Effect of sedation on resting energy expenditure in patients with extremely severe burns and the choice of energy estimation formula

Shen Tao; Zhang Liping; Wang Yiran; Zhu Zhikang; Han Chunmao

doi:10.3760/cma.j.cn501225-20220530-00207

Volume 38 Issue 8

Aug. 2022

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Article Navigation > CHINESE JOURNAL OF BURNS AND WOUNDS > 2022 > 38(8): 714-721

Cheng Lin, Du Weili, Zhang Ying, et al. Staged repair strategy for chronic sacrococcygeal radiation ulcer[J]. Chin j Burns, 2021, 37(3): 225-231. DOI: 10.3760/cma.j.cn501120-20210104-00003

Citation:

Shen T,Zhang LP,Wang YR,et al.Effect of sedation on resting energy expenditure in patients with extremely severe burns and the choice of energy estimation formula[J].Chin J Burns Wounds,2022,38(8):714-721.DOI: 10.3760/cma.j.cn501225-20220530-00207.

Cheng Lin, Du Weili, Zhang Ying, et al. Staged repair strategy for chronic sacrococcygeal radiation ulcer[J]. Chin j Burns, 2021, 37(3): 225-231. DOI: 10.3760/cma.j.cn501120-20210104-00003

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Effect of sedation on resting energy expenditure in patients with extremely severe burns and the choice of energy estimation formula

doi: 10.3760/cma.j.cn501225-20220530-00207

1.
Rehabilitation Department of Traditional Chinese Medicine, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China
2.
Department of Burn and Wound Repair, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China

Funds:

Construction Project of Clinical Medical Research Center for Acute and Critical Care of Zhejiang Province of China 2021E50004

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Corresponding author: Han Chunmao, Email: zrssk@zju.edu.cn
Received Date: 2022-05-30

