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Measured energy expenditure in critically ill infants and young children
W J Chwals1, K P Lally, M M Woolley
1Division of Pediatric Surgery, Childrens Hospital of Los Angeles, California 90027.
Insights
Critically ill children are often overfed due to inaccurate predicted energy expenditure (PEE) calculations. Measured energy expenditure (MEE) was significantly lower than PEE, highlighting the need for revised nutritional support strategies in pediatric intensive care.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Metabolic research
Background:
- Accurate energy expenditure assessment in critically ill infants and children is limited by technology.
- Predicted energy expenditure (PEE) is commonly used, based on factors like weight, stress, and activity.
- Current methods may lead to overfeeding in vulnerable pediatric populations.
Purpose of the Study:
- To compare measured energy expenditure (MEE) with predicted energy expenditure (PEE) in critically ill infants and children.
- To evaluate the accuracy of conventional PEE methods in this specific patient group.
- To determine the extent of overfeeding based on current predictive models.
Main Methods:
- Utilized a validated metabolic cart for accurate MEE measurement in 20 critically ill infants and children.
- Patients were studied within 4 days of major surgery or during acute critical illness, under mechanical ventilation.
- Study duration averaged 4 hours after a 30-minute stabilization period.
Main Results:
- Mean MEE (52.2 kcal/kg/day) was significantly lower than mean PEE (101.8 kcal/kg/day) (P < 0.001).
- The MEE/PEE ratio averaged 52.6%, indicating substantial overfeeding with PEE.
- Paralyzed patients showed even lower MEE compared to PEE and predicted basal metabolic rate (PBMR).
Conclusions:
- Conventional PEE significantly overestimates the actual energy needs of critically ill infants and children.
- Relying solely on PEE for caloric repletion can lead to substantial overfeeding in this population.
- Findings suggest a need for revised protocols for nutritional support in pediatric critical care.
Abstract:
Technological limitations have impeded accurate energy expenditure assessment in critically ill infants and young children. Instead, a predicted energy expenditure (PEE) is derived based on weight, heat loss, activity, growth requirements, and degree of stress. This study compared actual measured energy expenditure (MEE) with conventional predicted values in 20 critically ill infants and children using a validated metabolic cart designed for use in this age group. All patients were studied either within 4 days of major surgery or during an acute disease process necessitating intensive care. All were severely stressed clinically and were studied while mechanically ventilated in a temperature-controlled environment. The study interval ranged from 1 to 12 hr and averaged 4 hr after a stabilization period of 30 min. The mean MEE was significantly lower than the mean PEE (52.2 +/- 16 kcal/kg/day vs 101.8 +/- 17 kcal/kg/day, P less than 0.001) with a mean MEE/PEE of 52.6 +/- 17% (range 26 to 92%). In a subgroup of 7 paralyzed patients, the mean MEE was significantly lower than in the 13 nonparalyzed patients when compared with PEE and predicted basal metabolic rate (PBMR). The coefficient of variance, conventionally recognized to be approximately 15% for PEE, averaged 6.35% for MEE in this study. These data indicate that if PEE is used as the sole guide for caloric repletion in the stressed infant or child, these patients will be substantially overfed.