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Performance of Predictive Equations Specifically Developed to Estimate Resting Energy Expenditure in Ventilated
Corinne Jotterand Chaparro1, Patrick Taffé2, Clémence Moullet3
1Department of Nutrition and Dietetics, School of Health Professions, University of Applied Sciences Western Switzerland, Geneva 1227, Switzerland; Pediatric Intensive Care Unit, Medico-Surgical Department of Pediatrics, University Hospital of Lausanne, Lausanne 1011, Switzerland.
Insights
Predictive equations for resting energy expenditure (REE) in critically ill children are unreliable. Indirect calorimetry is recommended to avoid underfeeding or overfeeding in these vulnerable patients.
Area of Science:
- Critical care medicine
- Pediatric nutrition
- Metabolic research
Background:
- Accurate estimation of resting energy expenditure (REE) is crucial for nutritional management in critically ill children.
- Existing predictive equations for REE were developed for healthy populations or lack validation in pediatric intensive care settings.
- Ventilated critically ill children have unique metabolic demands that may not be captured by standard REE prediction formulas.
Purpose of the Study:
- To evaluate the accuracy of various predictive equations for estimating REE in ventilated critically ill children.
- To compare the biases of equations developed for general populations versus those specifically for critically ill children.
- To determine if any predictive equations meet acceptable performance criteria for REE estimation in this population.
Main Methods:
- Secondary analysis of a prospective study involving 75 ventilated critically ill children.
- Performed 407 indirect calorimetry measurements to determine actual REE.
- Assessed 15 different REE predictive equations, including those from White, Meyer, Mehta, Schofield, Henry, WHO, Fleisch, Harris-Benedict, and Talbot.
- Calculated differential and proportional biases using the Bland-Altman method.
Main Results:
- Most tested equations significantly underestimated or overestimated REE (200-1000 kcal/day).
- Equations by Mehta, Schofield, Henry, and Talbot showed bias ≤10%, but with wide confidence intervals, indicating poor reliability, especially at lower REE values.
- Equations specifically designed for critically ill children exhibited even greater biases.
Conclusions:
- None of the evaluated predictive equations accurately estimated REE across the 200-1000 kcal/day range in ventilated critically ill children.
- Even equations with the smallest bias pose a risk of malnutrition (underfeeding or overfeeding), particularly in younger children.
- Direct measurement of REE using indirect calorimetry is essential for optimal nutritional support in this patient group.
Objective:
To determine, based on indirect calorimetry measurements, the biases of predictive equations specifically developed recently for estimating resting energy expenditure (REE) in ventilated critically ill children, or developed for healthy populations but used in critically ill children.
Study Design:
A secondary analysis study was performed using our data on REE measured in a previous prospective study on protein and energy needs in pediatric intensive care unit. We included 75 ventilated critically ill children (median age, 21 months) in whom 407 indirect calorimetry measurements were performed. Fifteen predictive equations were used to estimate REE: the equations of White, Meyer, Mehta, Schofield, Henry, the World Health Organization, Fleisch, and Harris-Benedict and the tables of Talbot. Their differential and proportional biases (with 95% CIs) were computed and the bias plotted in graphs. The Bland-Altman method was also used.
Results:
Most equations underestimated and overestimated REE between 200 and 1000 kcal/day. The equations of Mehta, Schofield, and Henry and the tables of Talbot had a bias ≤10%, but the 95% CI was large and contained values by far beyond ±10% for low REE values. Other specific equations for critically ill children had even wider biases.
Conclusions:
In ventilated critically ill children, none of the predictive equations tested met the performance criteria for the entire range of REE between 200 and 1000 kcal/day. Even the equations with the smallest bias may entail a risk of underfeeding or overfeeding, especially in the youngest children. Indirect calorimetry measurement must be preferred.
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