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Cumulative Energy Imbalance in the Pediatric Intensive Care Unit: Role of Targeted Indirect Calorimetry
Nilesh M. Mehta, MD, DCH1*,
Lori J. Bechard, MEd, RD, LDN2,
Kristen Leavitt, RD, LDN1,
and
Christopher Duggan, MD, MPH1
1 Children’s Hospital, Boston, Massachusetts
2 Children's Hospital, Boston, Massachusetts
* To whom correspondence should be addressed. E-mail: nilesh.mehta{at}childrens.harvard.edu.
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Abstract |
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Introduction: Failure to accurately estimate energy requirements may result in underfeeding or overfeeding. In this study, a dedicated multidisciplinary nutrition team measured energy expenditure in critically ill children. Methods: Steady-state indirect calorimetry was used to obtain measured resting energy expenditure, which was compared with equation-estimated energy expenditure and the total energy intake for each subject. The children’s metabolic status was examined in relation to standard clinical characteristics. Results: Sixteen measurements were performed in 14 patients admitted to the multidisciplinary pediatric intensive care unit over a period of 12 months. Mean age of subjects in this cohort was 11.2 years (range 1.6 months to 32 years) and included 7 males and 7 postoperative patients. Altered metabolism was detected in 13 of 14 subjects and in 15 of 16 (94%) measurements. There was no correlation between the metabolic status of subjects and their clinical characteristics. Average daily energy balance was 200 kcal/d (range –518 to +859 kcal/d). Agreement between measured resting energy expenditure and equation-estimated energy expenditure was poor, with mean bias of 72.3 ± 446 kcal/d (limits of agreement –801.9 to + 946.5 kcal/d). Conclusions: A disparity was observed between equation-estimated energy expenditure, measured resting energy expenditure, and total energy intake, with a high incidence of underfeeding or overfeeding. A wide range of metabolic alterations were recorded, which could not be accurately predicted using standard clinical characteristics. Targeted indirect calorimetry on high-risk patients selected by a dedicated nutrition team may prevent cumulative excesses and deficits in energy balance. (JPEN J Parenter Enteral Nutr. XXXX;xx:xx-xx)
First published on January 6, 2009, doi:10.1177/0148607108325249
Journal of Parenteral and Enteral Nutrition 2009;33:336.
A more recent version of this article appeared on May 1, 2009
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