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Energy expenditure and nutritional substrate utilization in critically ill patients.
Korvasová, Hana ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
This thesis deals with the measurement of (resting) energy expenditure and oxidation of nutritional substrates in critically ill patients, according to variously given nutritional support. The comparison of nutritional substrate incomes followed recommendation of the ESPEN guidance. Patients were examined by indirect calorimetry. This study included 9 critically ill patients on the ventilator, of which 1 patient was spontaneously breathing. (Resting) energy expenditure and oxidation of individual nutritional substrates were determined from the measured values. Firstly, the measurements were taken on fasting patients (without nutritional support). Secondly, a low caloric nutrition (1370  296.7 kcal/day) and lastly, normocaloric nutrition (2169.802  500.926 kcal/day) were given. This study also demonstrated the inaccuracy of resting energy expenditure estimation using predictive equations (the Harris-Benedict equation specifically), compared to the measured (R)EE by indirect calorimetry. According to the results of the HB-equation, resting energy expenditure decreased with increasing nutritional support. However, indirect calorimetry values showed the opposite, namely the increase in (resting) energy expenditure with increasing nutritional support. A statistically significant difference was found...
Energy expenditure and nutritional substrate utilization in critically ill patients.
Korvasová, Hana ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
This thesis deals with the measurement of (resting) energy expenditure and oxidation of nutritional substrates in critically ill patients, according to variously given nutritional support. The comparison of nutritional substrate incomes followed recommendation of the ESPEN guidance. Patients were examined by indirect calorimetry. This study included 9 critically ill patients on the ventilator, of which 1 patient was spontaneously breathing. (Resting) energy expenditure and oxidation of individual nutritional substrates were determined from the measured values. Firstly, the measurements were taken on fasting patients (without nutritional support). Secondly, a low caloric nutrition (1370  296.7 kcal/day) and lastly, normocaloric nutrition (2169.802  500.926 kcal/day) were given. This study also demonstrated the inaccuracy of resting energy expenditure estimation using predictive equations (the Harris-Benedict equation specifically), compared to the measured (R)EE by indirect calorimetry. According to the results of the HB-equation, resting energy expenditure decreased with increasing nutritional support. However, indirect calorimetry values showed the opposite, namely the increase in (resting) energy expenditure with increasing nutritional support. A statistically significant difference was found...
Indirect calorimetry application in two different insulin-resistant states - polytrauma and pregnancy
Patková, Anna ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee) ; Kacerovský, Marian (referee)
Charles University, Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Candidate: Mgr. Anna Patková Supervisor: doc. PharmDr. Miloslav Hronek, Ph.D. Title of Doctoral Thesis: Indirect calorimetry application in two different insulin-resistant states - polytrauma and pregnancy Introduction and Objective: Indirect calorimetry is the gold standard for energy expenditure (EE) determination that is currently considered to be the best indicator of individual energy requirements - both in health and in illness. Although polytrauma and pregnancy could seem as two physiologically different states, they are quite similar in metabolic terms. Both in polytrauma and in late pregnancy, catabolism increases energy expenditure and insulin resistance occurs. Not only common characteristics mentioned above distinguish these two groups from healthy individuals and non-pregnant women. The aim of this dissertation was to describe the metabolism of polytrauma patients and healthy pregnant women together with the factors that affect it. Besides energy expenditure, this work focuses on respiratory quotient (RQ; in polytrauma also in relation to indirect prognostic markers), which characterizes nutritional substrate oxidations. In pregnant women, the dissertation is also focused on the...
Indirect calorimetry application in two different insulin-resistant states - polytrauma and pregnancy
Patková, Anna ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee) ; Kacerovský, Marian (referee)
Charles University, Faculty of Pharmacy in Hradec Králové Department of Biological and Medical Sciences Candidate: Mgr. Anna Patková Supervisor: doc. PharmDr. Miloslav Hronek, Ph.D. Title of Doctoral Thesis: Indirect calorimetry application in two different insulin-resistant states - polytrauma and pregnancy Introduction and Objective: Indirect calorimetry is the gold standard for energy expenditure (EE) determination that is currently considered to be the best indicator of individual energy requirements - both in health and in illness. Although polytrauma and pregnancy could seem as two physiologically different states, they are quite similar in metabolic terms. Both in polytrauma and in late pregnancy, catabolism increases energy expenditure and insulin resistance occurs. Not only common characteristics mentioned above distinguish these two groups from healthy individuals and non-pregnant women. The aim of this dissertation was to describe the metabolism of polytrauma patients and healthy pregnant women together with the factors that affect it. Besides energy expenditure, this work focuses on respiratory quotient (RQ; in polytrauma also in relation to indirect prognostic markers), which characterizes nutritional substrate oxidations. In pregnant women, the dissertation is also focused on the...
Application of insulin in the regulation of blood glucose levels within the therapy in critically ill patients
Beil, Kamil ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
This thesis presents and compares the results of clinical trials found during intensive insulin therapy (IIT) in critically ill patients (CIP) hospitalized in intensive care units (ICU). The aim of this thesis was to search usage processing and the importance applications of insulin in the treatment of critically ill patients in intensive care units. It explains principles and issues of insulin use in this indication with presentation of IIT risks. Clinical studies were carried out in the ICU with a different focus (medical, surgical, cardiac surgery, mixed etc.). In most studies, patients were randomized into two groups - group IIT maintained glycemic range from 80 to 110 mg / dl, i.e. from 4,4 to 6,1 mmol / l; group of conventional insulin therapy should range glycemia from 180 to 200 mg / dl, i.e. from 10,0 to 11,1 mmol / l. In most studies, it has been shown to reduce complications and mortality in patients treated with IIT compared to patients treated with conventional insulin therapy. Less strict insulin therapy was able partially leave IIT advantage and reduce the risk of hypoglycemia. On the other hand, although IIT increased risk of hypoglycemia, did not increase mortality. Explaining the observed differences in mortality and morbidity among studies appear to be obviously differences in...
