Objectives: To determine the outcome of oxygen consumption (Vo(2)) and
energy expenditure after cessation of sedation in severe head-injured
patients and to assess its usefulness as a predictor of neurologic se
verity. Design: Prospective, descriptive study. Setting: Neurosurgical
intensive care unit (ICU) in a university hospital. Patients: Fifteen
severe head-injured patients with tracheostomies and who were mechani
cally ventilated and sedated at the time of the study. Interventions:
None. Measurements and Main Results: Vo(2) and energy expenditure were
measured, using indirect calorimetry during and after discontinuation
of sedation. After the measurement period, the patients were divided
into two groups. Group 1 included patients who were completely weaned
from sedation; group 2 included patients who had to be sedated again u
sing predetermined criteria. In both groups, energy expenditure was cl
ose to basal energy expenditure during sedation, and increased to 150%
of basal energy expenditure during the recovery period, with maximum
hourly values 80% above basal energy expenditure. In group 1, Vo(2) an
d energy expenditure changed from 284 +/- 44 mL/min and 1833 +/- 261 k
cal/day during sedation to 390 +/- 85 mL/min and 2512 +/- 486 kcal/day
for the period without sedation. During this period, there was a sign
ificant correlation between Vo(2) and mean arterial pressure. For the
recovery period, there was no difference in mean or maximum Vo(2) betw
een the two groups of patients. At 24 and 48 hrs after cessation of se
dation, Vo(2) and energy expenditure decreased to 30% above basal ener
gy expenditure. These changes may be due to the recovery of muscular a
ctivity, weaning from mechanical ventilation, or an increase in the am
ount of circulating catecholamines. Conclusion: In severe head-injured
patients, during the first 12 hrs after the discontinuation of sedati
on, the patients experienced a large increase in Vo(2), energy expendi
ture, and mean arterial pressure. Although these changes have no progn
ostic value in our study, they have potential deleterious effects in h
ead-injured patients. Methods that blunt these changes which have prov
en efficacious in anesthesia may be effective for intensive care patie
nts.