Overestimation of caloric demand in a long-term critically ill patient

This case report deals with a clinical situation in which an alteration in the nutritional regimen based on indirect calorimetric monitoring may have promoted recovery. A 43-year-old man with a history of acute haemorrhagic pancreatitis, intra-abdominal sepsis, and requirements of mechanical ventilation and total parenteral nutrition over 9 weeks was studied metabolically by means of indirect calorimetry in an attempt to interpret his clinical condition, which was characterised by difficulties in weaning off the ventilator, jaundice and muscular wasting. The caloric load was found to be 56% above measured energy expenditure. The respiratory quotient (RQ) was > 1, indicating the presence of lipogenesis. An alteration in the nutritional regimen based on these findings was followed by a decrease in RQ and a rapid improvement in spontaneous breathing and clinical condition. These results suggest that monitoring of gas exchange in the long-term critically ill patient may be of great importance as a means of avoiding detrimental effects of inadequate nutritional therapy.