Clinical paperFulfilling caloric demands according to indirect calorimetry may be beneficial for post cardiac arrest patients under therapeutic hypothermia☆
Introduction
The role of nutrition has been revisited for many critical illnesses in the past decade. This has led to the implementation of new nutritional strategies, represented by the strong recommendations for early enteral nutrition 1, 2, 3. To date, nutrition for patients under therapeutic hypothermia has not been well described in literature, mainly because hypothermia is believed to suppress the energy metabolism 4, 5, 6, thus suppressing the need for exogenous energy supplementation. The lack of gut motility 7, and the need and the difficulty to control blood glucose level in such patients 4 also justify the resolution from alimenting hypothermic patients.
With advances in instruments and procedures, temperature management has become a matter of less concern 9, 10. This may have an effect on the energy requirements of hypothermic patients, with reduced use of sedatives and muscle relaxants to avoid shivering 11. Thus, modern hypothermia techniques may be related to increased demand for energy, and insufficient supplementation may lead to unfavorable outcomes 12, 13. This hypothesis may be applied more prominently for patient population with smaller BMI, with smaller amount of endogenous energy supply 14.
In this study, we sought to investigate the energy requirements for patients under therapeutic hypothermia. We also investigated the relationship of energy fulfillment during the hypothermia therapy to the patient outcome.
Section snippets
Study patients
Adult patients admitted to our ICU after successful resuscitation from cardiac arrest for post resuscitation therapeutic hypothermia from April, 2012 to March, 2014 were screened for eligibility. Patients were excluded if they were under 18 years of age, pregnant, under extracorporeal membrane oxygenation (ECMO) support, complicated uncontrolled metabolic disorder, or presented near moribund condition. Indirect calorimetry was performed for patients who met the criteria, in accordance with the
Patient characteristics
Seven post cardiac arrest patients were enrolled (Table 1). Median age was 62 years old for 5 male and 2 female patients. Four patients fell cardiac arrest outside the hospital, all successfully resuscitated before hospital arrival by emergency medical service. The patients required vasopressor support for hypotension at ICU admission, including 3 patients with cardiac arrest of cardiac origin. Duration of cardiac arrest ranged from 15 to 80 min (median: 34 min), and GCS at ICU admission ranged
Discussion
This study was conducted to investigate the energy consumption during therapeutic hypothermia, and also how fulfilling the energy requirement affect patient outcome, especially in terms of length of ICU stay. The importance of indirect calorimetry to estimate caloric demands for critically ill patients 15, 16, and the usefulness of targeting energy provision goals to the results 17, 18, have been reported recently. This is the first study to our knowledge to focus on energy requirements of
Conclusion
The EE for patients under therapeutic hypothermia was higher than expected. Meeting the energy demand may improve patient outcome, as observed in the association between cumulative energy deficit and the length of ICU stay in the present study. A larger, prospective study is awaited to validate the results of our study.
Conflict of interest statement
The authors declare no conflict of interest.
References (18)
- et al.
ESPEN guidelines on enteral nutrition: intensive care
Clin Nutr
(2006) - et al.
Pragmatic approach to nutrition in the ICU: expert opinion regarding which calorie protein target
Clin Nutr
(2014) - et al.
Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial
Lancet
(2013) - et al.
Early enteral nutrition in adults receiving venoarterial extracorporeal membrane oxygenation: an observational case series
JPEN J Parenter Enteral Nutr
(2013) - et al.
Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.)
JPEN J Parenter Enteral Nutr
(2009) - et al.
Energy expenditure in patients with severe head injury: controlled normothermia with sedation and neuromuscular blockade
J Crit Care
(2013) - et al.
Modification of the Harris–Benedict equation to predict the energy requirements of critically ill patients during mild therapeutic hypothermia
In Vivo
(2008) - et al.
Energy expenditure in ischemic stroke patients treated with moderate hypothermia
Intensive Care Med
(2004) - et al.
Stress procedures lowering body temperature augment gastric motility by increasing the sensitivity to acetylcholine in rats
J Pharma
(1982)
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A Spanish translated version of the summary of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2014.12.025.