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. 2022 Dec;41(12):3022-3025.
doi: 10.1016/j.clnu.2021.05.009. Epub 2021 May 25.

Neuromuscular blockade administration is associated with altered energy expenditure in critically ill intubated patients with COVID-19

D Karayiannis  1 , A Maragkouti  2 , T Mikropoulos  3 , A Sarri  4 , A Kanavou  5 , C Katsagoni  6 , E Jahaj  7 , A Kotanidou  8 , Z Mastora  9
Affiliations

Neuromuscular blockade administration is associated with altered energy expenditure in critically ill intubated patients with COVID-19

D Karayiannis et al. Clin Nutr. 2022 Dec.

Abstract

Background & aims: ESPEN guidelines advocate that energy needs of critically ill patients with COVID 19 should be assessed using indirect calorimetry, if safely available. This study described energy needs of intubated patients with COVID-19 and explores whether neuromuscular blockade administration (NMBAs) is associated with altered energy expenditure.

Methods: Resting energy expenditure (REE) and respiratory exchange rate (RER) evaluated among critically ill intubated COVID-19 patients until 28th day of intensive care unit stay (ICU-S) by indirect calorimetry. Paralysed patients were defined as those with drug induced paralysis using cicatracurium, for at least 3 days during their ICU-S.

Results: 34 adult COVID 19 patients (59.8% male, 35.2% obese) requiring mechanical ventilation were assessed prospectively. REE measurements suggest a gradual increase of energy needs post 3rd day of ICU-S in both patients without obesity (non ob) ((from 17.8 kcal/kgr up to 29.3 kcal/kgr actual body weight (AcBW) during 28th day of ICU-S, p = 0.011)) and patients with obesity (ob) ((from 18.1 kcal/kgr up to 30.1 kcal/kgr adjusted body weight (AjBW) during 28th day of ICU-S, p = 0.021)). NMBAs use was accompanied by a significant drop in REE, especially during first 7 days of hospitalization, both in non ob (22.9 vs 17.9 kcal/kgr AcBW, p = 0.014) and ob patients (22.5 vs 19.5 kcal/kgr ABW, p = 0.027).

Conclusion: We identified the energy needs of COVID-19 intubated patients and highlighted a significant increase beyond the 1st week in the ICU. Administration of NMBAs should be considered, as it may impact resting energy expenditure.

Keywords: COVID 19; Neuromuscular blockade; Resting energy expenditure.

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Conflict of interest statement

Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Daily resting energy expenditure values (REE) (median values) over time, measured by indirect calorimetry. A. REE over time in intubated COVID-19 patients without obesity (non ob) and with obesity (ob). B. REE over time in intubated COVID-19 patients without obesity according to NRMBAs administration. C. REE over time in intubated COVID -9 patients with obesity according to NRMBAs administration. Body weight: actual body weight for non ob (BMI<30 kgr/m2) and adjusted body weight for ob (BMI≥ 30 kgr/m2). ∗ Denotes statistical significant different between groups at <0.05 level, p = p value for Kruskal Wallis test, that was conducted to examine differences regarding REE measurements between different times (days). Abbreviations: ob, COVID-19 patients with obesity (BMI≥ 30 kgr/m2); non ob; COVID-19 patients without obesity (BMI< 30 kgr/m2); paralysed, administration of NMBAs.
Fig. 2
Fig. 2
Daily respiratory exchange ratio (RER) (median) over time, measured by indirect calorimetry. A. RER over time in intubated COVID-19 patients without obesity (non ob) and with obesity (ob). B. RRE over time in intubated COVID-19 patients without obesity according to NRMBAs administration. C. REE over time in intubated COVID -9 patients with obesity according to NRMBAs administration. ∗ Denotes statistical significant different between groups at <0.05 level, p = p value for Kruskal Wallis test, that was conducted to examine differences regarding RER measurements between different times (days). Abbreviations: ob, COVID-19 patients with obesity (BMI≥ 30 kgr/m2); non ob; COVID-19 patients without obesity (BMI< 30 kgr/m2); paralysed, administration of NMBAs; VO2, volume of oxygen consumed per minute; VCO2, volume of carbon dioxide consumed per minute.
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