Cargando…
Absent Metabolic Transition from the Early to the Late Period in Non-Survivors Post Cardiac Surgery
After major surgery, longitudinal changes in resting energy expenditure (REE) as well as imbalances in oxygen delivery (DO(2)) and distribution and processing (VO(2)) may occur due to dynamic metabolic requirements, an impaired macro- and microcirculatory flow and mitochondrial dysfunction. However,...
Autores principales: | , , , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2022
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9416122/ https://www.ncbi.nlm.nih.gov/pubmed/36014872 http://dx.doi.org/10.3390/nu14163366 |
_version_ | 1784776402702172160 |
---|---|
author | Veraar, Cecilia Fischer, Arabella Bernardi, Martin H. Sulz, Isabella Mouhieddine, Mohamed Dworschak, Martin Tschernko, Edda Lassnigg, Andrea Hiesmayr, Michael |
author_facet | Veraar, Cecilia Fischer, Arabella Bernardi, Martin H. Sulz, Isabella Mouhieddine, Mohamed Dworschak, Martin Tschernko, Edda Lassnigg, Andrea Hiesmayr, Michael |
author_sort | Veraar, Cecilia |
collection | PubMed |
description | After major surgery, longitudinal changes in resting energy expenditure (REE) as well as imbalances in oxygen delivery (DO(2)) and distribution and processing (VO(2)) may occur due to dynamic metabolic requirements, an impaired macro- and microcirculatory flow and mitochondrial dysfunction. However, the longitudinal pattern of these parameters in critically ill patients who die during hospitalization remains unknown. Therefore, we analyzed in 566 patients who received a pulmonary artery catheter (PAC) their REE, DO(2), VO(2) and oxygen extraction ratio (O(2)ER) continuously in survivors and non-survivors over the first 7 days post cardiac surgery, calculated the percent increase in the measured compared with the calculated REE and investigated the impact of a reduced REE on 30-day, 1-year and 6-year mortality in a uni- and multivariate model. Only in survivors was there a statistically significant transition from a negative to a positive energy balance from day 0 until day 1 (Day 0: −3% (−18, 14) to day 1: 5% (−9, 21); p < 0.001). Furthermore, non-survivors had significantly decreased DO(2) during the first 4 days and reduced O(2)ER from day 2 until day 6. Additionally, a lower REE was significantly associated with a worse survival at 30 days, 1 year and 6 years (p = 0.009, p < 0.0001 and p = 0.012, respectively). Non-survivors seemed to be unable to metabolically adapt from the early (previously called the ‘ebb’) phase to the later ‘flow’ phase. DO(2) reduction was more pronounced during the first three days whereas O(2)ER was markedly lower during the following four days, suggesting a switch from a predominantly limited oxygen supply to prolonged mitochondrial dysfunction. The association between a reduced REE and mortality further emphasizes the importance of REE monitoring. |
format | Online Article Text |
id | pubmed-9416122 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-94161222022-08-27 Absent Metabolic Transition from the Early to the Late Period in Non-Survivors Post Cardiac Surgery Veraar, Cecilia Fischer, Arabella Bernardi, Martin H. Sulz, Isabella Mouhieddine, Mohamed Dworschak, Martin Tschernko, Edda Lassnigg, Andrea Hiesmayr, Michael Nutrients Article After major surgery, longitudinal changes in resting energy expenditure (REE) as well as imbalances in oxygen delivery (DO(2)) and distribution and processing (VO(2)) may occur due to dynamic metabolic requirements, an impaired macro- and microcirculatory flow and mitochondrial dysfunction. However, the longitudinal pattern of these parameters in critically ill patients who die during hospitalization remains unknown. Therefore, we analyzed in 566 patients who received a pulmonary artery catheter (PAC) their REE, DO(2), VO(2) and oxygen extraction ratio (O(2)ER) continuously in survivors and non-survivors over the first 7 days post cardiac surgery, calculated the percent increase in the measured compared with the calculated REE and investigated the impact of a reduced REE on 30-day, 1-year and 6-year mortality in a uni- and multivariate model. Only in survivors was there a statistically significant transition from a negative to a positive energy balance from day 0 until day 1 (Day 0: −3% (−18, 14) to day 1: 5% (−9, 21); p < 0.001). Furthermore, non-survivors had significantly decreased DO(2) during the first 4 days and reduced O(2)ER from day 2 until day 6. Additionally, a lower REE was significantly associated with a worse survival at 30 days, 1 year and 6 years (p = 0.009, p < 0.0001 and p = 0.012, respectively). Non-survivors seemed to be unable to metabolically adapt from the early (previously called the ‘ebb’) phase to the later ‘flow’ phase. DO(2) reduction was more pronounced during the first three days whereas O(2)ER was markedly lower during the following four days, suggesting a switch from a predominantly limited oxygen supply to prolonged mitochondrial dysfunction. The association between a reduced REE and mortality further emphasizes the importance of REE monitoring. MDPI 2022-08-17 /pmc/articles/PMC9416122/ /pubmed/36014872 http://dx.doi.org/10.3390/nu14163366 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Veraar, Cecilia Fischer, Arabella Bernardi, Martin H. Sulz, Isabella Mouhieddine, Mohamed Dworschak, Martin Tschernko, Edda Lassnigg, Andrea Hiesmayr, Michael Absent Metabolic Transition from the Early to the Late Period in Non-Survivors Post Cardiac Surgery |
title | Absent Metabolic Transition from the Early to the Late Period in Non-Survivors Post Cardiac Surgery |
title_full | Absent Metabolic Transition from the Early to the Late Period in Non-Survivors Post Cardiac Surgery |
title_fullStr | Absent Metabolic Transition from the Early to the Late Period in Non-Survivors Post Cardiac Surgery |
title_full_unstemmed | Absent Metabolic Transition from the Early to the Late Period in Non-Survivors Post Cardiac Surgery |
title_short | Absent Metabolic Transition from the Early to the Late Period in Non-Survivors Post Cardiac Surgery |
title_sort | absent metabolic transition from the early to the late period in non-survivors post cardiac surgery |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9416122/ https://www.ncbi.nlm.nih.gov/pubmed/36014872 http://dx.doi.org/10.3390/nu14163366 |
work_keys_str_mv | AT veraarcecilia absentmetabolictransitionfromtheearlytothelateperiodinnonsurvivorspostcardiacsurgery AT fischerarabella absentmetabolictransitionfromtheearlytothelateperiodinnonsurvivorspostcardiacsurgery AT bernardimartinh absentmetabolictransitionfromtheearlytothelateperiodinnonsurvivorspostcardiacsurgery AT sulzisabella absentmetabolictransitionfromtheearlytothelateperiodinnonsurvivorspostcardiacsurgery AT mouhieddinemohamed absentmetabolictransitionfromtheearlytothelateperiodinnonsurvivorspostcardiacsurgery AT dworschakmartin absentmetabolictransitionfromtheearlytothelateperiodinnonsurvivorspostcardiacsurgery AT tschernkoedda absentmetabolictransitionfromtheearlytothelateperiodinnonsurvivorspostcardiacsurgery AT lassniggandrea absentmetabolictransitionfromtheearlytothelateperiodinnonsurvivorspostcardiacsurgery AT hiesmayrmichael absentmetabolictransitionfromtheearlytothelateperiodinnonsurvivorspostcardiacsurgery |