Do PICU patients meet technical criteria for performing indirect calorimetry?

Beggs, Megan R; Guerra, Gonzalo Garcia; Larsen, Bodil

doi:10.1016/j.clnesp.2016.06.003

Cited by 13 publications

(12 citation statements)

References 29 publications

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“…Thus, IC measures VO 2 and VCO 2 based on the assumption that gas exchange as a result of nutrient consumption and energy production is represented by the breath gas composition. IC is indicated (Appendix) in 72% of critically ill children, but only 34% of patients met technical criteria for IC . Scrutinizing the literature yielded no data on REE in CRRT‐treated critically ill pediatric patients.…”

Section: Resultsmentioning

confidence: 99%

“…IC is indicated (Appendix) in 72% of critically ill children, 23 but only 34% of patients met technical criteria for IC. 24 Scrutinizing the literature yielded no data on REE in CRRT-treated critically ill pediatric patients. Efforts have been made in adult patients to validate IC during CRRT by measuring REE with and without CRRT.…”

Section: In Absence Of Ic Equations Can Be Used (Weak Recommendation)mentioning

confidence: 99%

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Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Jonckheer¹,

Vergaelen²,

Spapen³

et al. 2018

Nutrition in Clinical Practice

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Introduction Nutrition is an important part of treatment in critically ill children. Clinical guidelines for nutrition adaptations during continuous renal replacement therapy (CRRT) are lacking. We collected and evaluated current knowledge on this topic and provide recommendations. Methods Questions were produced to guide the literature search in the PubMed database. Results Evidence is scarce and extrapolation from adult data was often required. CRRT has a direct and substantial impact on metabolism. Indirect calorimetry is the preferred method to assess resting energy expenditure (REE). Moderate underestimation of REE is common but not clinically relevant. Formula‐based calculation of REE is inaccurate and not validated in critically ill children on CRRT. The nutrition impact of nonintentional calories delivered as citrate, lactate, and glucose during CRRT must be considered. Quantifying nitrogen balance is not feasible during CRRT. Protein delivery should be increased by 25% to compensate for losses in the effluent. Fats are not removed by CRRT and should not be adapted during CRRT. Electrolyte disturbances are frequently present and should be treated accordingly. Vitamins B1, B6, B9, and C are lost in the effluent and should be adapted to the effluent dose. Trace elements, with the exception of selenium, are not cleared in relevant quantities. Manganese accumulation is of concern because of potential neurotoxicity. Conclusion Current recommendations regarding nutrition support in pediatric CRRT must be extrapolated from adult studies. Recommendations are provided, based on the weak level of evidence. Additional research on this topic is warranted.

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Section: Resultsmentioning

confidence: 99%

Section: In Absence Of Ic Equations Can Be Used (Weak Recommendation)mentioning

confidence: 99%

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Jonckheer¹,

Vergaelen²,

Spapen³

et al. 2018

Nutrition in Clinical Practice

View full text Add to dashboard Buy / Rent full text

show abstract

“…International guidelines recommend that where possible energy requirements should be measured using indirect calorimetry (IC) [4]. However, this device is available in only 15% of PICUs worldwide [28]. Furthermore, a number of PICU clinical conditions prevent the use of IC (27% of patients), such as FiO 2 > 60%, air leaks, extracorporeal circulation [28].…”

Section: Discussionmentioning

confidence: 99%

NUTRI-REAPED study: nutritional assessment of French critically ill children and nutrition practice survey in French-speaking pediatric intensive care units

Jacquot¹,

Mura²,

Tume

et al. 2019

Ann. Intensive Care

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BackgroundImpaired nutritional status is adversely associated with suboptimal outcomes in critically ill children. Undernutrition at pediatric intensive care unit (PICU) admission ranges from 15 to 65%. A lack of knowledge of the nutritional status of children in French PICUs prevents us from specifically targeting education. This study aims to describe the nutritional status of children in French PICUs and to assess nutritional practices and physicians’ knowledge of nutrition, in order to focus NutriSIP (the French-speaking PICU nutrition group) future education programs. A prospective observational multicenter point prevalence study was conducted in French PICUs, recruiting all children admitted over three different weeks. Anthropometric measurements were taken (weight, height/length, mid-upper arm, and head circumferences), in order to calculate nutritional indices. Nutritional status was defined according to WHO Body Mass Index z-score and dynamic assessment based on growth faltering detection. Concurrently, PICU physicians and PICU nurses from seven French-speaking countries completed a survey to ascertain knowledge about local nutritional care practices and overall nutrition knowledge. PICU physicians’ responses were compared to PICU nurses’ responses (previously published).ResultsFour hundred and thirty-two children were included in the observational study from 27 French PICUs. Undernutrition was diagnosed in 18.5% of them, young age and underlying chronic condition being the two independent risk factors. Faltering growth was diagnosed in 4.8% and overweight in 7.4%. Subjective nutritional assessment was not accurate. Thirty-eight French-speaking PICUs completed the survey. These showed nutritional practices frequently did not comply with international guidelines, especially regarding nutritional goals, and the reasons for withholding enteral nutrition. Comparison between physicians’ and nurses’ responses to the survey showed large discrepancies.ConclusionUndernutrition is frequent at admission in French PICUs. Nutritional status should be assessed using a holistic approach, because of the potential impact on outcome. French-speaking PICU healthcare professionals need further nutrition education, in order to improve nutritional practices to comply with international recommendations. This study will serve as a baseline to focus NutriSIP teaching programs in the future.Electronic supplementary materialThe online version of this article (10.1186/s13613-019-0493-z) contains supplementary material, which is available to authorized users.

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“…Es importante la provisión de proteína al inicio del curso de la enfermedad crítica para alcanzar las metas proteícas y promover balance de nitrógeno positivo [5][6][7][8][9][10][11][12][13][14][15][16][17] .…”

Section: Aporte De Macronutrientesunclassified

“…La NP debe mantenerse hasta que se consiga una adecuada transición a la NE, es decir, cuando dichos aportes alcancen 2/3 de los requerimientos nutricionales estimados [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21] .…”

Section: Nutrición Parenteral (Np)unclassified

Soporte Nutricional en El Paciente Pediátrico Crítico

2018

RFMH

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Do PICU patients meet technical criteria for performing indirect calorimetry?

Cited by 13 publications

References 29 publications

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

Modification of Nutrition Therapy During Continuous Renal Replacement Therapy in Critically Ill Pediatric Patients: A Narrative Review and Recommendations

NUTRI-REAPED study: nutritional assessment of French critically ill children and nutrition practice survey in French-speaking pediatric intensive care units

Soporte Nutricional en El Paciente Pediátrico Crítico

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