Although the fluid therapy plays a fundamental role in the management of polytrauma patients (PP), a tool which could determine it appropriately is still lacking. The aim of this study was to evaluate the application of a bioimpedance spectroscopy (BIS) for body fluids volume and distribution monitoring in these patients. This prospective, observational study was performed on 25 severe PP and 25 healthy subjects. The body fluids composition was repeatedly assessed using BIS between days 3 to 11 of intensive care unit stay while the impact of fluid intake and balance was evaluated. Fluid intake correlated significantly with fluid excess (FE) in edemas, and their values were significantly higher in comparison with the control group. FE was strongly associated with cumulative fluid balance (p<0.0001; r=0.719). Furthermore, this parameter was associated with the entire duration of mechanical ventilation (p=0.001, r=0.791) independently of injury severity score. In conclusion, BIS measured FE could be useful in PP who already achieved negative fluid balance in prevention the risk of repeated hypovolemia through inappropriate fluid restriction. What is more, measured FE has a certain prognostic value. Further studies are required to confirm BIS as a potential instrument for the improvement of PP outcome.

• MeSH
• dospělí MeSH
• kohortové studie MeSH
• lidé středního věku MeSH
• lidé MeSH
• pilotní projekty MeSH
• polytrauma diagnóza   patofyziologie   terapie   MeSH
• prospektivní studie MeSH
• senioři MeSH
• složení těla fyziologie   MeSH
• spektrální analýza metody   MeSH
• stupeň závažnosti nemoci * MeSH
• tekutinová terapie metody   MeSH
• vodní a elektrolytová rovnováha fyziologie   MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• senioři MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH

OBJECTIVE: The association between energy metabolism and prognosis in polytrauma patients has not yet been defined. The aim of this study was to describe energy metabolism and analyze the prognostic value of respiratory quotient (RQ) and nonprotein respiratory quotient (npRQ) in fasting polytrauma patients (fPP) and polytrauma patients with nutritional support (nsPP). METHODS: Twenty-two polytrauma patients (before and after parenteral nutrition administration) and 22 healthy controls (after overnight fasting) were examined on day 4 (median) after admission to the intensive care unit. To evaluate energy expenditure in nsPP and resting energy expenditure in fPP and controls with RQ and npRQ in all groups, we used indirect calorimetry. With regression analysis, the descriptive models of intensive care unit (ICU) length of stay (LOS) and mechanical ventilation time (VT) were derived. RESULTS: RQ and npRQ were significantly lower in fPP than in controls (P < 0.05 and P < 0.01, respectively) and in nsPP (P < 0.05). In nsPP, relationships between RQ or npRQ and the ICU LOS or mechanical VT were demonstrated (P < 0.0001, r = -0.78 for RQ and VT; P < 0.0001, r = -0.78 for npRQ and VT; P < 0.001, r = -0.69 for RQ and LOS; P < 0.001, r = -0.72 for npRQ and LOS). CONCLUSIONS: RQ and npRQ parameters measured by indirect calorimetry in polytrauma patients with parenteral nutrition on the fourth day of ICU stay related to clinical outcomes such as duration of mechanical ventilation and ICU LOS.

• MeSH
• bazální metabolismus MeSH
• časové faktory MeSH
• délka pobytu statistika a číselné údaje   MeSH
• dospělí MeSH
• energetický metabolismus MeSH
• jednotky intenzivní péče MeSH
• lidé středního věku MeSH
• lidé MeSH
• nepřímá kalorimetrie metody   statistika a číselné údaje   MeSH
• omezení příjmu potravy MeSH
• parenterální výživa statistika a číselné údaje   MeSH
• pilotní projekty MeSH
• polytrauma patofyziologie   terapie   MeSH
• prognóza MeSH
• prospektivní studie MeSH
• regresní analýza MeSH
• respirační funkční testy metody   statistika a číselné údaje   MeSH
• umělé dýchání statistika a číselné údaje   MeSH
• výsledek terapie MeSH
• Check Tag
• dospělí MeSH
• lidé středního věku MeSH
• lidé MeSH
• mužské pohlaví MeSH
• ženské pohlaví MeSH
• Publikační typ
• časopisecké články MeSH
• pozorovací studie MeSH
• práce podpořená grantem MeSH

OBJECTIVE: Loss of muscle mass in critically ill patients is associated with serious consequences, such as prolonged mechanical ventilation, intensive care unit confinement, and higher mortality. Thus, monitoring muscle mass, and especially its decline, should provide a useful indicator of morbidity and mortality. Performing evaluations according only to body mass index is imperfect, therefore the aim of this article was to evaluate appropriate methods for muscle mass loss determination in ICU patients. METHODS: For this review, the literature searches were conducted through Embase and Medline, PubMed and Google Scholar databases up to February 2018 for the following Medical Subject Headings terms muscle atrophy, protein catabolism, ICU-aquaired weakness, muscle muss loss, myolysis, critical illness, stress metabolism, computed tomography, magnetic resonance imaging, dual-energy X-ray absorptiometry, neutron activation analysis, anthropometric examination, determination of endogenous metabolites of the skeletal muscles, bioimpedance spectroscopy, ultrasound. RESULT: It appears that ultrasound, which is widely available in hospitals, is the most advantageous method. Muscle ultrasound is non-invasive, relatively inexpensive, and is a bedside method that is free of ionizing radiation. Furthermore, muscle ultrasound also seems to be valid in patients with severe fluid retention, which is a typical complication with other conventional methods. CONCLUSION: Early detection of critical illness neuromyo-pathy could be beneficial for improving the standards of intensive care, and thus reducing the risk of mortality in these patients.

• MeSH
• index tělesné hmotnosti * MeSH
• kritický stav mortalita   MeSH
• lidé MeSH
• míra přežití MeSH
• morbidita MeSH
• prognóza MeSH
• Check Tag
• lidé MeSH
• Publikační typ
• časopisecké články MeSH
• přehledy MeSH