Abstract

Abstract

Objective To investigate the effect of sedation on resting energy expenditure (REE) in patients with extremely severe burns and the choice of REE estimation formula during the treatment. Methods A retrospective non-randomized controlled clinical study was conducted. From April 2020 to April 2022, 21 patients with extremely severe burns who met the inclusion criteria and underwent mechanical ventilation treatment were admitted to the Department of Burn and Wound Repair of Second Affiliated Hospital of Zhejiang University School of Medicine, including 16 males and 5 females, aged 60 (50, 69) years. Early anti-shock therapy, debridement, skin transplantation, nutritional support, and other conventional treatments were applied to all patients. Patients were sedated when they had obvious agitation or a tendency to extubate, which might lead to aggravation of the disease. REE measurement was performed on patients using indirect calorimetry on post-injury day 3, 5, 7, 9, 11, 14 and every 7 days thereafter until the patient died or being successfully weaned from ventilator. Totally 99 times of measurements were carried out, of which 58 times were measured in the sedated state of patients, and 41 times were measured in the non-sedated state of patients. The age, weight, body surface area, residual wound area, post-injury days of patients were recorded on the day when REE was measured (hereinafter briefly referred to as the measurement day). The REE on the measurement day was calculated with intensive care unit conventional REE estimation formula Thumb formula and special REE estimation formulas for burns including the Third Military Medical University formula, the Peng Xi team's linear formula, Hangang formula. The differences between the sedated state and the non-sedated state in the clinical materials, measured and formula calculated values of REE of patients on the measurement day were compared by Mann-Whitney U test and independent sample t test. The differences between the REE formula calculated values and the REE measured value (reflecting the overall consistency) in the sedated state were compared by Wilcoxon signed rank-sum test. The Bland-Altman method was used to assess the individual consistency between the REE formula calculated value and the REE measured value in the sedated state, and to calculate the proportion of the REE formula calculated value within the range of ±10% of the REE measured value (hereinafter referred to as the accuracy rate). Root mean square error (RMSE) was used to evaluate the accuracy of the REE formula calculated value relative to the REE measured value. Results Compared with those in the non-sedated state, there was no statistically significant change in patient's age or post-injury days on the measurement day in the sedated state (P>0.05), but the weight was heavier (Z=-3.58, P<0.01), and both the body surface area and the residual wound area were larger (with Z values of -2.99 and -4.52, respectively, P<0.01). Between the sedated state and the non-sedated state, the REE measured values of patients were similar (P>0.05). Compared with those in the non-sedated state, the REE values of patients calculated by Thumb formula, the Third Military Medical University formula, the Peng Xi team's linear formula, and Hangang formula on the measurement day in the sedated state were significantly increased (with Z values of -3.58 and -5.70, t values of -3.58 and -2.74, respectively, P<0.01). In the sedated state, compared with the REE measured value, there were statistically significant changes in REE values of patients calculated by Thumb formula, the Third Military Medical University formula, and Hangang formula on the measurement day (with Z values of -2.13, -5.67, and -3.09, respectively, P<0.05 or P<0.01), while the REE value of patients calculated by the Peng Xi team's linear formula on the measurement day did not change significantly(P>0.05). The analysis of the Bland-Altman method showed that in the sedated state, compared with the REE measured value, the individual consistency of the calculated value of each formula was good; Thumb formula and Hangang formula significantly underestimated the patients' REE value (with the average value of the difference between the formula calculated value and the measured value of -1 463 and -1 717 kJ/d, the 95% confidence interval of -2 491 to -434 and -2 744 to -687 kJ/d, respectively), but the individual differences were small; the Third Military Medical University formula significantly overestimated the patients' REE value (with the average value of the difference between the formula calculated value and the measured value of 3 530 kJ/d, the 95% confidence interval of 2 521 to 4 539 kJ/d), but the individual difference was small; the Peng Xi team's linear formula did not significantly overestimate the patients' REE value (with the average value of the difference between the formula calculated value and the measured value of 294 kJ/d, the 95% confidence interval of -907 to 1 496 kJ/d), while the difference standard deviation was 4 568 kJ/d, which showed a large individual difference. In the sedated state, relative to the REE measured value, the accuracy rates of REE values calculated by Thumb formula, the Third Military Medical University formula, the Peng Xi team's linear formula, and Hangang formula were 25.9% (15/58), 15.5% (9/58), 10.3% (6/58), and 15.5% (9/58), respectively, and RMSE values were 4 143.6, 5 189.1, 4 538.6, and 4 239.8 kJ/d, respectively. Conclusions Sedative therapy leads to a significant decrease in REE in patients with extremely severe burns undergoing mechanical ventilation treatment. When REE cannot be regularly monitored by indirect calorimetry to determine nutritional support regimens, patients with extremely severe burns undergoing sedation may be prioritized to estimate REE using Thumb formula.
- Burns,
- Calorimetry, indirect,
- Nutritional support,
- Sedation,
- Resting energy expenditure

