The challenge of developing a new predictive formula to estimate energy requirements in ventilated critically ill children.

BACKGROUND Traditionally, energy requirements have been calculated using predictive equations. These methods have failed to calculate energy expenditure accurately. Routine indirect calorimetry has been suggested, but this method is technically demanding and costly. This study aimed to develop a new predictive equation to estimate energy requirements for critically ill children. METHODS This prospective, observational study on ventilated children included patients with an endotracheal tube leak of < 10% and fractional inspired oxygen of < 60%. An indirect calorimetry energy expenditure measurement was performed and polynomial regression analysis was used to develop new predictive equations. The new formulas were then compared with existing prediction equations. RESULTS Data from 369 measurements were included in the formula design. Only weight and diagnosis influenced energy expenditure significantly. Three formulas (A, B, C) with an R² > 0.8 were developed. When we compared the new formulas with commonly used equations (Schofield, Food and Agriculture Organization/World Health Organization/United Nations University, and White equation), all formulas performed very similar, but the Schofield equation seemed to have the lowest SD. CONCLUSIONS All 3 new pediatric intensive care unit equations have R² values of > 0.8; however, the Schofield equation still performed better than other predictive methods in predicting energy expenditure in these patients. Still, none of the predictive equations, including the new equations, predicted energy expenditure within a clinically accepted range, and further research is required, particularly for patients outside the technical scope of indirect calorimetry.

[1]  A. Wade,et al.  Effect of laparoscopy and laparotomy on energy and protein metabolism in children: a randomized controlled trial. , 2010, The Journal of pediatrics.

[2]  C. Duggan,et al.  Cumulative energy imbalance in the pediatric intensive care unit: role of targeted indirect calorimetry. , 2009, JPEN. Journal of parenteral and enteral nutrition.

[3]  C. Reid.  Poor agreement between continuous measurements of energy expenditure and routinely used prediction equations in intensive care unit patients. , 2007, Clinical nutrition.

[4]  Charlene Compher,et al.  Prediction of resting metabolic rate in critically ill adult patients: results of a systematic review of the evidence. , 2007, Journal of the American Dietetic Association.

[5]  R. Reed,et al.  Nutritional gain versus financial gain: The role of metabolic carts in the surgical ICU. , 2006, The Journal of trauma.

[6]  V. G. F. Alves,et al.  Indirect calorimetry: methodology, instruments and clinical application , 2006, Current opinion in clinical nutrition and metabolic care.

[7]  I. Papassotiriou,et al.  Early enteral administration of immunonutrition in critically ill children: results of a blinded randomized controlled clinical trial. , 2005, Nutrition.

[8]  C. Pichard,et al.  Increased length of hospital stay in underweight and overweight patients at hospital admission: a controlled population study. , 2005, Clinical nutrition.

[9]  H. Lafeber.  The art of using indirect calorimetry for nutritional assessment of sick infants and children. , 2005, Nutrition.

[10]  A. Randolph,et al.  International pediatric sepsis consensus conference: Definitions for sepsis and organ dysfunction in pediatrics* , 2005, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[11]  R. Branson,et al.  The measurement of energy expenditure. , 2004, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[12]  M. Oosterveld,et al.  Nutritional support in 111 pediatric intensive care units: a European survey , 2004, Intensive Care Medicine.

[13]  W. Hop,et al.  Malnutrition in critically ill children: from admission to 6 months after discharge. , 2004, Clinical nutrition.

[14]  D. Kennerly,et al.  Nutrition support in the intensive care unit. Adequacy, timeliness, and outcomes. , 2003, Critical care nurse.

[15]  V. Preedy,et al.  Nutritional support in critically ill children. , 2003, Clinical nutrition.

[16]  Alain Martinot,et al.  Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study , 2003, The Lancet.

[17]  V. Preedy,et al.  Can energy expenditure be predicted in critically ill children?* , 2003, Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

[18]  J. Dwyer,et al.  Pitfalls in predicting resting energy requirements in critically ill children: a comparison of predictive methods to indirect calorimetry. , 2002, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[19]  S. McClave,et al.  Can we justify continued interest in indirect calorimetry? , 2002, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[20]  C. Ireton-Jones,et al.  Improved equations for predicting energy expenditure in patients: the Ireton-Jones Equations. , 2002, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[21]  G. Briassoulis,et al.  Malnutrition, nutritional indices, and early enteral feeding in critically ill children. , 2001, Nutrition.

