Is critically ill patients really hyberned during the acute ebb phase?The Indirect Calorimetry point of view

Background Indirect calorimetry remains the only tool to accurately measure the metabolic changes in critical Illness, that is characterized by high degree of inflammation. During the EBB phase, the metabolic status responds to hypoperfusion, neuroendocrine and inflammatory-cytokin effect, and consequentely shifts to a decreased overall metabolism (1). During the flow phase, the catabolic response increases and the hypercatabolism occurs (Fig1). AIMS: Our aim is to evaluate the 'metabolic stupor' of the acute EBB phase and put it in relation to the degree of inflammation in order to minimize the risk of malnutrion. METHODS: We conducted observational pilot study: 11 septic patients admitted in ICU were enrolled: 8 M and 3 F, mean age 56 years, Calorimetric assessment and PCR were detected within the first 48 hours and after the 3rd day of admission RESULTS: REE of all patients is lower in the EBB phase than in the flow phase. The REE values are the lower, the higher the PCR is The second PCR values are lower than the first measurement CONCLUSION The higher the inflammatory state, the lower the basal metabolic rate.(Fig2) Calorimetry-guided nutritional therapy appears to be associated with better control of the inflammatory state (Fig 3) Fig1 REE acute phase/REE flow phase Fig2 REE/ PCR (ng/dl) acute phase Fig3 PCR acute phase PCR2 della flow phase 3000 2250 1500 750 8000 6000 4000 2000 EBB acute phase FLOW phase 6000 4500 3000 1500 REEaPhase PCR RM 44 f PCR PCR 2 00 M PM MBM TE BS RM MM 51m DD 71 m Bibliography: 0 MM 51m MV 67 f TE 60 m CR 87 f 1. Singer P, Blaser AR, Berger MM, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38:48–79.