Metabolic changes in children with severe traumatic injuries

Area of Science:

• Pediatric critical care medicine
• Trauma surgery
• Pediatric intensive care

Background:

• Combined traumatic injuries are a leading cause of death in children.
• Trauma induces acute metabolic stress, characterized by hypermetabolism and hypercatabolism.
• This metabolic state contributes to high morbidity and mortality in pediatric trauma patients.

Purpose of the Study:

• To accurately measure the actual energy expenditure in children with severe combined trauma.
• To compare measured energy expenditure with values calculated by standard formulas.
• To establish a correction factor for nutritional support in this patient population.

Main Methods:

• Twenty-five children (aged 4-15 years) with severe combined trauma were studied.
• Energy expenditure was measured using a computerised metabolic monitor (Deltatrac II).
• Parameters monitored included VO2, VCO2, respiratory quotient (RQ), and nitrogen excretion.

Main Results:

• Measured mean energy expenditure was significantly higher (50.63 kcal/kg/d) than calculated values (42.38 kcal/kg/d) using the Fleisch formula (p < 0.0001).
• The calculated injury correction factor (ICF) was 1.22.
• Oxygen consumption index was 7.32 ml/min/m2 and RQ was 0.81.

Conclusions:

• Actual energy expenditure in pediatric trauma patients exceeds calculations from standard formulas.
• A recommended increase in energy and substrate intake by a factor of 1.22 is proposed.
• Implementing this adjusted nutritional support may improve patient prognosis.