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Energy expenditure and gas exchange in thoracic surgical patients in the early postoperative period


, : Energy expenditure and gas exchange in thoracic surgical patients in the early postoperative period. Rivista Italiana di Nutrizione Parenterale ed Enterale 14(1): 14-22

Objectives: Several studies have reported the changes in energy expenditure after different elective surgical procedures, and large variations in energy expenditure have been described. The aim of this clinical study was to assess the energy expenditure before and after surgery in stable patients undergoing elective thoracotomy. Methods: Twenty-two well-nourished, non-obese adult patients undergoing elective pulmonary resection were prospectively studied. Oxygen consumption (VO-2), carbon dioxide production (VCO-2), respiratory quotient (RQ) and energy expenditure (EE) were measured by means of a computerized open-circuit indirect calorimetry before and after surgery. Heart rate, blood arterial pressure, and respiratory frequency were measured during gas exchange measurement. Blood gases were analyzed with an automated blood gas analyzer. Results: In the preoperative period the measured mean EE was 101% of the expected value according to the Harris-Benedict equation. Postoperatively, the measured EE was 116% of the expected value. Mean VO-2 and VCO-2 values were significantly higher than the preoperative values, while the mean RQ value was lower. Mean percent increases in EE, VO-2 and VCO-2 were 14.4 +- 2.3%, 16.4 +- 2.6% and 6.5 +- 1.4%, and mean percent decrease in RQ was 7.8 +- 1.6% (all p lt 0.001). Postoperatively, arterial oxygen tension and all the physiologic indexes of gas exchange were worse than the preoperative values (p lt 0.05). Mean arterial pressure, heart rate, and respiratory frequency were higher than the preoperative values (p lt 0.001). Conclusions: The early postoperative period of patients undergoing elective thoracic surgery is characterized by a condition of impaired gas exchange and by a hypermetabolic state. This latter condition may represent a critical factor in those patients with impaired or marginal cardiopulmonary function.

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