Article Text

DELIVERED AND PREDICTED ENERGY COMPARED TO MEASURED ENERGY EXPENDITURE IN CRITICALLY ILL CHILDREN
  1. C Jotterand1,
  2. J Depeyre1,
  3. M O Ranson2,
  4. M H Perez3,
  5. P Stucki3,
  6. J Cotting3
  1. 1Dietetics Department, University of Applied Sciences of Western Switzerland, Carouge, Switzerland
  2. 2Clinical Nutrition Unit, University Hospital, Lausanne, Switzerland
  3. 3Pediatric Intensive Care Unit, University Hospital, Lausanne, Switzerland

Abstract

Objective In pediatric intensive care units, energy needs vary widely and are complex to determine. The aim of this study was to compare energy expenditure measured (REEm) by indirect calorimetry with energy intake (EI) and theoretical REE in critically ill ventilated children.

Methods Children with expected mechanical ventilation ⩾72 hours and a FiO2 ⩽60% were studied. REEm was measured daily by indirect calorimetry until extubation; results were compared to EI and energy balance was calculated daily. REE was predicted by the equations of Schofield WH (1985) and White (2000). Comparisons were tested the by t-test and the Bland-Altman method.

Results 62 critically ill children, 36 males and 26 females were included; mean age (±SD) was 21.5±20.6 months with a body weight and body size of 9.1±4.9 kg and 75.5±19.7 cm, respectively. Reasons for admission were mainly post surgery and respiratory illness. 337 measurements were performed. REEm was 55.4±11.6 kcal/kg/d (median: 55.3; IQ: 46.2 to 62.4 kcal/kg/d). EI was 50.1±26.0 kcal/kg/d with a strong negative balance during the first 2 days which became clearly positive after the 7th day. Schofield estimated REE correctly with a mean bias of –0.40±14.1 kcal/kg/d (ns; 95% CI –1.9 to 1.1). White equation overestimated REE with a mean bias of 40.6±75.7 kcal/kg/d (p<0.0001; 95% CI 32.5 to 48.7).

Conclusion Ventilated critically ill children do not present an hypermetabolic state and their energy balance become highly positive since the 2nd week of hospitalization. The Schofield equation predicts REE accurately whereas the White equation overestimates REE.

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