Nutrition challenges in polytrauma patients. New trends in energy expenditure measurements

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Patients hospitalized in Intensive Care Units (ICU) are in severe general condition and they need specialized care, rehabilitation and proper nutrition to improve their condition and recover as soon as possible. Therefore, it is very important that nutrition consists of all necessary elements that will cover their daily demand for nutrients. However, malnutrition among ICU patients is very common. According to statistics, up to 50% is malnourished. It enhances average length of stay, risk of infection, prolongs ventilator days, delays wound healing and translates into an increased hospital cost. It may end in multi-organ failure, what in consequence increases mortality. Polytrauma pa tients lost their energy because of intensified catabolism, due to neuroendocrine changes and inflammatory reactions, which may worsen already existing malnutrition.

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  • 1. Finfer S. Clinical controversies in the management of critically ill patients with severe sepsis. Virulence [Internet]. 2014;5(1):200–5. Available from:

  • 2. Lee SH Park MS Park BH Jung WJ Lee IS Kim SY et al. Prognostic implications of serum lipid metabolism over time during sepsis. Biomed Res Int. 2015;2015(Ldl).

  • 3. Simsek T Uzelli Simsek H Canturk NZ. Response to trauma and metabolic changes: posttraumatic metabolism. Turkish J Surg [Internet]. 2014;30(3):153–9. Available from:

  • 4. Novak F Heyland DK Avenell A Drover JW Su X. Glutamine supplementation in serious illness: A systematic review of the evidence*. Crit Care Med [Internet]. 2002;30(9). Available from:

  • 5. Mara J Gentles E Alfheeaid HA Diamantidi K Spenceley N Davidson M et al. An evaluation of enteral nutrition practices and nutritional provision in children during the entire length of stay in critical care. 2014;1–9.

  • 6. Hu W Cajas-monson LC Eisenstein S Parry L Cosman B Ramamoorthy S. Preoperative malnutrition assessments as predictors of postoperative mortality and morbidity in colorectal cancer : an analysis of ACS-NSQIP. 2015;1–6.

  • 7. Id AS Theilla M Hellerman M Singer P Maggiore U Barbagallo M et al. Energy and Protein in Critically Ill Patients with AKI : A Prospective Multicenter Observational Study Using Indirect Calorimetry and Protein Catabolic Rate.

  • 8. Pravda J. Metabolic theory of septic shock. World J Crit Care Med [Internet]. 2014;3(2):45–54. Available from:

  • 9. Dogjani A Zatriqi S Uranues S Latifi R. Biology-based nutritional support of critically ill and injured patients. Eur Surg - Acta Chir Austriaca. 2011;43(1):7–12.

  • 10. Ostrowski SR Sørensen AM Windeløv NA Perner A Welling K-L Wanscher M et al. High levels of soluble VEGF receptor 1 early after trauma are associated with shock sympathoadrenal activation glycocalyx degradation and inflammation in severely injured patients: a prospective study. Scand J Trauma Resusc Emerg Med [Internet]. 2012;20(1):27. Available from:

  • 11. Davis SM Clark EAS Nelson LT Silver RM. The association of innate immune response gene polymorphisms and puerperal group A streptococcal sepsis. Am J Obstet Gynecol [Internet]. 2010 Mar;202(3):308. e1-308.e8. Available from:

  • 12. de Oliveira Iglesias S Leite H Paes  de Oliveira S Sarni R. Low plasma selenium concentrations in critically ill children: the interaction effect between inflammation and selenium deficiency. Crit Care [Internet]. 2014;18(3):R101. Available from:

  • 13. Rogobete AF Sandesc D Papurica M Stoicescu ER Popovici SE Bratu LM et al. The influence of metabolic imbalances and oxidative stress on the outcome of critically ill polytrauma patients: a review. Burn Trauma [Internet]. 2017;5(1):8. Available from:

  • 14. Hartl WH Jauch KW. Metabolic self-destruction in critically ill patients: Origins mechanisms and therapeutic principles. Nutrition [Internet]. 2014;30(3):261–7. Available from:

  • 15. Andrews PJD Avenell A Noble DW Campbell MK Croal BL Simpson WG et al. Randomised trial of glutamine selenium or both to supplement parenteral nutrition for critically ill patients. Bmj [Internet]. 2011;342(mar17 2):d1542–d1542. Available from:

  • 16. Papurica M Rogobete AF Sandesc D Dumache R Nartita R Sarandan M et al. Redox Changes Induced by General Anesthesia in Critically Ill Patients with Multiple Traumas. Mol Biol Int. 2015;2015:238586.

  • 17. Bedreag OH Rogobete AF Sandesc D Cradigati CA Sarandan M Popovici SE et al. Modulation of the Redox Expression and Inflammation Response in the Critically Ill Polytrauma Patient with Thoracic Injury. Statistical Correlations between Antioxidant Therapy and Clinical Aspects. A Retrospective Single Center Study. 2016;(10):1747–59.

