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Is indirect calorimetry a necessity or a luxury in the pediatric intensive care unit?
Ursula G Kyle1, Ana Arriaza, Monica Esposito
1Baylor College of Medicine/Texas Children's Hospital, Pediatric Critical Care Medicine, Houston, Texas 77030, USA. ukyle@bcm.tmc.edu
Insights
Most critically ill children in the pediatric intensive care unit (PICU) need indirect calorimetry (IC) to determine energy needs. Over 70% of PICU patients met criteria for IC, highlighting its importance in pediatric critical care.
Area of Science:
- Pediatric critical care medicine
- Nutritional support
- Metabolic assessment
Background:
- Critically ill children have unique energy requirements due to metabolic changes, comorbidities, and illness severity.
- Accurate assessment of energy expenditure is crucial for optimizing nutrition support in pediatric intensive care unit (PICU) patients.
- The American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) provides guidelines for identifying patients who would benefit from indirect calorimetry (IC).
Purpose of the Study:
- To determine the proportion of pediatric intensive care unit (PICU) patients who meet the criteria for indirect calorimetry (IC) based on A.S.P.E.N. recommendations.
- To identify specific patient populations and indications that most frequently warrant IC in a PICU setting.
Main Methods:
- A retrospective chart review of 150 pediatric intensive care unit (PICU) patients was conducted.
- Data collected included admission diagnosis, demographics, nutrition support details, and length of stay.
- Patients were classified as candidates for IC according to A.S.P.E.N. guidelines.
Main Results:
- Indirect calorimetry (IC) was indicated in 72.0% of the 150 studied PICU patients within the first 7 days of admission.
- Frequent indications for IC included neurological (73%), respiratory (81%), and sepsis (83%) diagnoses, as well as underweight/overweight/obesity (32.4%) and hypermetabolism (26.4%).
- Patients with neurological disease, oncology, respiratory conditions, or sepsis were significantly more likely to have multiple indications for IC.
Conclusions:
- A substantial majority (72.0%) of pediatric intensive care unit (PICU) patients are candidates for indirect calorimetry (IC) according to A.S.P.E.N. guidelines.
- Prioritizing IC for younger children (<2 years), malnourished patients, or those with prolonged PICU stays (>5 days) may be beneficial.
- Further research is needed to establish the cost-effectiveness of routine IC in the PICU population.
Background:
Critically ill children differ in their energy needs from healthy children in terms of underlying metabolic derangement, comorbidities, energy reserve, and response to illness. This study determined how many pediatric intensive care unit (PICU) patients were candidates for indirect calorimetry (IC), per American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommendations.
Methods:
Admission diagnosis, demographics, type/amount of nutrition support, length of intensive care unit/hospital stay were collected. Patients were classified as candidates for IC per A.S.P.E.N. guidelines.
Results:
Mean (SD) age of patients (n = 150) was 6.7 (5.6) years, with PICU length of stay of 3.9 (5.3) days. IC was indicated in 72.0% (108/150) of patients during PICU days 1-7. Patients with miscellaneous (50%), neurological (73%), respiratory (81%), sepsis (83%), and oncology (100%) diagnoses were candidates for IC. Underweight/overweight/obese (32.4%), hypermetabolism (26.4%), and not meeting nutrition goals (13.7%) were the most frequent indications for IC (χ(2), P < .001). Patients (31%) met ≥2 indications for IC. Patients with neurological disease (relative risk [RR], 4.8; 95% confidence interval [CI], 1.7-14.6), oncology patients (4.2; 1.1-15.9), respiratory patients (5.5; 2.0-16.9), and children with sepsis/septic shock/infection (5.6; 1.9-18.1) were more likely to have ≥2 indications for IC compared to those with other diagnoses.
Conclusions:
Three of 4 patients were candidates for IC per A.S.P.E.N. guidelines. PICUs might have to prioritize performing IC in patients who are <2 years of age, malnourished (underweight/overweight) on admission, or PICU stay of >5 days. Future studies should determine the cost-benefit ratios of performing IC in PICU patients.
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