The British journal of surgery
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In nine subjects undergoing oesophagectomy a transient but significant increase in pulmonary vascular permeability to transferrin was detected in both lungs 8 h after surgery. It coincided with a significant increase in plasma lactoferrin, evidence of intravascular and intra-alveolar neutrophil elastase release and with arterial hypoxaemia. The postoperative state in these patients had intravascular and pulmonary features often associated with the adult respiratory distress syndrome, and might be a useful model for the study of the early inflammatory events underlying lung injury in man.
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A prospective trial was conducted in 20 surgical intensive care unit patients receiving mechanical ventilation to compare estimates of resting energy expenditure (REE) with the measured values. The 12 women and 8 men (mean age 61.7 +/- 2.8 (s.e.m.) years) underwent a full nutritional assessment before measurement of their REE by indirect calorimetry using the MGM II metabolic cart (Utah Medical). Their REE was estimated by the Harris-Benedict formula (mean 1324 +/- 53 (s.e.m.) kcal/day) as well as an empirical formula (where empirical formula = 22 x body weight in kg) (1370 +/- 68 (s.e.m.) kcal/day). ⋯ Thus, mean estimates were excellent for the group but less predictive for the individual. Multiple linear regressions did reveal that body composition and metabolic stress were of greater predictive value, since an equation relating weight (P less than 0.003), sex (P less than 0.003), white blood cell count (P less than 0.003) and 24-h urinary creatinine excretion (P less than 0.05) could predict 76 per cent of the variation (r = 0.87) in the MREE with an overall significance of P = 0.0002. Given the importance of matching energy intake to needs in many critically ill patients who are mechanically ventilated, accurate measurement of the REE is recommended now that instrumentation is equal to the task.