Résumé :
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Background : The awareness of the importance of adequate nutrition in chronic non-invasively ventilated patients has increased during the past decade. The Harris-Benedict equation (H-B) is the classical formula to assess the resting energy expenditure (REE) in healthy individuals. Nevertheless, this equation may significantly overestimate the energy expenditure inneuromuscular or spinal cord injury patients who are totally non-ambulatory and use invasive emechanical ventilation with tracheotomy. The aim of this study was to estimate nutritional requirements of such patients. Patients and Methods : We assessed the REE of 6 male and 2 female patients, who were totally dependent on invasive ventilation due to their medical condition : five patients had ALS, one Becker’s muscular dystrophy, one had suffered subarachnoid hemorrhage, and one traumatic spinal cord injury. The REE of the patients was measured using indirect calorimetry (DeltatracII metabolic monitor, Datex, Finland) as a part of their routinetreatment.Themeasurementswere carried out in the morning after 10 hours' fasting. The weight was determined with bedscale (ADE M60011, Germany). The results are given as mean (range). Results : The age of the patients was 58 (41-76) years and weight 78 (54-98) kg. The measured REE was 1100 (870-1500) kcal/d.Whennormalizedwithbodysurfaceareaorbodyweight,REEwas580(440-690)kcal/d/m2or15(10-19)kcal/d/kg, respectively. When calculated by the H-B equation, REE was 1600 (1190-2020) kcal/d. Thus, H-B equation overestimated REE by approximately 46%, 500 (160-1020) kcal/d (p<0.001). Conclusion : The H-B equation significantly overestimates the energy expenditure in invasively ventilated patients with severe neuromuscular dystrophy or spinal cord injury. This overestimation leads easily to obesity, which further complicates treatment, and may result in increased morbidity and mortality.
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