Energy expenditure and utilization of nutritive substrates in septic patients during hospitalization in ICU
Hladová, Eliška ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
The aim of this work were examinations of septic patiens to determinate energy expenditure and the utilization of nutritional substrates and to compare results of examinations to standart recommendations of ESPEN for patient's nutrition. For investigations was used indirect calorimetry. Our group of septic patients consisted of three men and three women from 58 to 73 years old. The lenght of the hospital stay was different, so the group was heterogenous and each patient was in different phase of sepsis. Five of six patients were in hypermetabolism. The value of energy expenditure was from 87,3 % to 176,2 %. Average energy expenditure was 1790,3 ± 414,9 kcal/ kg/ day and average energy of nutrition was 2080,2 ± 754,7kcal/ kg/ day. As for nutritional substrates, average income of carbohydrates was 257,9 ± 109,9 g/ den. Average utilization of carbohydrates was 83,9 ± 62,1 g/ day. So the intake of carbohydrates were significantly higher, than the utilization. Average income of lipids was 63,6 ± 15,7 g/ day and average utilization was 102,1 ± 61,8 g/ day. There was also significant diference between lipid utilization and lipid intake. Average income of proteins was 127,4 ± 61,7 g/ day. Average utilization of proteins was 132,5 ± 53,6 g/ day. To conclusion, the results of examinations, measured by...
The evaluation of DNA oxidative damage at polytraumatic patients.
Štrofová, Marcela ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
The aim of this study was to observe levels of oxidative DNA damage in patients with multiple injuries in correlation with the nutritional support that the patients have received during their hospital stay. Oxidative DNA damage was evaluated in two periods of time, first evaluation was performed during standard nutritional support according to the ESPEN guidelines. Second evaluation was performed after a change in nutrition according to individual parameters of metabolism and utilization of nutritional components based on indirect calorimetric measurements. This study included 6 patients with multiple injuries hospitalized in the Intensive Care Unit 1 at the Department of Surgery, University Hospital in Hradec Kralove. In this experiment DNA isolated from peripheral lymphocytes was used to evaluate oxidative DNA damage. This DNA was analyzed using the Comet Assay method. The enzymatic version of the Comet Assay was used to determine the oxidative damage of purines and pyrimidines, and the alkaline version was used for detection of single strand breaks. Mann-Whitney test was used for statistic evaluation the difference between both measuremetns, correlation analysis for relations between Comet Assay results and clinical parameters. Significant correlations between a total amount of nutrients given...
Evaluation of nitrogen balance with respect to the administered parenteral and enteral nutrition and the composition of the body in critically ill patients
Vaňková, Martina ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
The aim of this thesis was to identify and assess the nitrogen balance due to the field of nutritional support, body composition, energy expenditure, utilization of nutritional substrates and their changes during the hospitalization. Nitrogen balance was determined in 12 men and one woman (age 44 ± 16,4 years) with multiple injuries (ISS 40 ± 11) in the ICU based on 2 measurements in the time interval of 1-7 days, as the difference between the received and the ecrected nitrogen. The energy expenditure and nutritional substrate utilization nutritional indirect calorimetry, body composition analysis and blood chemistry laboratory were examined at patients. Correlation analysis revealed dependence between nitrogen balance and other monitored parameters and also dependence on the length of their trauma. Total protein intake averaged 1,40 ± 0,69 g.kg-1 .d-1 . At this dose were recorded negative values of nitrogen balance in the first measurement of the 9-patients and in the second measurement of the whole group. In this work also the results of uptake of parenteral and enteral route were compared. In practice, significant correlations were found between total uptake and energy expenditure (p = 6,31.10-3 ; r = 0,6) in the first measurement, and on the other hand negative correlation during the second...
The energy expenditure at critically ill patients
Švrčková, Alexandra ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
The aim of this study was to determine energy expenditure and to find relations between resting energy expenditure (REE) and selected parameters in 14 polytraumatic patients in the ICU of University Hospital in Hradec Kralove, which were easily measurable and usable for REE prediction. In this study 7 men (age 36 ± 18 years) and 7 women (age 58 ± 28 years) with polytrauma were examined. The assessment of REE was measured via indirect calorimetry (IC) method. The examination also included bioimpedance analysis (BIA). BIA was useful especially for obtaining values of overhydration (OH), lean tissue mass (LTM) and metabolically active body cell mass (BCM). Average REE-IC (measured by IC) was 2116 ± 516 kcal·day-1 in men and 1450 ± 407 kcal·day-1 in women (P = 0.018). Statistically significant difference between men's and women's population was also found in these relations: calculation of basal energy expenditure according to Harris-Bennedict equation without (P = 0.001) and with deduction of OH from body weight (P = 0.001), at "breathing energy expenditure" (REE related to respiratory rate) (P = 0.018) and at (REE related to heart rate) "heart rate energy expenditure" (P = 0.038). REE-IC related to kilogram of BCM with and without deduction of overhydration was shown as statistically significant...

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