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0531. Cumulative effects of negative energy balance on myocardial deformity and diastolic function during the first week of ICU: a pilot study
Intensive Care Medicine Experimental volume 2, Article number: P31 (2014)
To evaluate whether a greater negative energy balance (NEB) accumulated during the first week of ICU correlates with worsening in longitudinal Strain (LS) and diastolic function (DF).
To evaluate whether improvement in the nutritional status (NS) correlates with improvement in LS and DF.
We made an observational, analytical, prospective, longitudinal pilot study.
LS, echocardiographic parameter used to assess myocardial deformity (contraction). We considered as an improvement an increase ≥ 10%.
E/é ratio, parameter used to assess DF. A reduction of E/é ratio ≥ 10 % was considered DF improvement.
NEB during the first week of admision.
Improvement in the NS: assessed by an increase in at least one level of prealbumin nutritional scale (PNS) after 10 days of receiving 100 % of estimated energy (EE) requirements (H. Benedict).
(PNS: Normal>18 md/dl, mild undernutrition: 17.9-15 , moderate: 14,9-10 severe < 10).
Convenience nonprobability sample.
S. analysis: The results were expressed as means with their ST deviations, %. Linear regression (LR) and Fisher test (FT) were used to analyze possible statistics associations, expressed with their CI and p values.
TTE were performed to patients admitted from July to October, 2013, in the first 24 h of admision, at 7th and 10th days of receiving enteral and/or parenteral nutrition with 100 % of EE. Acoustic catches are done in HQ digital format, f.r.> 100 Hz, for further analysis “of line" of LS. (Blind analysis).
Exclusion crit.: nephrotic syndrome, cirrhosis, chronic renal and HF.
PCR, MV (PEEP), PVC were recorded.
10 patients, 60 % male, mean age: 54 (27-75). 30 % normal NS, 30 % mild, 10% moderate and 30 % severe undernutrition. 40 % traumatic and 30 % spontaneous ICH , 10% thoracic trauma , 10% cardiac arrest and 10 % septic shock . 70 % required MV, 20 % norepinephrine.
KS test: p = 0.595. We observe a tendency to an inverse relationship (p = 0.375, r = - 0.315, N = 10) between NEB and LS but not s. significant. 40% of those who had improvement in at least 1 level of the PNS showed a 10% increase in LV LS at 10 days receiving 100% EE (FT: p = 0.714, OR: 0.667 , 95% CI : 0.025 to 18.059).
As in the Hammer et al study , in which acute progressive caloric restriction in young healthy men correlated with impaired DF, we observed a direct relationship (r = 0.462 , p = 0.434 , N = 5) between NEB and E/é, but not s. significant. The 50% who had an improvement in NS showed a 10% reduction in E /é (FT: p = 1.00, OR 1.00 , 95% CI : 0.03 to 29).
Patients with higher cumulative NEB during the first week of ICU had a decrease in LS and an increase in E/é but not s. significant. Given the limitations of this research (being a pilot study of a topic not addressed in ICU with few patients) should be carried further study with sufficient power to test this hypothesis.
J Clin Endocrinol Metab. 2008,93(2):497–503. 10.1210/jc.2007-2015
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Blizniak, A.G., Zapata, D.M., Bailén, M.R. et al. 0531. Cumulative effects of negative energy balance on myocardial deformity and diastolic function during the first week of ICU: a pilot study. ICMx 2, P31 (2014). https://doi.org/10.1186/2197-425X-2-S1-P31
- Nutritional Status
- Nephrotic Syndrome
- Diastolic Function
- Estimate Energy
- Longitudinal Strain