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Master Thesis

Mesure de la masse maigre sur les examens tomodensitométriques initiaux chez des patients de réanimation chirurgicale et traumatologique : lien avec la dépense énergétique et amélioration de sa prédiction

Abstract : Background : determining energy expenditure (EE) can be done via predictive equations (PE) or indirect calorimetry measurements (IC). IC is impractical in the critical care setting due to its limits and most intensive care units (ICU) still rely on PE. However most PE, particularly the one recommended in most guidelines, are imprecise. Fat free mass (FFM) is one of the key determinant of EE and can be assessed precisely through ct-scan analysis. Our objectives were to determine the correlation between FFM and EE in a trauma and surgical critical care setting and see if we could improve de reliability of PE using FFM. Methods : we conducted a monocentric, retrospective observational study on patients hospitalised in our trauma and surgical ICU. Patients who were sedated, ventilated and recieving nutritional support were included. EE was evaluated with 5 predictive formulae and measured using IC. If the difference between measured EE and EE evaluated with the Penn state formula was higher than 15%, we analysed the initial ct scans to assess fat free and fat mass. Our main study goal was to evaluate the correlation between FFM measured on ct scans and EE measured with IC. Our secondary goal was to increase the precision of evaluated EE creating a new formula including body composition parameters measured on ct scans at the thrid lumbar vertebrae level. Results : a total of 147 patients were included. 68 had difference of more than 15% between measured EE (MEE) with IC and evaluated EE (EEE) using the Penn state formula (that we found to be the most precise). A total of 67 initial ct scans allowing analysis of the third lumbar vertebrae level were available. Pearson correlation coeficient between MEE and FFM from the scans was R = 0,453 (p = 0,0001). Using multiple regression linear analysis analysis we were able to create a formula predicting EE with a r² = 0,63. Conclusion : in patients hospitalised in a trauma and surgical ICU, FFM assessed by ct-scans has a rather weak correlation with EE compared to the healthy population. Body composition assessed on the initial ct scans can be used to improve evaluation of EE through formulae in comparison to what is recomended in the european and north american guidelines.
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Master Thesis
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https://dumas.ccsd.cnrs.fr/dumas-01544980
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Submitted on : Thursday, June 22, 2017 - 12:54:27 PM
Last modification on : Wednesday, June 3, 2020 - 12:30:03 AM
Long-term archiving on: : Wednesday, January 10, 2018 - 2:52:58 PM

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Sébastien Girard. Mesure de la masse maigre sur les examens tomodensitométriques initiaux chez des patients de réanimation chirurgicale et traumatologique : lien avec la dépense énergétique et amélioration de sa prédiction. Médecine humaine et pathologie. 2017. ⟨dumas-01544980⟩

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