The Relationship of Energy Expenditure and Physiological Disturbance of Critical Patient

• Main Authors: Yu-Chih Ting, 丁玉芝
• Other Authors: Yann-Fen Chao
• Format: Others
• Language: en_US
• Published: 1998
• Online Access: http://ndltd.ncl.edu.tw/handle/29266553599389155188

碩士 === 慈濟醫學院 === 護理學研究所 === 86 === Optimal mangement of critically ill patients often involves nutrition support.It is now well accepted that nutrition can alter the outcome and survival of hospitalized patients.By prospective research method, we investigated the serial changes of energy expenditure and physiological disturbance and their relationship with prognosis in critically ill patients who were admitted to intensive care unit (ICU). The purpose of our study is to look for a prac-tical clinical index which may offer nurses in the ICU planning of optimal nutritional sup-port. Thirty patients admitted to a 28-bed ICU of one medical center in Taipei, who under-went endotracheal intubation and received mechanical ventilation, were enrolled. The ven-tilator settings of these patients were FiO2 less than 60 % and PEEP value less than 5 cmH2O. Changes of physiological disturbance of each patient were recorded daily for con-secutive 7 days. Energy expenditure for one hour was measured four times a day, and physiological data relevant to energy metabolism were collected. Totally 163 data were collected and analyzed. Our results are shown as the followings： (1).The degree of physiological disturbance and energy expenditure were not statisti-cally correlated in critically ill patients. The patients who survived for less than one week showed inversely correlated between acute physiological score (APS) and en-ergy expenditure; conversely was the condition for those who survived more than one week. (2).Grave prognosis can be predicted in the patients whose energy expenditure were low-er than 25 kcal/kg. (3).There was no significant correction between nutritional status and physiological dis-turbance for 5 days after ICU admission. (4).Energy expenditure was significnatly affected by body weight and age of the patients. (5).During the first 7 days after ICU admission, age, body weight at admission, serum lactate value, and multiple organ dysfunction score (MODS) can collectively illus-trate the variation of energy expenditure up to 58 %. (6).Multivariate analysis revealed that the potential risk of death within first week after ICU admission can be evaluated by sepsis related organ failure assessment (SOFA) scores, body weight on admission, and APACHE II scores. They collectively can pre-dict patient outcome with a positive predictive value up to 92.19%.