Related Experiment Video
Updated: Apr 20, 2026
A Clinical Trial Assessing the Safety, Efficacy, and Delivery of Olive-Oil-Based Three-Chamber Bags for Parenteral Nutrition
Published on: September 20, 2019
Metabolic assessment and individualized nutrition in children dependent on mechanical ventilation at home
Enid E Martinez1, Craig D Smallwood2, Lori J Bechard3
1Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
Insights
Children on home mechanical ventilation often experience malnutrition and altered metabolism, with particularly low protein intake. A home-based care model can help personalize nutritional support for this vulnerable group.
Area of Science:
- Pediatric critical care
- Nutritional science
- Metabolic disorders
Background:
- Long-term mechanical ventilation in children is increasingly managed at home.
- Nutritional, metabolic, and body composition status in these children require thorough evaluation.
- Home-based care models necessitate understanding the unique challenges faced by these patients.
Purpose of the Study:
- To assess the nutritional and metabolic status of children receiving long-term home mechanical ventilation.
- To evaluate the body composition of this pediatric cohort.
- To compare different methods for estimating energy expenditure and body fat.
Main Methods:
- The study included children requiring at least 12 hours of daily home mechanical ventilation.
- Assessments included anthropometry, bioelectrical impedance analysis (BIA), energy intake, and indirect calorimetry conducted at home.
- Agreement between measured and estimated energy expenditure, and between different body fat estimation methods was analyzed.
Main Results:
- Twenty children were enrolled; a majority showed signs of malnutrition, suboptimal protein intake, and altered metabolic rates (hypo- or hypermetabolism).
- Fat mass percentage was significantly higher than population norms, and bioelectrical impedance analysis (BIA) and anthropometry showed poor agreement.
- A novel volumetric carbon dioxide production-based equation demonstrated better agreement with measured energy expenditure than the Schofield equation.
Conclusions:
- Most children on home ventilation suffer from malnutrition, metabolic disturbances, and inadequate protein intake.
- A multidisciplinary, home-based approach is crucial for tailoring energy and protein delivery.
- Individualized nutritional strategies may lead to improved health outcomes for children on home mechanical ventilation.
Objective:
To evaluate the nutritional and metabolic status and body composition of children on long-term mechanical ventilation using a home-based model.
Study Design:
Children on home mechanical ventilation, for at least 12 hours a day, were eligible. We performed anthropometry, bioelectrical impedance analysis (BIA), actual energy intake (AEI), and indirect calorimetry in the subject's home. Agreement between measured energy expenditure (MEE) from indirect calorimetry, and estimated energy expenditure by the Schofield equation and a novel volumetric carbon dioxide production-based equation was examined. Agreement between fat mass estimates from anthropometry and BIA was examined and compared with population norms.
Results:
We enrolled 20 children, 11 (55%) male; mean age 8.4 years (SD 4.8). Mean weight for age z-score was -0.26 (SD 1.48); 9/20 had z-scores <-1 or >+1. Thirteen were underfed (AEI:MEE <90%) or overfed (AEI:MEE >110%); 11 of 19 had protein intake that was less than recommended by guidelines. Fifteen subjects were hypo- or hypermetabolic. Mean (SD) fat mass % was 33.6% (8.6) by anthropometry, which was significantly greater than matched population norms (mean 23.0%, SD 6.1, P < .001). The estimated energy expenditure by a volumetric carbon dioxide production-based equation was in stronger agreement with the MEE than the Schofield equation (mean bias 0.06%, limits -15.98% to 16.16% vs mean bias -1.31%, limits -74.3% to 72%, respectively). BIA and anthropometric fat mass values were not in agreement.
Conclusion:
A majority of children on home ventilation are characterized by malnutrition, altered metabolic status, and suboptimal macronutrient intake, in particular low protein intake. A multidisciplinary home-based model facilitates individualized energy and protein delivery and may improve outcomes in this cohort.
Related Concept Videos
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
01:20Assessment of Ventilation I: Respiratory Rate
A Ventilation assessment is critical for monitoring a patient's health status. Respiration, one of the most accessible vital signs, provides insights into the function of numerous body systems and can indicate serious health issues, such as brainstem injuries from head trauma.
Critical Guidelines for Assessing Ventilation:
01:19Respiratory Assessment: Purpose and Indications
Objectives and Importance:
The primary goal of respiratory assessment is to evaluate patients at early risk of clinical deterioration. Since respiratory distress often precedes other signs of declining health, breathing patterns and sounds become a...
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
01:23Assessment of Respiration
Subjective Assessment: Nurses interview the patient to gather information directly during the subjective assessment. It includes questions about the individual's medical history, medications, and symptoms, focusing on past respiratory conditions like...