Resting energy expenditures in haemodynamically compromised cardiac patients

Letter to the editor resting energy expenditures in haemodynamically compromised cardiac patients The impetuous development of malnutrition due to increased catabolic requirements as a consequence of critical illness is a well-known clinical problem (1). Adequate energy provision in critically ill patients improves clinical outcomes (2, 3), decreases hospital costs (4), and recommended by international guidelines (5, 6). The aim of present pilot trial was to evaluate the actual resting energy expenditures (REE) among haemodynamically compromised cardiac patients. Our study compared different methods for assessing REE. The resting energy expenditure was assessed using REE measured by indirect calorimetry (CCM Express, Medgraphics, St. Paul, MN, USA). The results of indirect calo-rimetry were compared with those determined by the Harris–Benedict formula and an em-piric approach. REE was calculated using the empiric approach as follows: for patients with a body mass index 20-30, REE was set at 25 kcal·kg –1 ·d –1 ; for patients with a body mass index <20, REE was set at 25 kcal/kg ideal body weight; and for patients with a body mass index >30, REE was calculated as 25 kcal/kg ideal body weight + 30% (7, 8). Data presented as median (25-75 percentiles). Forty patients operated on under cardiopulmo-nary bypass were included to the study. Measurements of REE were performed daily during the first 7 postoperative days and at the day of 14. The inclusion criteria were as follows: 1) signed informed consent from the patient or their next of kin; 2) age 18 years or older; 3) cardiopulmonary bypass surgery no more than 24 hours before eligibility assessment; 4) acute heart failure syndrome; 5) anticipated time of ventilation more than 48 hours. Acute heart failure syndrome was defined as a vasoactive-inotropic score (VIS) >5 calculated as follows: VIS = dobutamine (μg·kg −1 ·min −1) + dopamine (μg·kg −1 ·min −1) + 100 × epi-nephrine (μg·kg −1 ·min −1) + 100 × norepi-nephrine (μg·kg −1 ·min −1) + 10 × phenyleph-rine (μg·kg −1 ·min−1). The exclusion criteria were as follows: 1) increasing of VIS; 2) acidosis (pH <7.350 and/or serum lactate >4 mM); 3) hypoxia (arterial SpO 2 >60 mmHg); 4) bleeding; 5) cerebrovascular accident; 6) ileus; 7) diarrhoea (≥3 loose or liquid stools per day); 8) signs of mesenteric ischaemia. The estimates of REE by indirect calorimetry were significantly higher than those calculated empirically and using the Harris–Bene-dict equation (both p<0.05) at all time points. The actual REE …