Клінічна та профілактична медицина (May 2020)

CURRENT POSSIBILITIES OF USE OF INDIRECT CALORIMETRY IN PERIOPERATIVE ENERGY MONITORING

  • V.I. Cherniy,
  • A.I. Denysenko

DOI
https://doi.org/10.31612/2616-4868.2(12).2020.05
Journal volume & issue
no. 2
pp. 79 – 89

Abstract

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The purpose of the study is to develop a method of perioperative energy monitoring and to implement it in clinical practice. Material and methods. The study involved 125 patients who underwent various surgical interventions under general anesthesia using sevoflurane (inhalation anesthetics) and fentanyl (narcotic analgesics) in low-flow artificial lung ventilation. Methods of perioperative monitoring (International Standards for a Safe Practice of Anesthesia 2010, WFSA) were supplemented using indirect calorimetry. Results. Analyzing the literature data, a close correlation was found between the energy equivalent of oxygen (EEE2) and the respiratory factor (RQ). The authors obtained the corresponding one-factor linear regression formula, which had the form: EEE2 = 1.157 × RQ + 4,037. Using the basic principles of gas exchange in the lungs of Bohr-Engoff, a method of perioperative energy monitoring was developed, based on indirect calorimetry, taking into account the real values ​​of the energy equivalent of patients' oxygen. The universal formula for determining the level of metabolism of the patient (MR, cal / min) in the form of: MR = [0,863 × VE × (PECO2 / PaCO2) × (FiO2 - FeO2)] (1,157 × RQ + 4,037) where, VE - total ventilation of the lungs per minute (ml / min), PECO2, PaCO2 - partial pressure, respectively, in a mixture of gases, which is exhaled and in the arterial blood (mm Hg). FiO2 and FEO2 are the oxygen fraction in the gas mixture that is inhaled and exhaled in units (% / 100). The method is implemented as a computer program created on the basis of the developed formula. The methods of intensive perioperative therapy taking into account the level of metabolism are presented. Conclusion. The method of perioperative energy monitoring substantially complements the "International Standards for Safe Anesthesiology Practice", WFSA (2010) enhances the perioperative safety of patients by detecting metabolic disorders and conducting appropriate pathogenetic correction.

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