title: Systemic inflammation increases energy expenditure following pediatric cardiopulmonary bypass.
abstract: OBJECTIVE
  To examine the association between cardiopulmonary bypass-related systemic inflammation and resting energy expenditure in pediatric subjects following cardiac surgery.
  
  
  METHODS
  Single-center, prospective cohort study.
  
  
  METHODS
  Pediatric cardiac critical care unit in Toronto, Canada.
  
  
  METHODS
  Children with congenital heart disease undergoing cardiopulmonary bypass surgery.
  
  
  METHODS
  Resting energy expenditure was determined by indirect calorimetry and the modified Weir equation, using VO2 and VCO2 measured by in-line respiratory mass spectrometry. Measurements were taken at baseline and 6-hour intervals from separation from cardiopulmonary bypass for a maximum of 72 hours. Plasma interleukin-6, glucose delivery, feeding status, and cardiac output (calculated by Fick equation) were monitored at each resting energy expenditure measurement.
  
  
  RESULTS
  We studied 111 subjects at a median (interquartile range) age of 5.3 months (0.8-10.5 mo), weighing 5.7 kg (3.9-8.1 kg), of whom 88% underwent biventricular repair. Resting energy expenditure decreased from 51 kcal/kg/d to 45 kcal/kg/d during the study period. Resting energy expenditure was positively associated with increased plasma interleukin-6 (estimate variable, 1.76; p = 0.001) and inversely associated with preoperative methylprednisolone use (estimate variable, -6.7; p = 0.003) even after accounting for other predictors. Increase in cardiac output was also associated (estimate variable, 13.7; p < 0.0001) with higher resting energy expenditure.
  
  
  CONCLUSIONS
  Resting energy expenditure ranges between 40 and 60 kcal/kg/d and decreases progressively in children following cardiopulmonary bypass surgery. It is directly associated with increased inflammation and higher cardiac output and inversely associated with anti-inflammatory strategies. Further studies are required to predict the appropriate caloric delivery in this cohort.
authors: 1Labatt Family Heart Centre, Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada. 2Labatt Family Heart Centre, Division of Cardiology, Cardiac Critical Care, Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON, Canada. 3Labatt Family Heart Centre, Division of Cardiology, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada. 4Labatt Family Heart Centre, Division of Cardiovascular Surgery, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada.
authors: Alejandro A
authors: AA
authors: Floh
authors: Masayuki
authors: M
authors: Nakada
authors: Gustavo
authors: G
authors: La Rotta
authors: Kandice
authors: K
authors: Mah
authors: Joann E
authors: JE
authors: Herridge
authors: Glen
authors: G
authors: Van Arsdell
authors: Steven M
authors: SM
authors: Schwartz
mesh_terms: D002153:Calorimetry, Indirect / Q000379:methods*; D002170:Canada; D002302:Cardiac Output / Q000502:physiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects / Q000379:methods; D002315:Cardiopulmonary Bypass / Q000009:adverse effects / Q000379:methods; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006330:Heart Defects, Congenital / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007249:Inflammation / Q000503:physiopathology; D015278:Intensive Care Units, Pediatric; D008297:Male; D013058:Mass Spectrometry; D008991:Monitoring, Physiologic / Q000379:methods; D010101:Oxygen Consumption / Q000502:physiology; D011446:Prospective Studies