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Utilisation of nutritive substrates at polytraumatic patients.
Valentová, Gabriela ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
There are significant differences in the metabolism of nutritional substrates in polytrauma patients. The actual metabolic needs of the patient may not be achieved despite the guidelines and recommendations for energy supply in the parenteral and enteral form of nutrition are followed. Subsequently this may lead to the occurrence of complications. The aim of the study was to compare the energy intake of each nutrient substrate supplied with nutrition by finding the nutritional substrate utilisation value which is obtained from indirect calorimetry measurements in patients with multiple injuries at the surgical ICU 1 of the Hradec Králové Teaching Hospital. By comparing this data you can obtain the optimum value for the nutritional needs of the patients. In the study we used seven spontaneously breathing polytrauma patients, three women and four men, of an average age of 41±21 years. Utilisations of nutritive substrates of each patient were obtained by indirect calorimetry. Accurate information on the amount and composition of nutrition supplied over 24 hours was also obtained. The patients received an average of 3.80±1.40 g/kg/day of carbohydrates, 1.03±0.56 g/kg/day of lipids and 1.40 ± 0.44 g/kg /day of proteins. The total energy intake was on average 30.94±11.03 kcal/kg/day. In six of seven...
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Resting energy expenditure by polytraumatic patients.
Tichá, Veronika ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
Critically ill patients are characterized by an increased catabolic response, a hypermetabolic state, higher nutritional requirements and a decreased capacity for utilization of parenteral substrate. Measurement of energetic expenditure in critically ill patients is necessery to determine the optimal nutritional support which is individual for everyone patient with the view of contribute to recovery, to prevent possible complications of overfeeding or underfeeding and reduce the hospitalization period. Energy expenditure was measured in two intervals by indirect calorimetry in 12 polytrauma patients (mean age 32 years ± 16 years) in the intensive care unit at FN HK. The hypermetabolic state of patients was evaluated from the ratio of REE/BEE (REE regarding basal energy expenditure calculated on the basis of the Harris-Benedict equation) and was also evaluated utilization of substrates. Resting energy expenditure during the first examination was on average 2195 kcal/d ± 665,8 kcal/d, at the second examination of 2031 kcal/d ± 590,9 kcal/d. Between measurements was no statistically significant difference. Mean REE/BEE was 122,3 % ± 27,44 %, 118,5 % ± 23,15 %, respectively. Respiratory quotient has an average around 0,81, which indicates a preferential utilization of proteins. The large loss of...
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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...
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Resting energy expenditure at polytraumatic patients.
Šimandl, Ondřej ; Hronek, Miloslav (advisor) ; Havel, Eduard (referee)
The aim of this study was to determine and evaluate resting energy expenditure (REE) and the utilization of nutritional substrates in 14 polytrauma patients in the ICU. Was also assessed level of impact Overhydration (OH) on the accuracy of the determination. Diagnostic investigations using indirect calorimetry (IC) was performed in 9 men and 5 women (age 30 ± 15 years, BMI 27.5 ± 9.4 kg·m-2) with polytrauma (ISS 41 ± 16). For more accurate sizing of REE and extent of utilization of nutritional substrates were used equations derived from the equation of Weir, not Softwear calorimeter. Using IC volumes were determined only inspired an expired oxygen and carbon dioxide. To determine the rate of OH was used bioimpedance analysis methods using BCM. Almost 86% (8 men and 4 women) examined patients showed hypermetabolism. Average REE value was 2241.38 ± 854.27 kcal·day-1, which represented an average increase of prediction of 38.09 ± 49.09% due to the physiological condition. A statistically significant relationship was demonstrated between REE determined using the Weir equation according and the Harris-Bennedict equation without (P = 0,01) with deduction of OH (P = 0,007) only in men. In clinical practice, significant correlations were established between the REE-IC and BSA (P < 0,01), LTM (P < 0,05),...
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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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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...
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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...
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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...
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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...
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