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Validation of Indirect Calorimetry in Children Undergoing Single-Limb Non-Invasive Ventilation: A Proof of Concept,
Veronica D'Oria1, Giulia Carla Immacolata Spolidoro2, Carlo Virginio Agostoni2,3
1Pediatric Intensive Care Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy.
Insights
Indirect calorimetry (IC) accurately measures resting energy expenditure (REE) in critically ill children on non-invasive ventilation (NIV). This study validates IC during NIV-CPAP and NIV-PS, showing good agreement with spontaneous breathing measurements.
Area of Science:
- Pediatric critical care medicine
- Clinical nutrition
- Respiratory physiology
Background:
- Accurate resting energy expenditure (REE) assessment is crucial for personalized nutrition in critically ill children.
- Indirect calorimetry (IC) is the gold standard for REE measurement, utilizing oxygen consumption (VO2) and carbon dioxide production (VCO2).
- IC validation is lacking for patients receiving non-invasive ventilation (NIV).
Purpose of the Study:
- To investigate the accuracy and applicability of IC in pediatric patients undergoing non-invasive ventilation (NIV).
- To compare REE, VO2, VCO2, and respiratory quotient (RQ) measurements during spontaneous breathing (SB), NIV with continuous positive airway pressure (NIV-CPAP), and NIV with pressure support (NIV-PS).
Main Methods:
- A prospective study involving 14 children under 6 years old weaning from NIV in a Pediatric Intensive Care Unit.
- Indirect calorimetry (IC) was performed during spontaneous breathing (SB), NIV-CPAP, and NIV-PS in each patient.
- Bland-Altman analysis was used to compare measurements between the different ventilation modes.
Main Results:
- No significant differences were observed in REE, VO2, VCO2, and RQ between SB, NIV-CPAP, and NIV-PS.
- Good agreement was found for REE between SB and NIV-CPAP (bias +4.4 kcal/kg/day) and between SB and NIV-PS (bias 0.4 kcal/kg/day).
- Limits of Agreement (LoA) indicated acceptable variability for REE measurements across the ventilation modes.
Conclusions:
- Indirect calorimetry (IC) appears accurate for assessing REE in children receiving non-invasive ventilation (NIV).
- These preliminary findings suggest IC can be reliably used during NIV-CPAP and NIV-PS.
- Further validation in a larger patient cohort is recommended to confirm these results.
Background:
The accurate assessment of resting energy expenditure (REE) is essential for personalized nutrition, particularly in critically ill children. Indirect calorimetry (IC) is the gold standard for measuring REE. This methodology is based on the measurement of oxygen consumption (VO2) and carbon dioxide production (VCO2). These parameters are integrated into the Weir equation to calculate REE. Additionally, IC facilitates the determination of the respiratory quotient (RQ), offering valuable insights into a patient's carbohydrate and lipid consumption. IC validation is limited to spontaneously breathing and mechanically ventilated patients, but it is not validated in patients undergoing non-invasive ventilation (NIV). This study investigates the application of IC during NIV-CPAP (continuous positive airway pressure) and NIV-PS (pressure support).
Methods:
This study was conducted in the Pediatric Intensive Care Unit of IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, between 2019 and 2021. Children < 6 years weaning from NIV were enrolled. IC was performed during spontaneous breathing (SB), NIV-CPAP, and NIV-PS in each patient. A Bland-Altman analysis was employed to compare REE, VO2, VCO2, and RQ measured by IC.
Results:
Fourteen patients (median age 7 (4; 18) months, median weight 7.7 (5.5; 9.7) kg) were enrolled. The REE, VO2, VCO2, and RQ did not differ significantly between the groups. The Limits of Agreement (LoA) and bias of REE indicated good agreement between SB and NIV-CPAP (LoA +28.2, -19.4 kcal/kg/day; bias +4.4 kcal/kg/day), and between SB and NIV-PS (LoA -22.2, +23.1 kcal/kg/day; bias 0.4 kcal/kg/day).
Conclusions:
These preliminary findings support the accuracy of IC in children undergoing NIV. Further validation in a larger cohort is warranted.
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