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Relationship Between Energy Balance and Complications After Subarachnoid Hemorrhage
Author(s) -
Badjatia Neeraj,
Fernandez Luis,
Schlossberg Marin J.,
Schmidt J. Michael,
Claassen Jan,
Lee Kiwon,
Connolly E. Sander,
Mayer Stephan A.,
Rosenbaum Michael
Publication year - 2010
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607109348797
Subject(s) - medicine , subarachnoid hemorrhage , parenteral nutrition , anemia , anesthesia , caloric theory , gastroenterology
Background: Subarachnoid hemorrhage patients are hypermetabolic and at risk for developing medical complications. A relationship was hypothesized between energy balance and complications following subarachnoid hemorrhage. Methods: Fifty‐eight consecutive poor‐grade subarachnoid hemorrhage patients (mean age, 58; range, 26–86; 66% women) were studied between 2005 and 2007. Caloric intake and energy expenditure were assessed. In‐hospital complications over the first 14 days posthemorrhage were defined as renal failure, fever (>38.3°C), any infection, anemia, hyperglycemia (>11 mmol/L), and myocardial infarction. Energy balance was calculated by subtracting energy expenditure from caloric intake. Results: Enteral nutrition was begun 1 day posthemorrhage (range, 0–5 days). Recommended (mean ± SD) caloric intake was 28 ± 3 kcal/kg/d, and the actual was 14 ± 5 kcal/kg/d. Enteral nutrition accounted for 67% of caloric intake; propofol and dextrose infusions accounted for 33% of caloric intake. Cumulative energy balance over the first 7 days was –117 ± 53 kcal/kg. The average energy balance during the first 7 days after subarachnoid hemorrhage significantly correlated with the total number of infectious complications ( r = –0.5, P < .001) but not medical complications ( r = –0.2, P = .1). After adjustment for Hunt‐Hess grade, fever, hyperglycemia, and anemia, negative energy balance during the first 7 days after subarachnoid hemorrhage correlated with the number of infectious complications ( P = .01). Conclusions: Infectious complications after subarachnoid hemorrhage are associated with negative energy balance. Studies are needed to better understand the impact of negative energy balance on outcome after subarachnoid hemorrhage.