  • 18. Papurica M Rogobete AF Sandesc D Dumache R Cradigati CA Sarandan M et al. Advances in biomarkers in critical ill poly-trauma patients. Clin Lab. 2016;62(6).

  • 19. Bedreag OH Rogobete AF Sărăndan M Cradigati A Păpurică M Maria O et al. Oxidative stress and antioxidant therapy in traumatic spinal cord injuries. 2014;21(2):123–9.

  • 20. Koekkoek WAC (Kristine) van Zanten ARH. Antioxidant Vitamins and Trace Elements in Critical Illness. Nutr Clin Pract [Internet]. 2016;31(4):457–74. Available from:

  • 21. Maraki MI Panagiotakos B Jansen LT. Validity of Predictive Equations for Resting Energy Expenditure in Greek Adults. 2018;72701:134–41.

  • 22. Nakajima N Ito Y Yokoyama K Uno A Kato K Iwasaki A et al. The expresssion of Mdm2 on Helicobacter pylori infected intestinal metaplasia and gastric cancer. J Clin Biochem Nutr. 2005;128(4):A401–2.

  • 23. Compher C Frankenfield D Keim N Roth-Yousey L. Best Practice Methods to Apply to Measurement of Resting Metabolic Rate in Adults: A Systematic Review. J Am Diet Assoc. 2006;106(6):881–903.

  • 24. Frankenfield D Hise M Malone A Russell M Gradwell E Compher C. Prediction of resting metabolic rate in critically ill adult patients: results of a systematic review of the evidence. J Am Diet Assoc. 2007;107(9):1552–61.

  • 25. Kross EK Sena M Schmidt K Stapleton RD. A comparison of predictive equations of energy expenditure and measured energy expenditure in critically ill patients. J Crit Care [Internet]. 2012;27(3):321. e5-321.e12. Available from:

  • 26. In R Eh E. Recent advances in gas exchange measurement in intensive care patients. 2003;91(1):120–31.

  • 27. Hensel M Kox WJ. Increased intrapulmonary oxygen consumption in mechanically ventilated patients with pneumonia. Am J Respir Crit Care Med [Internet]. 1999;160(1):137–43. Available from:

  • 28. Moral V. Alveolar recruitment improves ventilation during thoracic surgery : a randomized controlled trial. 2012;108(May 2011):517–24.

  • 29. Peyton P Stuart-andrews C Robinson G. Indirect Calorimetry has Better Reproducibility than the Reverse Fick Method in Measurement of Oxygen Uptake. 2010;1–6.

  • 30. Singer P Pogrebetsky I Attal-Singer J Cohen J. Comparison of metabolic monitors in critically ill ventilated patients. Nutrition. 2006;22(11–12):1077–86.

  • 31. Briassoulis G Michaeloudi E Fitrolaki DM Spanaki AM Briassouli E. Influence of different ventilator modes on Vo2 and Vco2 measurements using a compact metabolic monitor. Nutrition [Internet]. 2009;25(11–12):1106–14. Available from:

  • 32. Meyer R Briassouli E Briassoulis G Habibi P. Evaluation of the M-COVX metabolic monitor in mechanically ventilated adult patients. e-SPEN. 2008;3(5).

  • 33. Sundström M Tjäder I Rooyackers O Wernerman J. Indirect calorimetry in mechanically ventilated patients. A systematic comparison of three instruments. Clin Nutr [Internet]. 2013;32(1):118–21. Available from:

  • 34. Blond E Maitrepierre C Normand S Sothier M Roth H Goudable J et al. A new indirect calorimeter is accurate and reliable for measuring basal energy expenditure thermic effect of food and substrate oxidation in obese and healthy subjects. e-SPEN [Internet]. 2011;6(1):e7–15. Available from:

  • 35. Graf S Karsegard VL Viatte V Heidegger CP Fleury Y Pichard C et al. Evaluation of three indirect calorimetry devices in mechanically ventilated patients: Which device compares best with the Deltatrac II®? A prospective observational study. Clin Nutr [Internet]. 2015;34(1):60–5. Available from:

  • 36. Wang X Ms YW Ding Z Ms GC Hu F. Relative validity of an indirect calorimetry device for measuring resting energy expenditure and respiratory quotient. 2018;27(December 2015):72–7.

  • 37. Rosado EL Kaippert VC Brito RS De. Energy Expenditure Measured by Indirect Calorimetry in Obesity. 2013;

  • 38. Panitchote A Thiangpak N Hongsprabhas P Hurst C. Short Communication Energy expenditure in severe sepsis or septic shock in a Thai Medical Intensive Care Unit. 2017;26(April 2016):794–7.

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