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[Energy expenditure during a pregnancy complicated by post-traumatic coma: analysis of 2 clinical cases]
A Paccagnella1, M A Calo, L Turolla
1II Servizio di Anestesia e Rianimazione, USSL 10-Ospedale Regionale di Treviso.
Objective:
To analyze the measured resting energy expenditure, the clinical evolution and the nutritional therapy of two pregnant women complicated by post-traumatic coma and sepsis.
Design:
Clinical study.
Setting:
The ICU of Neurosurgery in Regional Hospital in Italy.
Patients:
Two subjects with head trauma due to a motor vehicle accident.
Method:
The resting energy expenditure was measured (M-REE) by indirect calorimetry by oxygen consumption (VO2) and carbon dioxide production (VCO2). Values were controlled in patients with a hemodynamic stability every 4 hours. Predicted REE (P-REE) was calculated according to the Harris-Benedict formula. A total parenteral nutrition (1.2-1.3 x M-REE) composed of dextrose (70-80% of total caloric amount) and fat (20-30%) was infused in both the subjects. As an average 12-15 g of nitrogen were infused daily.
Results:
VO2 and VCO2 increased during the study (case 1: from 225 +/- 33 to 325 +/- 35 ml/min; p < 0.02; LR: p < 0.0001; VCO2: from 170 +/- 24 to 289 +/- 23 ml/min; p < 0.0001. Case 2: VO2: from 239 +/- 22 to 315 +/- 35 ml/min; p < 0.05; LR: p < 0.01. VCO2 from 177 +/- 31 to 247 +/- 22 ml/min; p < 0.05; LR: p < 0.001). M-REE/kg increased with statistical significance during the study (case 1: from 23.6 +/- 4.1 to 34.1 +/- 4.3, p < 0.05, LR: p < 0.005; case 2: from 23.7 +/- 5.8 to 33.4 +/- 7.7, p < 0.05, LR: p < 0.05). A physiological variation in oxidative capacity on nutritional substrates was reported throughout the study.
Conclusion:
Sepsis and miscarriages following trauma seem to be the cause in an increase of the energy expenditure rather than pregnancy itself. However our observations must be viewed with caution because they are based on a small number of patients.