Energy expenditure in postoperative multiple organ failure with acute renal failure

The provision of an adequate energy supply is of particular importance in patients sustaining long periods of multiple organ failure (MOF). Energy expenditure (EE) and hypermetabolism (measured EE expressed as percent above predicted basal metabolic rate) were investigated in 22 artificially ventilated patients with MOF during the second to fourth postoperative weeks. Eleven of these patients had severe acute renal failure (ARF) necessitating extracorporeal renal replacement therapy, whereas eleven patients had normal or only moderately impaired renal function (serum creatinine less than 200 mumol/l). The average EE in all patients was 124 +/- 17 (SD) kJ/kg x 24 h and the average hypermetabolism was 35 +/- 12%. Patients with MOF including ARF had significantly (p less than 0.01) lower EE (114 +/- 12 kJ/kg x 24 h) and hypermetabolism (28 +/- 7%) than patients with normal or only moderately impaired renal function (133 +/- 17 kJ/kg x 24 h and 42 +/- 12%, respectively). The results confirm that patients with MOF have only a moderate hypermetabolism and indicate that hypermetabolism is even less pronounced in MOF patients with ARF. The results suggest that the presence of ARF in MOF is associated with a more extensive reduction in aerobic metabolism than may be attributed to the loss of renal function. The marked interindividual variation in EE emphasizes the importance of EE monitoring as a guideline for nutritional support.