Relationships between resting and total energy expenditure in injured and septic patients.
OBJECTIVE
To quantify resting and total energy expenditure in patients who have suffered severe trauma and sepsis.


METHODS
Prospective, unblinded, observational, nonrandomized study.


METHODS
Critical care unit of a Level I adult trauma center.


METHODS
Immediate posttrauma patients or trauma patients exhibiting signs of sepsis with multiple organ dysfunction.


METHODS
An indirect calorimeter was used to measure energy expenditure at rest (resting energy expenditure) at 0700 and 1900 hrs. The energy expenditure measurement was then continued for up to 12 hrs (total energy expenditure). Clinical data were collected for computation of an illness severity score.


RESULTS
Thirteen trauma and 20 septic patients were studied 240 times. All patients were mechanically ventilated. Morphine or fentanyl was infused during 99% of studies. Neuromuscular blocking agents were used in 42% of septic studies. Both the trauma and septic groups were hypermetabolic (mean trauma resting energy expenditure, 36 +/- 6 kcal/kg; mean septic resting energy expenditure, 44 +/- 8 kcal/kg; p < .05). Total energy expenditure was similar to resting energy expenditure (trauma total energy expenditure = resting energy expenditure x 1.035 +/- 0.078, septic total energy expenditure = resting energy expenditure x 1.039 +/- 0.071). Total energy expenditure and resting energy expenditure were linearly related (r2 = .89, p < .0001).


CONCLUSIONS
Trauma and septic patients are hypermetabolic, even when heavily sedated or medically paralyzed. A measurement of resting energy expenditure is a close approximation of total energy expenditure in most patients.
Nutrition Services, RA Cowley Shock Trauma Center, University of Maryland, Baltimore 21201.
D C
DC
Frankenfield
C E
CE
Wiles
S
S
Bagley
J H
JH
Siegel
D000328:Adult; D015142:Baltimore / Q000453:epidemiology; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006801:Humans; D008297:Male; D009102:Multiple Organ Failure / Q000453:epidemiology / Q000378:metabolism; D010101:Oxygen Consumption / Q000502:physiology; D011446:Prospective Studies; D012044:Regression Analysis; D012146:Rest / Q000502:physiology*; D018805:Sepsis / Q000453:epidemiology / Q000378:metabolism*; D013997:Time Factors; D014947:Wounds and Injuries / Q000453:epidemiology / Q000378:metabolism*