D Karayiannis1, A Maragkouti2, T Mikropoulos3, A Sarri4, A Kanavou5, C Katsagoni6, E Jahaj7, A Kotanidou8, Z Mastora9. 1. Department of Clinical Nutrition, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece. Electronic address: jimkar_d@yahoo.com. 2. First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece. Electronic address: katrinmara@hotmail.com. 3. First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece. Electronic address: tmikropoulos@gmail.com. 4. First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece. Electronic address: katsarri5@hotmail.com. 5. First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece. Electronic address: agg_kan@hotmail.com. 6. Department of Clinical Nutrition, "Evangelismos" General Hospital of Athens, Ypsilantou 45-47, 10676, Athens, Greece. Electronic address: christina.katsagoni@gmail.com. 7. First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece. Electronic address: edison.jahaj@gmail.com. 8. First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece. Electronic address: akotanid@gmail.com. 9. First Department of Critical Care Medicine and Pulmonary Services, Evangelismos General Hospital, National and Kapodistrian University of Athens, 11527 Athens, Greece. Electronic address: zafimast@yahoo.gr.
Abstract
BACKGROUND & AIMS: ESPEN guidelines advocate that energy needs of critically ill patients with COVID 19 should be assessed using indirect calorimetry, if safely available. This study described energy needs of intubated patients with COVID-19 and explores whether neuromuscular blockade administration (NMBAs) is associated with altered energy expenditure. METHODS: Resting energy expenditure (REE) and respiratory exchange rate (RER) evaluated among critically ill intubated COVID-19 patients until 28th day of intensive care unit stay (ICU-S) by indirect calorimetry. Paralysed patients were defined as those with drug induced paralysis using cicatracurium, for at least 3 days during their ICU-S. RESULTS: 34 adult COVID 19 patients (59.8% male, 35.2% obese) requiring mechanical ventilation were assessed prospectively. REE measurements suggest a gradual increase of energy needs post 3rd day of ICU-S in both patients without obesity (non ob) ((from 17.8 kcal/kgr up to 29.3 kcal/kgr actual body weight (AcBW) during 28th day of ICU-S, p = 0.011)) and patients with obesity (ob) ((from 18.1 kcal/kgr up to 30.1 kcal/kgr adjusted body weight (AjBW) during 28th day of ICU-S, p = 0.021)). NMBAs use was accompanied by a significant drop in REE, especially during first 7 days of hospitalization, both in non ob (22.9 vs 17.9 kcal/kgr AcBW, p = 0.014) and ob patients (22.5 vs 19.5 kcal/kgr ABW, p = 0.027). CONCLUSION: We identified the energy needs of COVID-19 intubated patients and highlighted a significant increase beyond the 1st week in the ICU. Administration of NMBAs should be considered, as it may impact resting energy expenditure.
BACKGROUND & AIMS: ESPEN guidelines advocate that energy needs of critically illpatients with COVID 19 should be assessed using indirect calorimetry, if safely available. This study described energy needs of intubated patients with COVID-19 and explores whether neuromuscular blockade administration (NMBAs) is associated with altered energy expenditure. METHODS: Resting energy expenditure (REE) and respiratory exchange rate (RER) evaluated among critically ill intubated COVID-19patients until 28th day of intensive care unit stay (ICU-S) by indirect calorimetry. Paralysed patients were defined as those with drug induced paralysis using cicatracurium, for at least 3 days during their ICU-S. RESULTS: 34 adult COVID 19patients (59.8% male, 35.2% obese) requiring mechanical ventilation were assessed prospectively. REE measurements suggest a gradual increase of energy needs post 3rd day of ICU-S in both patients without obesity (non ob) ((from 17.8 kcal/kgr up to 29.3 kcal/kgr actual body weight (AcBW) during 28th day of ICU-S, p = 0.011)) and patients with obesity (ob) ((from 18.1 kcal/kgr up to 30.1 kcal/kgr adjusted body weight (AjBW) during 28th day of ICU-S, p = 0.021)). NMBAs use was accompanied by a significant drop in REE, especially during first 7 days of hospitalization, both in non ob (22.9 vs 17.9 kcal/kgr AcBW, p = 0.014) and obpatients (22.5 vs 19.5 kcal/kgr ABW, p = 0.027). CONCLUSION: We identified the energy needs of COVID-19 intubated patients and highlighted a significant increase beyond the 1st week in the ICU. Administration of NMBAs should be considered, as it may impact resting energy expenditure.
Authors: Friedrich Hohmann; Lisa Wedekind; Felicitas Grundeis; Steffen Dickel; Johannes Frank; Martin Golinski; Mirko Griesel; Clemens Grimm; Cindy Herchenhahn; Andre Kramer; Maria-Inti Metzendorf; Onnen Moerer; Nancy Olbrich; Volker Thieme; Astrid Vieler; Falk Fichtner; Jacob Burns; Sven Laudi Journal: Cochrane Database Syst Rev Date: 2022-06-29