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Background Indirect calorimetry (IC) is the gold standard for measuring resting energy expenditure. Energy expenditure (EE) estimated by ventilator‐derived carbon dioxide consumption (EEVCO 2 ) has also been proposed. In the absence of IC, predictive weight‐based equations have been recommended to estimate daily energy requirements. This study aims to compare simple predictive weight‐based equations with those estimated by EEVCO 2 and IC in mechanically ventilated patients of COVID‐19. Methods Retrospective study of a cohort of critically ill adult patients with COVID‐19 requiring mechanical ventilation and artificial nutrition to compare energy estimations by three methods through the calculation of bias and precision agreement, reliability, and accuracy rates. Results In 58 mechanically ventilated patients, a total of 117 paired measurements were obtained. The mean estimated energy derived from weight‐based calculations was 2576 ± 469 kcal/24 h, as compared with 1507 ± 499 kcal/24 h when EE was estimated by IC, resulting in a significant bias of 1069 kcal/day (95% CI [−2158 to 18.7 kcal]; P < 0.001). Similarly, estimated mean EEVCO 2 was 1388 ± 467 kcal/24 h when compared with estimation of EE from IC. A significant bias of only 118 kcal/day (95% CI [−187 to 422 kcal]; P < 0.001), compared by the Bland‐Altman plot, was noted. Conclusion The energy estimated with EEVCO 2 correlated better with IC values than energy derived from weight‐based calculations. Our data suggest that the use of simple predictive equations may potentially lead to overfeeding in mechanically ventilated patients with COVID‐19.

Acute overfeeding-related problems are seldom reported in literature when compared to the effects of underfeeding. A 41year female patient, on chronic antipsychotic medications (tab Olanzapine at 20 mg/day), presented do the intensive care unit (ICU) with severe shortness of breath and decreased responsiveness. She had very poor oral intake for the last 3 months. On admission, her height was 160 cm, weight was 50 kg (ideal body weight -55 kg), and body mass index (BMI), 19.5 kg/m 2 . Her serum albumin on admission was 2.0 g/dL with mild anemia ( hemoglobin -8.5 g/dL). The initial estimated caloric requirement was 1600 kcal/ day, proteins -56 g, to reach target at 5 th day. Initial feeding was started at 10 kcal/kg /day with 0.5 g/kg /day of protein with close watch on potassium and phosphorous, as part of the dreaded "refeeding syndrome," and she slowly progressed to goal over five days.

Background: Hyperglycemia (>180 mg/dL or >10.0 mmol/L) has serious health implications in intensive care unit (ICU) patients. The aim of the present study was to explore the effectiveness of SavenG (Sanjith's Very Easy Nurse managed glucose control) protocol in the maintenance of glucose concentration in ICU patients. Materials and Methods: In this observational study, a total of 108 patients admitted to the ICU unit of SL Raheja hospital, a tertiary care institute in Mumbai, were enrolled. The patients received insulin therapy as proposed in SavenG protocol. The glucose in serum was measured using a glucometer and was categorized into three levels: <150 mg/dL, 150–200 mg/dL, and >200 mg/dL. The collected data were statistically analyzed by using SPSS version 24.0. Results: Patients were primarily male (69%), with an average age of 63.96 ± 13.14 years, reporting at least two complications (1.49 ± 1.03), and with a greater risk of hypertension (60%). Higher doses of insulin (~59.9 units) were administered on the first two days of protocol. By day 5, the requirement of insulin dose was gradually decreased to 36.8 units. The insulin was administered for totally seven days. The insulin dosing that was administered was sufficient to maintain the glucose level of 150–200 mg/dL for 12 h (F = 79.35, P < 0.01) and this sugar level showed a comparatively lower level of variation within a day (F = 13.123, P < 0.01). Further, the sugar level was not influenced by demographic characteristics such as age, gender and concomitant complications such as hypertension, ischemic heart disease, coronary artery bypass grafting, and kidney disease. Conclusion: The proposed SavenG protocol validates the effectiveness of insulin doses to regulate and maintain the glucose level at 150–200 mg/dL for 12 h within a day in ICU patients.