00:00
abstract::In a prospective randomized trial in patients with a history of preoperative pulmonary hypertension who were undergoing surgery for valvular replacement or annuloplasty, the effects of ketanserin (KET) (12 patients) and sodium nitroprusside (SNP) (14 patients) on the systemic and pulmonary circulation and pulmonary sh...
journal_title:Critical care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1097/00003246-198907000-00003
更新日期:1989-07-01 00:00:00
abstract:OBJECTIVE:Review data obtained from high-frequency oscillatory ventilation (HFOV) and mechanical test lung models with respect to delivered tidal volume, distal pressure transmission, endotracheal tube cuff leaks, and simulated clinical conditions. DESIGN:Review of selected studies from PubMed, published abstracts, an...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.ccm.0000155924.74942.7f
更新日期:2005-03-01 00:00:00
abstract:OBJECTIVES:To create a novel tool to predict favorable neurologic outcomes during ICU stay among children with critical illness. DESIGN:Logistic regression models using adaptive lasso methodology were used to identify independent factors associated with favorable neurologic outcomes. A mixed effects logistic regressio...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000002753
更新日期:2018-01-01 00:00:00
abstract::Patient awareness of intermittent positive-pressure ventilation (IPPV) treatment in the ICU was studied in 304 patients. These ICU patients were divided into three groups: those treated for internal medical diseases (IMD; n = 129), patients admitted after major surgical procedures (MSP; n = 126), and patients treated ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198901000-00006
更新日期:1989-01-01 00:00:00
abstract:OBJECTIVE:End-of-life practices vary worldwide. The objective was to demonstrate that there is no clear-cut distinction between treatments administered to relieve pain and suffering and those intended to shorten the dying process. DESIGN:Secondary analysis of a prospective, observational study. SETTING:Thirty-seven i...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/01.CCM.0000295304.99946.58
更新日期:2008-01-01 00:00:00
abstract::Serum ionized calcium (Ca+2), creatinine, magnesium, phosphate, and arterial pH were measured in patients on admission to the medical ICU (MICU). Patients were classified into three groups: a) hypotensive (n = 38), those who received vasopressor support for frank hypotension; b) hypertensive (n = 21), those who requir...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198806000-00002
更新日期:1988-06-01 00:00:00
abstract::Twenty-one patients who underwent cardiopulmonary bypass for myocardial revascularization received postoperatively controlled mechanical ventilation (CMV) or intermittent mandatory ventilation (IMV), with or without positive end-expiratory pressure (PEEP). Functional residual capacity (FRC), right-to-left intrapulmona...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-197611000-00002
更新日期:1976-11-01 00:00:00
abstract:OBJECTIVE:Cocaine, which first made its appearance >1,000 yrs ago, is now widely used throughout the world. The physiologic responses to cocaine may cause severe pathologic effects. This review highlights the many critical care challenges resulting from these effects. DESIGN:Historical vignettes, epidemiologic factors...
journal_title:Critical care medicine
pub_type: 杂志文章,评审
doi:10.1097/01.CCM.0000063258.68159.71
更新日期:2003-06-01 00:00:00
abstract:OBJECTIVE:To investigate glycemic dynamics and its relation with mortality in critically ill patients. We searched for differences in complexity of the glycemic profile between survivors and nonsurvivors in patients admitted to a multidisciplinary intensive care unit. DESIGN:Prospective, observational study, convenien...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3181ce49cf
更新日期:2010-03-01 00:00:00
abstract::Subcutaneous, transcutaneous, and conjunctival oxygen tensions (PscO2, PtcO2, and PcjO2, respectively) were measured in anesthetized dogs subjected sequentially to normoxia, hyperoxia, and hypoxia. Intravascular pressure, hemodynamic and oxygen transport variables were measured simultaneously. PtcO2 and PcjO2 closely ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198812000-00011
更新日期:1988-12-01 00:00:00
abstract::Critical Care Medicine encompasses an extremely broad scope. Examination questions were, therefore, chosen to cover a wide variety of critical care topics. A near Gaussian distribution of scores was found for all physician groups studied. We believe the low mean score of 15% reflects the general difficulty of the exam...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198305000-00014
更新日期:1983-05-01 00:00:00
abstract:OBJECTIVES:To determine whether relative hyperglycemia was associated with in-hospital mortality in critically ill patients independent of other prognostic variables and whether this association is affected by background glycemia. DESIGN:Prospective observational study. SETTING:Mixed medical-surgical ICU in a metropo...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000004133
更新日期:2020-02-01 00:00:00
abstract:OBJECTIVE:Liquid lung ventilation has been demonstrated to improve cardiorespiratory function after cardiopulmonary bypass. We hypothesized that liquid lung ventilation (LLV) would decrease the pulmonary inflammatory response after cardiopulmonary bypass (CPB). DESIGN:Prospective, randomized, experimental, controlled,...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200104000-00021
更新日期:2001-04-01 00:00:00
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
doi:10.1097/00003246-199302000-00010
更新日期:1993-02-01 00:00:00
abstract:OBJECTIVE:To compare the classification performance of the Revised Atlanta Classification, the Determinant-Based Classification, and a new modified Determinant-Based Classification according to observed mortality and morbidity. DESIGN:A prospective multicenter observational study conducted in 1-year period. SETTING:F...
