Simple and accurate assessment of energy expenditure in ventilated paediatric intensive care patients

Area of Science:

• Pediatric critical care medicine
• Clinical nutrition
• Metabolic assessment

Background:

• Accurate energy expenditure (EE) measurement is vital for nutritional support in critically ill children.
• Standard metabolic monitors and predictive equations like Schofield have limitations in this population.

Purpose of the Study:

• To evaluate the validity and reliability of a brief Douglas bag protocol for EE measurement.
• To compare EE measurements from the Douglas bag method against a standard metabolic monitor and Schofield equations in pediatric intensive care patients.

Main Methods:

• Paired measurements of EE were conducted using the Douglas bag method and a metabolic monitor in 14 ventilated pediatric patients (sepsis, trauma, post-surgery).
• Data were analyzed using Bland-Altman analysis to compare the two methods and against Schofield equations.
• Intra-measurement variability was assessed using the coefficient of variation.

Main Results:

• The Douglas bag method showed minimal bias (-2%) and acceptable limits of agreement (-16% to +13%) compared to the metabolic monitor.
• Both methods demonstrated significant bias when compared to Schofield equations, with wide limits of agreement.
• Intra-measurement variability was within 10% for both EE measurement techniques.

Conclusions:

• The Douglas bag method is a valid and reliable tool for assessing energy expenditure in critically ill children.
• It performs favorably compared to the metabolic monitor and is more robust than Schofield equations for individual EE prediction.
• Its low cost and simplicity make the Douglas bag method suitable for routine nutritional assessment in pediatric intensive care units.