INTRODUCTION: Patients who have sustained extensive burns frequently exhibit substantial damage to skeletal muscle and associated complications. The rehabilitation of these patients can be challenging due to the nature of the injury and the subsequent complications. Nevertheless, there is a possibility that functional proprioceptive stimulation (illusory movements) may facilitate effective rehabilitation in patients with limited physiotherapy options. Nevertheless, this approach has yet to be tested in patients with burn injuries. MATERIAL AND METHODOLOGY: A prospective, randomised, crossover trial was conducted at a burn centre in a tertiary teaching hospital. The objective was to assess the effects of illusory movements on energy metabolism, insulin sensitivity, and skeletal muscle biology in adult critically ill patients with deep burns covering 30 % or more of the total body surface area. Two 30-minute daily sessions of functional proprioceptive stimulation were administered in addition to the standard physical therapy or physical activity regimen. Subsequently, the patients proceeded to the next stage of the trial, which involved a two-week crossover period. MEASUREMENTS AND MAIN RESULTS: Daily indirect calorimetry and calculation of nitrogen balance. Skeletal muscle biopsies from vastus lateralis for high resolution respirometry and euglycemic clamps to assess whole body glucose disposal were performed three times: at baseline and then fortnightly after each intervention period. The intervention was feasible and well tolerated in both early and late stages of burn disease. It did not change energy expenditure (mean change -33 [95 % CI: -292;+227] kcal .24 h-1, p = 0.79), nitrogen balance (+2.0 [95 % CI: -3.1;+7.1] g N .1.73 m-2 BSA .24 h-1), or insulin sensitivity (mean change of insulin-mediated glucose disposal -0.33 [95 % CI: -1.18;+0.53] mmol.h-1). At the cellular level, the intervention increased the capacity of mitochondria to synthesize ATP by aerobic phosphorylation and tended to increase mitochondrial coupling. Functional capacities of fatty acid oxidation and electron transfer chain complexes I, II, and IV were unaffected. CONCLUSIONS: Compared to physical therapy alone, two daily sessions of functional proprioceptive stimulation in addition to usual physical therapy in patients with extensive burns did not change energy expenditure, insulin sensitivity, nitrogen balance, or energy substrate oxidation. At cellular level, the intervention improved the capacity of aerobic phosphorylation in skeletal muscle mitochondria. Clinical effects remain to be demonstrated in adequately powered trials.
- MeSH
- dospělí MeSH
- energetický metabolismus * fyziologie MeSH
- fyzioterapie (techniky) MeSH
- inzulinová rezistence fyziologie MeSH
- klinické křížové studie * MeSH
- kosterní svaly * metabolismus patofyziologie MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- nepřímá kalorimetrie MeSH
- popálení * metabolismus terapie rehabilitace patofyziologie komplikace MeSH
- povrch těla MeSH
- propriocepce fyziologie MeSH
- prospektivní studie MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mladý dospělý MeSH
- mužské pohlaví MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- randomizované kontrolované studie MeSH
OBJECTIVE: We aimed at assessing the predictive value of plasmatic Neutrophil Gelatinase Associated Lipocalin (pNGAL) at admission and severity scores to predict major adverse kidney events (MAKE, defined as death and/or need for renal replacement therapy (RRT) and/or non-renal recovery at day 90) in critically ill burn patients. MATERIAL AND METHODS: Single-center cohort study in a burn critical care unit in a tertiary center, including all consecutive severely burn patients (total burned body surface >20%) from January 2012 until January 2015 with a pNGAL dosage at admission. Reclassification of patients was assessed by Integrated Discrimination Improvement (IDI). MEASUREMENTS AND RESULTS: 87 patients were included. Mean age was 47.7 (IQ 25-75: 33.4-65.2) years; total burn body surface area was 40 (IQ 25-75: 30-55) % and ICU mortality 36%. 39 (44.8%) patients presented a MAKE, 32 (88.9%) patients died at day 90. pNGAL was higher in the MAKE group (423 [IQ 25-75: 327-518]pg/mL vs 184 [IQ 25-75: 147-220]pg/mL, p<0.001). In multivariate analysis, pNGAL and abbreviated burn severity index (ABSI) remained associated with MAKE (OR 1.005 [CI 95% 1.0005-1.009], p=0.03 and OR 1.682 [CI95%1.038-2.726], p=0.035 respectively). Adding pNGAL to abbreviated burn severity index, simplified organ failure assessment and the simplified acute physiology score 2 did outperform clinical scores for the prediction of MAKE and AKI and for most severe forms of AKI and allowed a statistically significant reclassification of patients compared to ABSI for MAKE, RRT, AKI at Day 7 and AKI during hospitalization with a number of patients needed to screen to detect one extra episode of MAKE was 44, 13 for severe AKI and 15 for AKI. CONCLUSIONS: pNGAL at admission is associated with the risk of MAKE in this population, and outperform severity scores when associated. Interventional studies are now needed to assess if impact of biomarkers-guided strategies would improve outcome.