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References

[1]	OshimaT,BergerMM,De WaeleE,et al.Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group[J].Clin Nutr,2017,36(3):651-662.DOI: 10.1016/j.clnu.2016.06.010.
[2]	DelsoglioM,AchamrahN,BergerMM,et al.Indirect calorimetry in clinical practice[J].J Clin Med,2019,8(9):1387.DOI: 10.3390/jcm8091387.
[3]	GuptaRD,RamachandranR,VenkatesanP,et al.Indirect calorimetry: from bench to bedside[J].Indian J Endocrinol Metab,2017,21(4):594-599.DOI: 10.4103/ijem.IJEM_484_16.
[4]	RousseauAF,LosserMR,IchaiC,et al.ESPEN endorsed recommendations: nutritional therapy in major burns[J].Clin Nutr,2013,32(4):497-502.DOI: 10.1016/j.clnu.2013.02.012.
[5]	XieWG,LiA,WangSL.Estimation of the calorie requirements of burned Chinese adults[J].Burns,1993,19(2):146-149.DOI: 10.1016/0305-4179(93)90039-b.
[6]	PengX,WangKF,ZhangH,et al.Establishment and assessment of new formulas for energy consumption estimation in adult burn patients[J]. PLoS One,2014,9(10):e110409.DOI: 10.1371/journal.pone.0110409.
[7]	JeonJ,KymD,ChoYS,et al.Reliability of resting energy expenditure in major burns: comparison between measured and predictive equations[J].Clin Nutr,2019,38(6):2763-2769.DOI: 10.1016/j.clnu.2018.12.003.
[8]	RimdeikaR,GudavicieneD,AdamonisK,et al.The effectiveness of caloric value of enteral nutrition in patients with major burns[J].Burns,2006,32(1):83-86.DOI: 10.1016/j.burns.2005.08.003.
[9]	De WaeleE,JonckheerJ,WischmeyerPE.Indirect calorimetry in critical illness: a new standard of care?[J].Curr Opin Crit Care,2021,27(4):334-343.DOI: 10.1097/MCC.0000000000000844.
[10]	LinYC,HuangCC,SuNY,et al.Patient-controlled analgesia for background pain of major burn injury[J]. J Formos Med Assoc,2019,118(1 Pt 2):299-304.DOI: 10.1016/j.jfma.2018.05.008.
[11]	FuzaylovG,KellyTL,BlineC,et al.Post-operative pain control for burn reconstructive surgery in a resource-restricted country with subcutaneous infusion of local anesthetics through a soaker catheter to the surgical site: preliminary results[J].Burns,2015,41(8):1811-1815.DOI: 10.1016/j.burns.2015.06.003.
[12]	YangC,XuXM,HeGZ.Efficacy and feasibility of opioids for burn analgesia: an evidence-based qualitative review of randomized controlled trials[J].Burns,2018,44(2):241-248.DOI: 10.1016/j.burns.2017.10.012.
[13]	GriggsC,GovermanJ,BittnerEA,et al.Sedation and pain management in burn patients[J].Clin Plast Surg,2017,44(3):535-540.DOI: 10.1016/j.cps.2017.02.026.
[14]	XiaF, HaoW, LiangJ, et al. Applicability of creatinine-based equations for estimating glomerular filtration rate in elderly Chinese patients[J].BMC Geriatr,2021,21(1):481.DOI: 10.1186/s12877-021-02428-y.
[15]	刘琰,王际壮.烧伤应激反应及其调控策略[J].中华烧伤杂志,2021,37(2):126-130.DOI: 10.3760/cma.j.cn501120-20201125-00499.
[16]	HansenJK,VossJ,GanatraH,et al.Sedation and analgesia during pediatric burn dressing change: a survey of american burn association centers[J].J Burn Care Res,2019,40(3):287-293.DOI: 10.1093/jbcr/irz023.
[17]	StanojcicM,AbdullahiA,RehouS,et al.Pathophysiological response to burn injury in adults[J].Ann Surg,2018,267(3):576-584.DOI: 10.1097/SLA.0000000000002097.
[18]	TignanelliCJ,AndrewsAG,SieloffKM,et al. Are predictive energy expenditure equations in ventilated surgery patients accurate?[J].J Intensive Care Med,2019,34(5):426-431.DOI: 10.1177/0885066617702077.
