Metabolic changes in children with severe traumatic injuries.

INTRODUCTION

Combined traumatic injuries are the leading cause for more than half the cases of lethal outcome in childhood. Trauma triggers a series of endocrinic and metabolic changes commonly known as acute metabolic stress. The hypermetabolic and hypercatabolic condition which develops as a result contributes to the high morbidity and mortality rates in children with traumatic injuries.

METHODS

Twenty five children (16 boys and 9 girls aged 4-15 years) were recruited from the patients admitted for treatment to the Department of Pediatric Anesthesia and Intensive Care at the Clinic of Pediatric Surgery in the Higher Medical Institute--Plovdiv, between 1994 and 1998. All children had severe combined trauma. Of these 20 (80%) presented with severe craniocerebral trauma; they were comatose with Glasgow Coma Scale Score of 7.3 +/- 4.3 (Sx = 3.59); the children were on mechanical ventilation and total parenteral nutrition. Energy expenditure was measured using computerised metabolic monitor Deltatrac II. VO2, VCO2, RQ, energy expenditure (MEE), oxygen consumption and nitrogen excretion levels were monitored.

RESULTS

The mean energy expenditure measured during the first, second and third 24-hour period was 50.04 kcal/kg/d-1, 50.54 kcal/kg/d-1 and 51.38 kcal/kg/d-1, respectively; the respiratory quotient was 0.81 +/- 0.0114 Sd, the oxygen consumption index 7.32 +/- 0.08 Sd ml/min/m2. The energy expenditure calculated by the Fleisch formula was 42.38 +/- 1.24 kcal/kg/d-1, (Sx = 6.19); this value differed statistically significantly from the value we measured (50.63 +/- 1.31, Sx = 6.57, p < 0.0001), the injury correction factor (ICF) was calculated to be 1.22 +/- 0.02 Sd.

CONCLUSIONS

Actual energy expenditure in children with severe traumatic injuries is considerably higher than that calculated by formulae. Based on our results we recommend that the energy and substrate intake to be increased above the values calculated by formulae by a coefficient of 1.22 which is the measured correction factor. Thus the increased energy requirements will be met and the patients' prognosis will be improved.