- MeSH
- akutní poškození ledvin krev epidemiologie metabolismus MeSH
- dospělí MeSH
- hodnocení rizik MeSH
- jednotky intenzivní péče MeSH
- kohortové studie MeSH
- kreatinin metabolismus MeSH
- kritický stav * MeSH
- lidé středního věku MeSH
- lidé MeSH
- lipokalin-2 krev MeSH
- mortalita * MeSH
- náhrada funkce ledvin statistika a číselné údaje MeSH
- obnova funkce * MeSH
- popálení krev metabolismus mortalita MeSH
- prognóza MeSH
- prospektivní studie MeSH
- senioři MeSH
- Check Tag
- dospělí MeSH
- lidé středního věku MeSH
- lidé MeSH
- mužské pohlaví MeSH
- senioři MeSH
- ženské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
Poznatky z patofyziologie metabolismu rozsáhle popáleného pacienta nám formou parenterální a enterální výživy umožňují zvýšit úspěšnost léčby a přežívání pacientů s tímto závažným traumatem. V článku autor rozebírá charakter poruch v utilizaci cukrů, tuků a bílkovin a současně jsou uvedeny návody pro aplikaci výživy z kvalitativní i kvantitativní stránky.
The knowledge of pathophysiology of the metabolism of a patient with severe burns help us to use proper parenteral and enteral nutrition to increase the chances of successful treatment and improving lives of these patients. The author describes the nature of disorders of utilization of carbohydrates, fats and proteins and provides guidelines for administration of nutrition with both qualitative and quantitative aspects.
- Klíčová slova
- popáleninové trauma, proteinová malnutrice,
- MeSH
- energetický příjem fyziologie MeSH
- enterální výživa metody využití MeSH
- fyziologie výživy fyziologie MeSH
- lidé MeSH
- metabolické nemoci etiologie MeSH
- ošetřovatelská péče metody využití MeSH
- parenterální výživa metody využití MeSH
- popálení komplikace metabolismus ošetřování MeSH
- protein-energetická malnutrice ošetřování prevence a kontrola MeSH
- Check Tag
- lidé MeSH
- MeSH
- endotel fyziologie patologie MeSH
- ezofageální a žaludeční varixy komplikace krev mortalita MeSH
- intrakraniální hypertenze farmakoterapie ošetřování MeSH
- kardiopulmonální resuscitace metody trendy MeSH
- lidé MeSH
- nemoci jater klasifikace komplikace terapie MeSH
- péče o pacienty v kritickém stavu metody trendy využití MeSH
- popálení komplikace metabolismus MeSH
- renální insuficience klasifikace krev terapie MeSH
- selhání jater komplikace ošetřování terapie MeSH
- Check Tag
- lidé MeSH
- MeSH
- krysa rodu rattus MeSH
- kyseliny kávové farmakologie MeSH
- ledviny enzymologie MeSH
- malondialdehyd analýza MeSH
- oxidační stres účinky záření MeSH
- oxidoreduktasy analýza MeSH
- plíce enzymologie MeSH
- popálení metabolismus MeSH
- zvířata MeSH
- Check Tag
- krysa rodu rattus MeSH
- mužské pohlaví MeSH
- zvířata MeSH
- MeSH
- endokrinologie MeSH
- hormony krev MeSH
- popálení metabolismus MeSH
- Publikační typ
- kongresy MeSH
