Clinical use of the respiratory quotient obtained from indirect calorimetry
Clinical use of the respiratory quotient obtained from indirect calorimetry
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DOI：
10.1177/014860710302700121
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发表时间：
2003-01-01
影响因子：
3.4
通讯作者：
Goldsmith, LJ
中科院分区：
文献类型：
--
作者：
McClave, SA;Lowen, CC;Goldsmith, LJ
背景：获得呼吸商(RQ)。从间接量热法(IC)来看，由二氧化碳产量(VCO(2))/氧气消耗(VO(2))的比率定义的间接热量法(IC)受人体使用底物的极端影响。喂养不足，促进内源性脂肪储备的利用，应导致RQ下降，而过度喂养，导致脂肪生成，应导致RQ增加。过度喂养引起的VCO(2)显著增加(随后RQ增加)可能会导致肺储备有限的患者的呼吸受损。因此，RQ随喂养方案的变化可能表明不适当的喂养，并可作为患者不耐受的标志。这项前瞻性的多中心研究旨在确定RQ在监测营养支持的充分性和耐受性方面的临床应用。方法：在30家长期急性护理的亲属医院中的任何一家，口服零食(NPO)并给予完全肠外或肠内喂养的患者符合本研究的条件。所有患者均行动脉血气、血酮、24小时尿尿素氮和IC测定。记录IC实施前24小时内肠内/肠外喂养的实际输入量。结果：共263例患者(平均年龄70.2岁，男性57.4%)进入研究。在263名研究患者中，88.6%的患者需要机械通气，92.0%的患者仅接受肠道管喂养。总体而言，41.5%的患者饮食过量，摄入了所需卡路里的110%，而34.2%的患者饮食不足，摄入了所需热量的110%。
Background: The respiratory quotient (RQ) obtained. from indirect calorimetry (IC), defined by the ratio carbon dioxide production (Vco(2))/oxygen consumption (Vo(2)), is affected by extremes of substrate use by, the body. Underfeeding, which promotes use of endogenous fat stores, should cause decreases in the RQ, whereas overfeeding, which results in lipogenesis, should cause increases in the RQ. Marked increases in Vco(2) (with subsequent increases in RQ) in response to overfeeding may cause respiratory compromise in patients with limited pulmonary reserve. Thus, variation in the RQ in response to the feeding regimen may indicate inappropriate feeding and serve as a marker for patient intolerance. This prospective, multicenter study was designed to determine the clinical use of RQ for monitoring adequacy and tolerance of nutrition support. Methods: Patients in any 1 of 30 long-term acute care Kindred hospitals made nil orally (NPO) and placed on total parenteral or enteral feeding were eligible for this study. Arterial blood gas, serum ketones, 24-hour collection of urine urea nitrogen, and IC measurements were obtained on all. Actual volume of enteral/parenteral feeding infused over the 24 hours before performance of IC was documented. Results: A total of 263 patients (mean age, 70.2 years, 57.4% male) were entered in the study. Of the 263 study patients, 88.6% required mechanical ventilation, and 92.0% received enteral tube feeding only. Overall, 41.5% of patients were overfed, receiving >110% of required calories, whereas 34.2% were underfed, receiving