journal_title:Critical care medicine
pub_type: 杂志文章,多中心研究
doi:10.1097/CCM.0000000000001565
更新日期:2016-05-01 00:00:00
abstract:OBJECTIVE:To determine the maternal morbidity and mortality in patients with eclampsia admitted to an intensive care unit (ICU), and to establish the efficacy of the Acute Physiology and Chronic Health Evaluation (APACHE) II score, the organ system failure score as defined by Knaus, and the Glasgow Coma Scale (GCS) sco...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200001000-00020
更新日期:2000-01-01 00:00:00
abstract:OBJECTIVES:Ethicists advise that life-sustaining treatment decisions should be made in keeping with patient preferences. Until recently, there has been little systematic study of the impact of patient preferences on the use of various life-sustaining treatments or the consequent cost of hospital care. This prospective ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199611000-00009
更新日期:1996-11-01 00:00:00
abstract:OBJECTIVES:Prophylactic levetiracetam is currently used in ~40% of patients with intracerebral hemorrhage, and the potential impact of levetircetam on health-related quality of life is unknown. We tested the hypothesis that prophylactic levetiracetam is independently associated with differences in cognitive function he...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0000000000003272
更新日期:2018-09-01 00:00:00
abstract:OBJECTIVES:The role of nitric oxide in mediating the early phase of hypotension and cardiovascular hyporeactivity in sepsis, and the cellular sources of inducible nitric oxide synthase expression under in vivo conditions, remain unclear. The objective of this study was to elucidate the time course and cellular location...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-199703000-00022
更新日期:1997-03-01 00:00:00
abstract:OBJECTIVE:To evaluate the pathophysiology involved in hypocalcemia in septic shock and to investigate the value of calcium administration. DESIGN:Prospective, randomized placebo-controlled trial with parallel groups. SETTING:Animal research laboratory at the University Hospital of Uppsala. SUBJECTS:Twenty-four pigs ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200008000-00037
更新日期:2000-08-01 00:00:00
abstract:OBJECTIVE:The mortality of critically ill patients associated with intestinal ischemia/reperfusion remains very high, which results from multiorgan dysfunction or failure due to intestinal injury induced by intestinal ischemia/reperfusion. This study was carried out to investigate whether intestinal ischemia/reperfusio...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/CCM.0b013e3182546855
更新日期:2012-08-01 00:00:00
abstract:BACKGROUND:Hemoglobin (Hb) induces vasoconstriction by heme group binding nitric oxide in an irreversible fashion. Recent in vitro studies indicate that the thiol groups in Hb reversibly bind nitric oxide and participate in trans-nitrosylation reactions with other thiols. Sepsis is a pathophysiologic state characterize...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-200211000-00015
更新日期:2002-11-01 00:00:00
abstract::Previous studies have confirmed the improved tolerance of a peptide enteral compared to standard enteral alimentation in hypoalbuminemic, critically ill patients. Animal studies, including hypoproteinemic, volume-expanded rats, demonstrated that the protein hydrolysate of a peptide enteral formula was responsible for ...
journal_title:Critical care medicine
pub_type: 杂志文章
doi:10.1097/00003246-198907000-00012
更新日期:1989-07-01 00:00:00