The Influence of Verticalization on the Dynamics of the Energy Demand at Rest in Patients With Unresponsive Wakefulness Syndrome

Abstract

Relevance . For the acute phase of cerebral insufficiency (ACI) analysis of energy demand at rest (REE) using indirect calorimetry method is effective to evaluate the level of hypermetabolism and selection of optimal nutritional support. In patients with chronic impairment of consciousness (CIC) the reasonability of such an approach is shown, but in this category of patients the influence of rehabilitation measures on energy demand is not taken into account. Verticalization is a routine method of prevention and treatment of immobilization syndrome in patients with ACI and its consequences today. Aim of study . To determine the effect of the verticalization procedure on the turntable on the dynamics of REE index in patients with unresponsive wakefulness syndrome (UWS). Material and methods . A prospective, comparative, non-randomized study was conducted in 136 patients in the neuro-intensive care unit of the Brain Institute Clinic. The REE index was determined using the method of indirect calorimetry without load and during verticalization in 75 patients with UWS and in 51 patients of the intensive care unit, who also underwent ACI, but were clearly conscious. Results . In patients with clear consciousness during verticalization REE increased by an average of 300 kcal (20%) from the initial values. The energy value of verticalization was about 5 kcal/kg. On the contrary, in the group of patients with UWS, the verticalization procedure practically did not increase the energy consumption, and the energy value of verticalization slightly exceeded 1 kcal/kg. Conclusion . Patients with UWS have a special metabolic status, probably due to a decrease in the functional activity of the brain. This can be confirmed using indirect calorimetry.