Influence of different dialysis modalities in the measurement of resting energy expenditure in patients with acute kidney injury in ICU

Góes, Cassiana Regina de; Vogt, Barbara; Sanches, Ana Cláudia Soncini; Balbi, André Luís; Ponce, Daniela

doi:10.1016/j.clnu.2016.08.008

Cited by 8 publications

(7 citation statements)

References 36 publications

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“…Scrutinizing the literature yielded no data on REE in CRRT‐treated critically ill pediatric patients. Efforts have been made in adult patients to validate IC during CRRT by measuring REE with and without CRRT . This seems like oversimplification of a complex issue, as REE measurement during CRRT is underestimated because of CO 2 removal .…”

Section: Resultsmentioning

confidence: 99%

“…Efforts have been made in adult patients to validate IC during CRRT by measuring REE with and without CRRT. 25,26 This seems like oversimplification of a complex issue, as REE measurement during CRRT is underestimated because of CO 2 removal. 27,28 Dialysis and ultrafiltration rate, the type of filters used, and the patient's underlying condition likely contribute to variations in REE.…”

Section: In Absence Of Ic Equations Can Be Used (Weak Recommendation)mentioning

confidence: 99%

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Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Jonckheer¹,

Vergaelen²,

Spapen³

et al. 2018

Nut in Clin Prac

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Introduction Nutrition is an important part of treatment in critically ill children. Clinical guidelines for nutrition adaptations during continuous renal replacement therapy (CRRT) are lacking. We collected and evaluated current knowledge on this topic and provide recommendations. Methods Questions were produced to guide the literature search in the PubMed database. Results Evidence is scarce and extrapolation from adult data was often required. CRRT has a direct and substantial impact on metabolism. Indirect calorimetry is the preferred method to assess resting energy expenditure (REE). Moderate underestimation of REE is common but not clinically relevant. Formula‐based calculation of REE is inaccurate and not validated in critically ill children on CRRT. The nutrition impact of nonintentional calories delivered as citrate, lactate, and glucose during CRRT must be considered. Quantifying nitrogen balance is not feasible during CRRT. Protein delivery should be increased by 25% to compensate for losses in the effluent. Fats are not removed by CRRT and should not be adapted during CRRT. Electrolyte disturbances are frequently present and should be treated accordingly. Vitamins B1, B6, B9, and C are lost in the effluent and should be adapted to the effluent dose. Trace elements, with the exception of selenium, are not cleared in relevant quantities. Manganese accumulation is of concern because of potential neurotoxicity. Conclusion Current recommendations regarding nutrition support in pediatric CRRT must be extrapolated from adult studies. Recommendations are provided, based on the weak level of evidence. Additional research on this topic is warranted.

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Section: Resultsmentioning

confidence: 99%

Section: In Absence Of Ic Equations Can Be Used (Weak Recommendation)mentioning

confidence: 99%

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Jonckheer¹,

Vergaelen²,

Spapen³

et al. 2018

Nut in Clin Prac

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“…A total of 38 intermittent hemodialysis sessions were performed, but as their duration was short, these too were unlikely to have affected EE measurements. 23 Fourth, IC is less reliable when the fraction of inspired oxygen is >0.6; however, in this study, we compared different periods of measurements during the same day and during different days; therefore, the ratio is likely to remain unaffected.…”

Section: Discussionmentioning

confidence: 92%

“…22 This is attributed to several mechanisms, such as the conversion of bicarbonate infusion to CO 2 , uncompensated heat loss, and the small contribution of citrate to the energy intake. 23,24 However, all of these are considered very mild, altering measurements by up to 3%. 25 Although mean hourly EE while on CRRT was indeed significantly lower (1480 ± 382 kcal/day vs 1578 ± 555 kcal/day without CRRT; P < 0.01), EE measurement of only 713 of the 51,448 h (1.4%) was conducted during CRRT; therefore, the use of CRRT is unlikely to have significantly influenced the results.…”

Section: Discussionmentioning

confidence: 99%

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Two‐hour indirect calorimetry measurement as a predictor of 24‐hour energy expenditure in critically ill surgical patients: A longitudinal study

Lichter

Sold

Angel

et al. 2023

J Parenter Enteral Nutr

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BackgroundMeasuring energy expenditure (EE) by indirect calorimetry (IC) has become the gold standard tool for critically ill patients to define energy targets and tailor nutrition. Debate remains as to the optimal duration of measurements or the optimal time of day in which to perform IC.MethodsIn this retrospective longitudinal study, we analyzed results of daily continuous IC in 270 mechanically ventilated, critically ill patients admitted to the surgical intensive care unit in a tertiary medical center and compared measurements performed at different hours of the day.ResultsA total of 51,448 IC hours was recorded, with an average 24‐h EE of 1523 ± 443 kcal/day. Night shift (00:00–8:00) was found to have significantly lower EE measurements (mean, 1499 ± 439 kcal/day) than afternoon (16:00–00:00; mean, 1526 ± 435 kcal/day) and morning (8:00–16:00; mean, 1539 ± 462 kcal/day) measurements (P < 0.001 for all). The bi‐hourly time frame that most closely resembled the daily mean was 18:00–19:59, with a mean of 1521 ± 433 kcal/day. Daily EE measurements of the continuous IC at days 3–7 of admission showed a trend toward a daily increase in 24‐h EE, but the difference was not statistically significant (P = 0.081).ConclusionsPeriodic measurements of EE can differ slightly when performed at various hours of the day, but the error range is small and may not necessarily have a clinical impact. When continuous IC is not available, a 2‐h EE measurement between 18:00 and 19:59 can serve as a reasonable alternative.

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Indirect calorimetry as point of care testing

Rattanachaiwong

Singer

2019

Clinical Nutrition

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Influence of different dialysis modalities in the measurement of resting energy expenditure in patients with acute kidney injury in ICU

Abstract: The three evaluated modalities did not change REE. Indirect calorimetry can be performed during dialysis procedures and there was no difference between ventilation parameters, sedatives use, body temperature and VAD in both moments.

Cited by 8 publications

References 36 publications

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Two‐hour indirect calorimetry measurement as a predictor of 24‐hour energy expenditure in critically ill surgical patients: A longitudinal study

Indirect calorimetry as point of care testing

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