A methodological and clinical approach to measured energy expenditure in the critically ill pediatric patient

Abstract

The metabolic response to injury and stress is characterized initially by a decreased energy expenditure (Ebb phase) followed by an increased metabolic expenditure (Flow phase). Indirect calorimetry is a methodology utilized to measure energy expenditure and substrate utilization by measuring gas exchange in exhaled air and urinary nitrogen. The use of indirect calorimetry in critically ill patients requires precise equipment to obtain accurate measurements. The most recent guidelines suggested that measured energy expenditure by indirect calorimetry be used to determine energy requirements. This article reviews the methodological and clinical use of indirect calorimetry in critically ill pediatric patients.

Feasibility of Achieving Nutritional Adequacy in Critically Ill Children with Critical Neurological Illnesses (CNIs)?—A Quaternary Hospital Experience

“…Ideally, providers can utilize indirect calorimetry (IC) to determine critically ill patients’ basal metabolic needs. IC is a more accurate method than the commonly used equation, i.e., the World Health Organization (WHO) and Schofield equations, as they are proven to be inherently inaccurate in estimating the basal metabolic rate (BMR) of neurologically critically ill children [ 36 , 37 ].…”

Editorial: Methods in Pediatric Critical Care 2022

“…In a case-control study nested within a multicenter randomized controlled trial among children with a complicated severe malnutrition in developing countries, the authors found that blood metabolomic and proteomic profiles robustly differentiated children who died ( n = 92) from those who survived ( n = 92) and these data reinforce other recent study with similar outcome ( 10 , 11 ). In this edition of Methods in Pediatric Critical Care 2022, Silva-Gburek et al discuss about a clinical and methodological approach to measure energy expenditure in the critically ill pediatric patient reviewing the utilization of indirect calorimetry, considering the gold standard method, to evaluate energy expenditure and substrate utilization by measuring gas exchange in exhaled air and urinary nitrogen ( 12 ). Regarding to cost-benefit ratio, this evaluation can measure energy requirements in a precise way and optimize nutritional therapy avoiding degradation of nutritional status and worsening prognosis.…”

Let Us Put More Energy Into Measuring Energy Expenditure: The Next Phase of Indirect Calorimetry*

“…In an ideal framework, measured resting energy expenditure (mREE) by IC would be desirable in all patients with TBI, through sampling of oxygen consumption and carbon dioxide elimination from modern ventilators (6, 7). This remains the current recommended gold standard (8, 9).…”