[19]	SingletonA,PrestonRJ,CochranA.Sedation and analgesia for critically ill pediatric burn patients: the current state of practice[J].J Burn Care Res,2015,36(3):440-445.DOI: 10.1097/BCR.0000000000000165.
[20]	BatemanRM,SharpeMD,JaggerJE,et al.36th international symposium on intensive care and emergency medicine: Brussels, Belgium. 15-18 March 2016[J].Crit Care,2016,20(Suppl 2):S94.DOI: 10.1186/s13054-016-1208-6.
[21]	SingerP,AnbarR,CohenJ,et al.The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients[J].Intensive Care Med,2011,37(4):601-609.DOI: 10.1007/s00134-011-2146-z.
[22]	HeideggerCP,BergerMM,GrafS,et al.Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial[J].Lancet,2013,381(9864):385-393.DOI: 10.1016/S0140-6736(12)61351-8.
[23]	李如兵,陈茜,张红艳,等.重症烧伤患者休克期镇痛镇静治疗安全性及疗效观察[J].中华烧伤杂志,2018,34(4):197-202.DOI: 10.3760/cma.j.issn.1009-2587.2018.04.002.
[24]	FaginA,PalmieriTL.Considerations for pediatric burn sedation and analgesia[J/OL].Burns Trauma,2017,5:28[2022-05-30]. https://pubmed.ncbi.nlm.nih.gov/29051890/.DOI: 10.1186/s41038-017-0094-8.
[25]	MancusoCE,TanziMG,GabayM.Paradoxical reactions to benzodiazepines: literature review and treatment options[J].Pharmacotherapy,2004,24(9):1177-1185.DOI: 10.1592/phco.24.13.1177.38089.
[26]	BaoN,TangB.Organ-protective effects and the underlying mechanism of dexmedetomidine[J].Mediators Inflamm,2020,2020:6136105.DOI: 10.1155/2020/6136105.
[27]	张钊,王英伟.丙泊酚对大脑功能网络调节机制的研究进展[J].国际麻醉学与复苏杂志,2021,42(10):1120-1124.DOI: 10.3760/cma.j.cn321761-20210713-00405.
[28]	杨逸成,陈贝儿,叶凯雁,等.右美托咪定的心脏保护机制及其临床应用价值[J].中国医学科学院学报,2022,44(1):130-135.DOI: 10.3881/j.issn.1000-503X.12895.
[29]	MuraseM,TaniH,SumitaYI,et al.Nutritional assessment in a maxillectomy patient from the preoperative period to definitive obturator insertion: a case report[J].J Prosthodont Res,2022,66(3):514-518.DOI: 10.2186/jpr.JPR_D_20_00250.
[30]	KaysenGA.Serum albumin concentration in dialysis patients: why does it remain resistant to therapy?[J].Kidney Int Suppl,2003(87):S92-98.DOI: 10.1046/j.1523-1755.64.s87.14.x.
[31]	RattanachaiwongS,SingerP.Should we calculate or measure energy expenditure? practical aspects in the ICU[J].Nutrition,2018,55-56:71-75.DOI: 10.1016/j.nut.2018.05.001.
[32]	RuanH,ZhaoX,YangQ,et al.Relationship between energy intake, prognosis and related indicators in adults after cardiac, thoracic, and vascular surgery: a prospective observational study[J].Asia Pac J Clin Nutr,2021,30(3):365-373.DOI: 10.6133/apjcn.202109_30(3).0003.
[33]	SergiG,CoinA,MuloneS,et al.Resting energy expenditure and body composition in bedridden institutionalized elderly women with advanced-stage pressure sores[J].J Gerontol A Biol Sci Med Sci,2007,62(3):317-322.DOI: 10.1093/gerona/62.3.317.
[34]	彭曦.重症烧伤患者的代谢分期及营养治疗策略[J].中华烧伤杂志,2021,37(9):805-810.DOI: 10.3760/cma.j.cn501120-20210802-00264.
[35]	原博,刘琰.严重烧伤后高代谢反应及其应对策略[J/CD].中华损伤与修复杂志:电子版,2021,16(4):343-348.DOI: 10.3877/cma.j.issn.1673-9450.2021.04.011.
[36]	秦启红,钮丹叶,刘军,等.代谢车在重度烧伤病人能量代谢测定中的应用[J].肠外与肠内营养,2016,23(6):332-335.DOI: 10.16151/j.1007-810x.2016.06.004.

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Effect of sedation on resting energy expenditure in patients with extremely severe burns and the choice of energy estimation formula

doi: 10.3760/cma.j.cn501225-20220530-00207