Related Experiment Videos
Measured energy expenditure in pediatric intensive care patients
S J Tilden1, S Watkins, T K Tong
1Pediatric Intensive Care Unit, Children's Health Center, Phoenix, Ariz.
Insights
Mechanically ventilated children require higher energy intake than predicted. Resting energy expenditure measurements are crucial for accurate nutritional support in critically ill pediatric patients, with a recommended 1.5 times basal energy expenditure when measurements aren
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Metabolic research
Background:
- Limited data exist on the energy needs of mechanically ventilated, critically ill children.
- Accurate energy assessment is vital for optimizing outcomes in pediatric intensive care.
- Existing adult-based factors may not accurately reflect pediatric metabolic demands.
Purpose of the Study:
- To measure resting energy expenditure (REE) in mechanically ventilated pediatric patients.
- To compare measured REE with predicted basal energy expenditure (BEE) using Harris-Benedict equations.
- To establish evidence-based recommendations for energy and nitrogen requirements in this population.
Main Methods:
- Indirect calorimetry was used to measure REE in 18 mechanically ventilated children (ages 2-18 years).
- Patients were hemodynamically stable, afebrile, without active infection, and receiving 5% dextrose.
- Fractional inspired oxygen concentration was <0.6, and spontaneous respirations were absent.
Main Results:
- All subjects demonstrated hypermetabolism, with measured REE/predicted BEE ratio of 1.48 ± 0.09.
- Energy derived from macronutrient oxidation: 33% carbohydrates, 53% fat, 14% protein.
- Recommended energy requirement: 1.5 times BEE in absence of REE measurement; 250 mg/kg/day nitrogen.
Conclusions:
- Mechanically ventilated pediatric patients exhibit significantly elevated metabolic rates.
- Direct measurement of REE is recommended for personalized nutritional management.
- Adjusted injury factors (1.25) and a general recommendation of 1.5x BEE are proposed for pediatric critical care.
Abstract:
Few data are available on energy requirements of mechanically ventilated, critically ill children. We measured the resting energy expenditure in 18 mechanically ventilated patients between ages 2 and 18 years, using indirect calorimetry. All patients had fractional inspired oxygen concentration less than 0.6, no spontaneous respirations, hemodynamic stability, and no fever or active infection, and were receiving 5% dextrose. All subjects were hypermetabolic, since the measured resting energy expenditure divided by the predicted basal energy expenditure from the Harris-Benedict equations was 1.48 +/- 0.09 (mean +/- SEM). The energy requirements calculated using "injury factors" and "activity factors" adapted for adults is 1.62 times basal energy expenditure. The injury factor for the pediatric multiple trauma patients should be 1.25 compared with 1.35 in adults. In these pediatric intensive care patients 33% +/- 8% of the energy is derived from carbohydrates, 53% +/- 8% from fat, and 14% +/- 2% from protein oxidation. In individual critically ill pediatric patients, energy requirements should be estimated by measuring their resting energy expenditure whenever possible and adding 5% for their activity. In the absence of the actual measurement of resting energy expenditure, the recommended energy requirement is 1.5 times basal energy expenditure. In this acute phase of injury, the daily nitrogen requirement is 250 mg per kilogram of body weight.