Nutritional Support for the Patient with Multiple Organ Failure in Gastroenterological Surgery

Hiroyuki Hirasawa, Takao Sugai, Yoshio Ohtake, Shigeto Oda, Hidetoshi Shiga, Kazuya Nakanishi, Nobuya Kitamura, Hirokazu Ueno

Department of Emergency and Critical Care Medicine, Chiba University School of Medicine

The present study was undertaken to investigate the metabolic changes in the patients with multiple organ failure (MOF) receiving gastroenterological surgery and to establish better nutritional support based on the observed metabolic changes for those patients. The useful parameters for the evaluation of metabolic changes were energy expenditure, respiratory quotient, and percent fat measured by indirect calorimetry, arterial ketone body ratio along with ketone body volume, and blood lactate level as an index of tissue oxygen metabolism. Those patients were hypermetabolic, expending 140-150% of the basal energy expenditure. The MOF patients with complicating acute hepatic failure (AHF) could utilize only a limited energy substrate and showed depressed protein metabolism. All the patients were nutritionally supported with total parenteral nutrition. It was difficult to administer the amount of energy compatible with the measured energy expenditure, especially among the patients with complicating AHF and/or acute renal failure (ARF). The adjunctive administration of ATP-Mg and concurrent plasma exchange for the MOF patients with complicating AHF, and simultaneous continuous hemofiltration and continuous hemodiafiltration for the MOF patients with complicating ARF were effective for administering the necessary energy with the total parenteral nutrition. Branched-chain amino acid-enriched amino acids solution was effective in the nutritional support for those patients. These results suggest that the precise evaluation of metabolic changes is of utmost importance for better nutritional support for the patients with MOF, especially for the MOF patients with complicating AHF and ARF.

Key words
multiple organ failure, indirect calorimetry, arterial ketone body ratio

Reprint requests
Hiroyuki Hirasawa Department of Emergency and Critical Care Medicine, Chiba University School of Medicine
1-8-1 Inohana, Chuo-ku, Chiba, 260 JAPAN

Accepted
December 9, 1992

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