Yoğun bakım hastalarında metabolik monitör ile ölçülen enerji tüketiminin standart denklemlerle karşılaştırılması

Year 2021, Volume: 46 Issue: 2, 589 - 600, 30.06.2021

Emre Karakoç Onur Taktakoğlu Murat Erdogan

https://doi.org/10.17826/cumj.865721

Abstract

Amaç: Bu çalışmda yoğun bakım hastalarında enerji tüketimini etkileyen parametreleri ve enerji tüketiminin hesaplanması için en güvenilir formüllerin belirlenmesi amaçlanmıştır.
Gereç ve Yöntem: Bu prospektif çalışma Çukurova Üniversitesi Hastanesi İç Hastalıkları Anabilim Dalı yoğun bakım ünitesinde yapıldı. Çalışmaya, hemodinamik ve solunum stabilitesi olan, mekanik ventilatörde 24 saatten fazla izlenen 18 yaş üstü toplam 71 hasta dahil edildi. Formüllerden elde edilen hesaplanan enerji tüketim değerlerinin, indirekt kalorimetre ile ölçülen enerji tüketim değerleri ile korelasyonunu inceledik.
Bulgular: Çalışma 71 hasta üzerinde gerçekleştirildi. Hastaların ortalama enerji tüketimi 2078 ± 794 kcal ve kilogram başına ortalama enerji ihtiyacı 31.64 ± 13.82 kcal olarak bulundu. İndirekt kalorimetre ölçümleri Swinamer formülü ile en güçlü korelasyonu gösterdi.
Sonuç: İndirekt kalorimetri, enerji tüketiminin belirlenmesinde sadece "altın standart" değil, "ulaşılabilir altın standart" haline geldi. Yoğun bakım hastalarında beslenmenin doğru şekilde sürdürülmesi için indirekt kalorimetre yönteminin kullanılmasını öneriyoruz. İndirekt kalorimetrenin kullanılamadığı veya 24 saat beklemenin istenmediği koşullar altında; 2 saatlik bir ölçümün sonuçlarına göre veya güvenilir tahmin denklemlerine göre besleme başlatılabilir.

Keywords

Beslenme desteği, indirekt kalorimetre, yetersiz beslenme, yoğun bakım ünitesi

Comparison of energy consumptions measured by metabolic monitor with standard equations in intensive care patients

Abstract

Purpose: The aim of this study was to determine parameters affecting the energy consumption in intensive care patients, and the most reliable formulas for calculation of energy consumption.
Materials and Methods: This prospective study was carried out in the intensive care unit of the Internal Medicine Department of Çukurova University Hospital. Total 71 patients above 18 years of age, with hemodynamical and respirational stability, and being followed up on a mechanical ventilator for more than 24 hours, were included to this study. We analyzed the correlation of calculated energy consumption values obtained from formulas, with the energy consumption values measured by indirect calorimeter.
Results: The study was executed on 71 patients. The mean energy consumption of the patients was 2078±794 kcal and the mean energy need per kilogram was found as 31.64±13.82 kcal. Indirect calorimeter measurements showed the strongest correlation with Swinamer formula.
Conclusion: Indirect calorimetry has become not only a "gold standard" but an "achievable gold standard" in determining energy consumption. We recommend that the indirect calorimeter method should be used in intensive care patients to maintain nutrition properly. Under conditions where indirect calorimeter cannot be used, or it is not desirable to wait for 24 hours; feeding can be started according to the results of a 2-hour measurement, or reliable predictive equations.

Keywords

Nutritional support, indirect calorimetry, malnutrition, intensive care unit

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