Nutritional and metabolic alterations during continuous venovenous hemofiltration

Onderzoeksoutput: PhD Thesis

Samenvatting

Nutrition therapy guided by indirect calorimetry (IC) to define caloric targets is the gold standard in critical ill patients. It is associated with a lower morbidity and mortality.
Continuous renal replacement therapy and thus continuous venovenous hemofiltration (CVVH) is frequently used in critically ill patients. We aimed at achieving a correct caloric target using the gold standard in patients treated with CVVH.
In our first paper we described the difficulties to define caloric targets in nutrition therapy during continuous renal replacement therapy. The hypothesis was that the resting energy expenditure (REE) would probably change due to this therapy. However, measuring REE with IC was not possible due to an exchange of CO2. Also, nutrients are exchanged.
Therefor in paper 2 we determined in a prospective interventional trial the gas exchange during CVVH. We found that CO2 was clinically significantly removed in the filter but O2 remained stable. This enabled the use of IC during CVVH.
In paper 3 we measured REE during different settings of CVVH and evaluated the effect of CO2 removal on REE. There we confirmed the hypothesis that REE changed significantly between the different CVVH settings. We also found that adding the exchanged CO2 to the measured REE did not result in a clinically significantly different true REE.
Finally, in paper 4 we analyzed how non-intentional calories were exchanged during CVVH so our research could enable a correct caloric prescription.
Combining our findings, we made the gold standard for nutrition therapy in ICU patients available for patients treated with CVVH. Future trials should investigate if this approach translates into better patient outcomes.
Originele taal-2English
KwalificatieDoctor in Medical Sciences
Toekennende instantie
  • Vrije Universiteit Brussel
Begeleider(s)/adviseur
  • De Waele, Elisabeth, Promotor
  • Poelaert, Jan, Promotor
Datum van toekenning30 mei 2022
StatusPublished - 2022

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