title: Energy expenditure in patients with severe head injury: controlled normothermia with sedation and neuromuscular blockade.
abstract: OBJECTIVE
  Providing optimal caloric intake is important for patients with severe traumatic brain injury. Insufficient nutrition worsens prognosis, and excessive nutrition may lead to complications such as weaning delay from mechanical ventilation. However, using controlled normothermia with sedation and neuromuscular blockade for patients with anticipated severe brain edema, the optimal caloric intake is still unclear.
  
  
  METHODS
  Ten patients with severe traumatic brain injury were studied. All patients received midazolam and vecuronium or pancuronium to control body temperature to 36.0°C. Energy expenditure was measured using indirect calorimetry. Age, body height, body weight, heart rate, blood pressure, body temperature, and minute ventilation volume were evaluated at the time of the study. Differences between the mean measured energy expenditures (MEEs) and predicted basal energy expenditures (PEEs from the Harris-Benedict equation) were analyzed using paired t test. Furthermore, the relationships between these variables and MEEs were analyzed with multiple regression analysis.
  
  
  RESULTS
  The result of MEE was 1279±244 kcal/d. When compared with PEE, MEE/PEE was 87.2% ± 10%. Multiple regression analysis showed that age, body height, body weight, heart rate, and minute ventilation volume were related with MEE.
  
  
  CONCLUSIONS
  Energy expenditure in patients with severe traumatic brain injury who need mechanical ventilation and have received controlled normothermia with sedation and neuromuscular blockade was 13% less than predicted basal levels. Energy expenditure might be obtained from age, body height, body weight, heart rate, and minute ventilation.
authors: Osaka Prefectural Senshu Critical Care Medical Centre, Izumisano, Osaka 598-0048, Japan. akinori@sccmc.izumisano.osaka.jp
authors: Akinori
authors: A
authors: Osuka
authors: Taeko
authors: T
authors: Uno
authors: Jun
authors: J
authors: Nakanishi
authors: Hiromi
authors: H
authors: Hinokiyama
authors: Yoshiaki
authors: Y
authors: Takahashi
authors: Tetsuya
authors: T
authors: Matsuoka
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D001831:Body Temperature; D001837:Body Weights and Measures; D002153:Calorimetry, Indirect; D002648:Child; D006259:Craniocerebral Trauma / Q000503:physiopathology* / Q000628:therapy*; D054810:Deep Sedation; D004734:Energy Metabolism / Q000502:physiology*; D006339:Heart Rate; D006801:Humans; D008875:Middle Aged; D019148:Neuromuscular Blockade; D015599:Trauma Severity Indices; D055815:Young Adult