[22]  S. Eaton,et al.  Energy Metabolism of Infants and Children with Systemic Inflammatory Response Syndrome and Sepsis , 2001, Annals of surgery.

[23]  J. McEniery,et al.  Energy expenditure in 100 ventilated, critically ill children: Improving the accuracy of predictive equations , 2000, Critical care medicine.

[24]  S. Venkataraman,et al.  Energy expenditure in critically ill children , 2000, Critical care medicine.

[25]  W. Hop,et al.  Indirect calorimetry in mechanically ventilated infants and children: accuracy of total daily energy expenditure with 2 hour measurements. , 1999, Clinical nutrition.

[26]  J. Hazelzet,et al.  Comparison of measured and predicted energy expenditure in mechanically ventilated children , 1998, Intensive Care Medicine.

[27]  T. Jaksic,et al.  Stable isotopic quantitation of protein metabolism and energy expenditure in neonates on- and post-extracorporeal life support. , 1997, Journal of pediatric surgery.

[28]  N. Smyrnios,et al.  Accuracy of 30-minute indirect calorimetry studies in predicting 24-hour energy expenditure in mechanically ventilated, critically ill patients. , 1997, JPEN. Journal of parenteral and enteral nutrition.

[29]  D. Frankenfield,et al.  Validation of a 5-minute steady state indirect calorimetry protocol for resting energy expenditure in critically ill patients. , 1996, Journal of the American College of Nutrition.

[30]  R. Letton,et al.  Early postoperative alterations in infant energy use increase the risk of overfeeding. , 1995, Journal of pediatric surgery.

[31]  B. Delafosse,et al.  Clinical validation of the Deltatrac monitoring system in mechanically ventilated patients , 1995, Intensive Care Medicine.

[32]  D. Frankenfield,et al.  Correlation between measured energy expenditure and clinically obtained variables in trauma and sepsis patients. , 1994, JPEN. Journal of parenteral and enteral nutrition.

[33]  A. Pierro,et al.  A new equation to predict the resting energy expenditure of surgical infants. , 1994, Journal of pediatric surgery.

[34]  C. Baxter,et al.  Equations for the estimation of energy expenditures in patients with burns with special reference to ventilatory status. , 1992, The Journal of burn care & rehabilitation.

[35]  S. Heymsfield,et al.  Bioenergetic and metabolic response to continuous v intermittent nasoenteric feeding. , 1987, Metabolism: clinical and experimental.

[36]  J. S. Wiley,et al.  Early nutritional depletion in critically ill children , 1981, Critical care medicine.

[37]  K. Michaelsen,et al.  The need for nutrition support teams in pediatric units: a commentary by the ESPGHAN committee on nutrition. , 2005, Journal of pediatric gastroenterology and nutrition.

[38]  Gustavo Cardigni,et al.  How much energy must we spend to assess the energy expenditure in the critically ill pediatric patient? , 2004, Pediatric Critical Care Medicine.

[39]  S. Allison.  What is the goal of nutrition in the intensive care unit? , 2003, Nestle Nutrition workshop series. Clinical & performance programme.

[40]  D. Spain,et al.  Achievement of steady state optimizes results when performing indirect calorimetry. , 2003, JPEN. Journal of parenteral and enteral nutrition.

[41]  W. Hop,et al.  Serial measurements of energy expenditure in critically ill children: useful in optimizing nutritional therapy? , 2002, Intensive Care Medicine.

[42]  T. Jaksic,et al.  Do critically ill surgical neonates have increased energy expenditure? , 2001, Journal of pediatric surgery.

[43]  M. Behrends,et al.  In vitro validation of a metabolic monitor for gas exchange measurements in ventilated neonates , 2001, Intensive Care Medicine.

[44]  E. Smith,et al.  Resting energy expenditure in children in a pediatric intensive care unit: comparison of Harris-Benedict and Talbot predictions with indirect calorimetry values. , 1998, The American journal of clinical nutrition.