Predicted versus measured energy expenditure by continuous, online indirect calorimetry in ventilated, critically ill children during the early postinjury period*

Martínez, José Luis; Martínez-Romillo, Paloma Dorao; Sebastián, Jesús; Tarrío, Francisco Ruza

doi:10.1097/01.pcc.0000102224.98095.0a

Cited by 93 publications

(65 citation statements)

References 46 publications

(44 reference statements)

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“…Previous studies have shown that prediction equations are not accurate to predict energy expenditure in critically ill children (34,35), because the dynamic metabolic responses to injury and illness in critically ill children render the prediction of energy needs more difficult (36). With indirect calorimetry, Metha et al (37) found that slightly more than half of patients were hypometabolic, about 25% were normometabolic, and 17% were hypermetabolic.…”

Section: Discussionmentioning

confidence: 99%

Nutrition Support among Critically Ill Children with AKI

Kyle

Akcan-Arikan

Orellana

et al. 2013

Clinical Journal of the American Society of Nephrology

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SummaryBackground Critically ill children are at high risk of underfeeding and AKI, which may lead to further nutritional deficiencies. This study aimed to determine the adequacy of nutrition support during the first 5 days of intensive care unit (ICU) stay. Results Of the 167 patients, 102 were male and 65 were female (median age 1.4 years). Using the RIFLE criteria, 102 (61%) patients had no AKI, whereas 44 (26%) were classified as category R (risk), 12 (7%) as category I (injury), and 9 (5%) as category F (failure). The median 5-day energy intake was lower relative to estimated BMR. Overall protein provision (19%) was lower than energy provision (55%) compared with estimated needs (P,0.001). I/F patients were more likely to be fasted versus receiving enteral/parenteral nutrition (n=813 patient days) and to receive ,90% of BMR (n=832 patient days) than No AKI/R patients.Conclusions Underfeeding, common in critically ill children, was accentuated in AKI. Protein underfeeding was greater than energy underfeeding in the first 5 days of PICU stay. Efforts should be made to provide adequate nutrition in ICU patients with AKI.

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Section: Discussionmentioning

confidence: 99%

Nutrition Support among Critically Ill Children with AKI

Kyle

Akcan-Arikan

Orellana

et al. 2013

Clinical Journal of the American Society of Nephrology

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“…The common belief that critically ill children would be hypermetabolic has not been confirmed (19,37); on the contrary, they are more frequently hypometabolic (38). The patterns of energy expenditure, the nature of fuel utilization, and whether manipulation of these or other factors can affect patient outcome represent an important research field.…”

Section: Discussionmentioning

confidence: 99%

Oxidation of Intravenous Lipid in Infants and Children With Systemic Inflammatory Response Syndrome and Sepsis

et al. 2007

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During sepsis in adults, fat becomes a preferred fuel; however, oxidation may be impaired relative to the circulating fatty acid levels. Little is known about the ability of infants and children to oxidize lipids during systemic inflammation (SIRS) and sepsis. The aim of this study was to examine the oxidation of exogenous lipid in these patients. Sixteen patients with SIRS/sepsis and eight controls with no evidence of sepsis were studied by indirect calorimetry during an i.v. lipid utilization test (1 h of 0.3 g/kg/h glucose followed by 3 h of 0.1 g/kg/h glucose plus 0.15 g/kg/h lipid). The respiratory quotient (RQ) (1.0 for carbohydrate utilization and 0.7 for fat utilization) was measured. Results were compared by repeatedmeasures analysis of variance (ANOVA), paired or unpaired t tests.

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“…In a survey of 100 mechanically ventilated children, White et al 18 reported a mean V CO 2 and V O 2 of 5.3 and 6.3 mL/kg/min, respectively, for a cohort with a mean age of 4.5 y and a mean height of ϳ97 cm. Furthermore, in a slightly younger population with a mean age of 4.2 y, Martinez et al 19 reported a mean V CO 2 and V O 2 of 4.8 and 6.1 mL/kg/min, respectively, for a cohort of mechanically ventilated children recently admitted to the PICU. These findings suggest that the values from our study are largely in agreement with values reported elsewhere.…”

Section: Discussionmentioning

confidence: 99%

Carbon Dioxide Elimination and Oxygen Consumption in Mechanically Ventilated Children

et al. 2014

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BACKGROUND: Accurate measurement of carbon dioxide elimination (V CO 2 ) and oxygen consumption (V O 2 ) at the bedside may help titrate nutritional and respiratory support in mechanically ventilated patients. Continuous V CO 2 monitoring is now available with many ventilators. However, because normative data are sparsely available in the literature, we aimed to describe the range of V CO 2 and V O 2 values observed in mechanically ventilated children. We also aimed to examine the characteristics of V CO 2 values that are associated with standard steady state (5-min period when V CO 2 and V O 2 variability are < 10%). METHODS: Mechanically ventilated patients who underwent indirect calorimetry testing were eligible for inclusion, and subjects who achieved standard steady state were included. Normalized V CO 2 and V O 2 values (mL/kg/min) were modeled against subject height, and correlation coefficients were computed to quantify the goodness of fit. A steadystate definition using only V CO 2 was developed (V CO 2 variability of < 5% for a 5-min period) and tested against standard steady state using sensitivity and specificity. RESULTS: Steady-state data from 87 indirect calorimetry tests (in 70 subjects) were included. For age groups < 0.5, 0.5-8, and > 8 y, the mean V CO 2 values were 7.6, 5.8, and 3.5 mL/kg/min. Normalized V CO 2 and V O 2 values were inversely related to subject height and age. The relationships between normalized gas exchange values and height were demonstrated by the models: V CO 2 ‫؍‬ 115 ؋ (height in cm) ؊0.71 (R ‫؍‬ 0.61, P < .001) and V O 2 ‫؍‬ 130 ؋ (height in cm) ؊0.72 (R ‫؍‬ 0.61, P < .001). Steady-state V CO 2 predicted standard steady state (sensitivity of 0.84, specificity of 1.0, P < .01). CONCLUSIONS: V CO 2 and V O 2 measurements correlated with subject height and age. Smaller and younger subjects produced larger amounts of CO 2 and consumed more O 2 per unit of body weight. The use of a 5-min period when V CO 2 varied by < 5% predicted standard steady state. Our observations may facilitate greater utility of V CO 2 at the bedside in the pediatric ICU and thereby extend the benefits of metabolic monitoring to a larger group of patients.

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Predicted versus measured energy expenditure by continuous, online indirect calorimetry in ventilated, critically ill children during the early postinjury period*

Abstract: Predictive equations do not accurately predict energy expenditure in ventilated, critically ill children during the early postinjury period; if available, indirect calorimetry must be performed.

Cited by 93 publications

References 46 publications

Nutrition Support among Critically Ill Children with AKI

Nutrition Support among Critically Ill Children with AKI

Oxidation of Intravenous Lipid in Infants and Children With Systemic Inflammatory Response Syndrome and Sepsis

Carbon Dioxide Elimination and Oxygen Consumption in Mechanically Ventilated Children

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