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Energy expenditure and substrate utilization in mechanically ventilated children
K F Joosten1, J J Verhoeven, J A Hazelzet
1Department of Pediatrics, Sophia Children's Hospital, University Hospital Rotterdam, The Netherlands. joosten@alkg.azr.nl
Nutrition (Burbank, Los Angeles County, Calif.)
|June 23, 1999
Summary
Indirect calorimetry accurately measures energy needs in mechanically ventilated children. Feeding protocols that align with or exceed measured energy expenditure correlate with positive nitrogen balance, aiding in nutritional assessment.
Area of Science:
- Critical Care Medicine
- Pediatric Nutrition
- Metabolic Monitoring
Background:
- Optimizing nutritional support is crucial for mechanically ventilated children.
- Accurate assessment of energy expenditure and substrate utilization is essential for effective feeding protocols.
Purpose of the Study:
- To evaluate the utility of indirect calorimetry and nitrogen balance in assessing feeding protocols for mechanically ventilated children.
- To determine energy expenditure and substrate utilization in this patient population.
Main Methods:
- A cross-sectional prospective study involving 36 mechanically ventilated children.
- Indirect calorimetry was used to measure total energy expenditure (TMEE).
- Nitrogen balance was assessed by measuring total urinary nitrogen excretion (TUN); substrate utilization and respiratory quotient (RQ) were calculated.
Main Results:
- Total measured energy expenditure (TMEE) varied widely (155-272 kJ.kg-1.d-1).
- Nitrogen balance was positive in 20 patients and negative in 16.
- A higher caloric intake/TMEE ratio correlated with positive nitrogen balance (P < 0.001), and RQ differences indicated substrate utilization patterns.
Conclusions:
- Indirect calorimetry provides accurate energy needs assessment in critically ill, mechanically ventilated children.
- Feeding in accordance with or exceeding TMEE is linked to positive nitrogen balance.
- Combining RQ and macronutrient-specific RQ (RQmacr) aids in identifying under- or overfeeding.