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Energy Expenditure in Children after Severe Traumatic Brain Injury
Filetype[PDF - 317.20 KB]


Details:
  • Pubmed ID:
    24394999
  • Pubmed Central ID:
    PMC4703075
  • Funding:
    U01 CE001630/CE/NCIPC CDC HHS/United States
    R01 NS072308/NS/NINDS NIH HHS/United States
    NS070003/NS/NINDS NIH HHS/United States
    R21 NS070003/NS/NINDS NIH HHS/United States
    R01 NS069247/NS/NINDS NIH HHS/United States
    F32 HD008003/HD/NICHD NIH HHS/United States
    U01 NS052478/NS/NINDS NIH HHS/United States
    T32 HD040686/HD/NICHD NIH HHS/United States
  • Document Type:
  • Collection(s):
  • Description:
    Objective

    To evaluate energy expenditure in a cohort of children with severe traumatic brain injury (TBI).

    Design

    A prospective observational study.

    Setting

    A pediatric neurotrauma center within a tertiary care institution.

    Patients

    Mechanically-ventilated children admitted with severe traumatic brain injury (GCS<9) with a weight greater than 10 kg were eligible for study. A subset of children was co-enrolled in a phase 3 study of early, therapeutic hypothermia. All children were treated with a comprehensive neurotrauma protocol that included sedation, neuromuscular blockade, temperature control, anti-seizure prophylaxis and a tiered-based system for treating intracranial hypertension.

    Interventions

    Within the first week after injury, indirect calorimetry measurements were performed daily when the patient’s condition permitted.

    Measurements and Main Results

    Data from 13 children were analyzed (with a total of 32 assessments). Measured energy expenditure (MEE) obtained from indirect calorimetry was compared to resting energy expenditure (pREE) calculated from Harris-Benedict equation. Overall, MEE/pREE averaged 70.2 ± 3.8%. Seven measurements obtained while children were hypothermic did not differ from normothermic values (75 ± 4.5% vs. 68.9 ± 4.7% respectively, p = 0.273). Moreover, children with favorable neurologic outcome at 6 months did not differ from children with unfavorable outcome (76.4 ± 6% vs. 64.7 ± 4.7% for the unfavorable outcome, p = 0.13).

    Conclusions

    Contrary to previous work from several decades ago that suggested severe pediatric TBI is associated with a hypermetabolic response (MEE/pREE > 110%); our data suggest that contemporary neurocritical care practices may blunt such a response. Understanding the metabolic requirements of children with severe TBI is the first step in development of rational nutritional support goals that might lead to improvements in outcome.