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Metabolic changes in children with severe traumatic injuries
1Department of Pediatric Anesthesia and Intensive Care, Pediatric Surgery, Higher Medical Institute, Plovdiv, Bulgaria. slazarov@plovdiv.techno-link.com
Insights
Children with severe traumatic injuries have higher energy needs than standard formulas suggest. Increased nutritional support, guided by a correction factor of 1.22, can improve patient outcomes.
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.
Introduction:
Combined traumatic injuries are the leading cause for more than half the cases of lethal outcome in childhood. Trauma triggers a series of endocrinic and metabolic changes commonly known as acute metabolic stress. The hypermetabolic and hypercatabolic condition which develops as a result contributes to the high morbidity and mortality rates in children with traumatic injuries.
Methods:
Twenty five children (16 boys and 9 girls aged 4-15 years) were recruited from the patients admitted for treatment to the Department of Pediatric Anesthesia and Intensive Care at the Clinic of Pediatric Surgery in the Higher Medical Institute--Plovdiv, between 1994 and 1998. All children had severe combined trauma. Of these 20 (80%) presented with severe craniocerebral trauma; they were comatose with Glasgow Coma Scale Score of 7.3 +/- 4.3 (Sx = 3.59); the children were on mechanical ventilation and total parenteral nutrition. Energy expenditure was measured using computerised metabolic monitor Deltatrac II. VO2, VCO2, RQ, energy expenditure (MEE), oxygen consumption and nitrogen excretion levels were monitored.
Results:
The mean energy expenditure measured during the first, second and third 24-hour period was 50.04 kcal/kg/d-1, 50.54 kcal/kg/d-1 and 51.38 kcal/kg/d-1, respectively; the respiratory quotient was 0.81 +/- 0.0114 Sd, the oxygen consumption index 7.32 +/- 0.08 Sd ml/min/m2. The energy expenditure calculated by the Fleisch formula was 42.38 +/- 1.24 kcal/kg/d-1, (Sx = 6.19); this value differed statistically significantly from the value we measured (50.63 +/- 1.31, Sx = 6.57, p < 0.0001), the injury correction factor (ICF) was calculated to be 1.22 +/- 0.02 Sd.
Conclusions:
Actual energy expenditure in children with severe traumatic injuries is considerably higher than that calculated by formulae. Based on our results we recommend that the energy and substrate intake to be increased above the values calculated by formulae by a coefficient of 1.22 which is the measured correction factor. Thus the increased energy requirements will be met and the patients' prognosis will be improved.
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