Postoperative metabolic and circulatory responses in patients that express SIRS after major digestive surgery.
OBJECTIVE
Systemic inflammatory response syndrome (SIRS) includes a number of pathologic states because of its loose definition. This study assessed differences in metabolic and circulatory host responses in various patients with SIRS perioperatively.


METHODS
Fifty-four patients who underwent abdominal surgeries [gastric resection (n=20), colorectal resection (n=24), hepatic resection (n=8)] were divided into two groups: Group A; SIRS (+) on 1 postoperative day (POD), (n=29), B; SIRS (-) on 1 POD, (n=25). The other eight non-operated patients with SIRS caused by infection were enrolled in Group C, as common SIRS. Indirect calorimetry, body impedance measurement to assess water compartments and pulse dye-densitometry for hemodynamic examination were performed in subjects until 14 POD.


RESULTS
The ratio of energy expenditure to basal energy expenditure (%REE) was significantly increased postoperatively, and there were significant differences on %REE from 3 POD to 14 POD between groups A and B. However, %REE in group C was 162+/-23%, which was significantly increased compared with that at 1 POD of groups A (130 +/- 17%) and B (125+/-18%). Cardiac output in group A showed a significant increase until 3 POD compared with that in group B but was significantly lower than that in group C.


CONCLUSIONS
Subjects with common SIRS caused by infection were significantly more hypermetabolic than subjects with postoperative SIRS. Adequate energy intake and circulatory management should be cautiously determined according to the severity of SIRS.
Ishikawa
M
M
Department of Surgery, National Kochi Hospital, Kochi, Japan. masa1192@tokushima-med.jrc.or.jp
Nishioka
M
M
Hanaki
N
N
Kikutsuji
T
T
Miyauchi
T
T
Kashiwagi
Y
Y
Miki
H
H
D000368:Aged; D001810:Blood Volume / Q000502:physiology*; D001823:Body Composition; D001834:Body Water; D002302:Cardiac Output / Q000502:physiology*; D016022:Case-Control Studies; D003720:Densitometry; D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D017097:Electric Impedance; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006801:Humans; D007424:Intracellular Fluid; D008297:Male; D008875:Middle Aged; D018746:Systemic Inflammatory Response Syndrome / Q000209:etiology / Q000378:metabolism* / Q000503:physiopathology*