Energy expenditure in 100 ventilated, critically ill children: Improving the accuracy of predictive equations

White, Mary; Shepherd, Ross W.; McEniery, Julie

doi:10.1097/00003246-200007000-00021

Cited by 126 publications

(121 citation statements)

References 20 publications

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“…In many treatment centres, Schofield prediction equations of basal metabolic rate (BMR) are used to determine the energy requirements of children pre-BMT; however, these equations are derived from indirect calorimetry methods in healthy children. 9 It has been demonstrated that these prediction equations are inaccurate in children under intensive care, 10 but it is unknown whether they can be applied to calculate energy requirements of children who will undergo a BMT. The final aim of this study was to determine if the Schofield prediction equations could accurately predict resting energy expenditure (REE) in children prior to BMT.…”

Section: Discussionmentioning

confidence: 99%

Nutritional status and energy expenditure in children pre-bone-marrow-transplant

White

Murphy

Hastings

et al. 2005

Bone Marrow Transplant

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Summary:The aims of this study were to establish the nutritional status of children pre-BMT and to determine whether predictive methods of assessing nutritional status and resting energy expenditure (REE) are accurate in this population. We analysed the body cell mass (BCM) (n ¼ 26) and REE (n ¼ 24) in children undergoing BMT. BCM was adjusted for height (BCM/HT p ) and expressed as a Z score to represent nutritional status. To determine whether body mass index (BMI) was indicative of nutritional status in children undergoing BMT, BMI Z scores were compared to the reference method of BCM/ HT p Z scores. Schofield predictive equations of basal metabolic rate (BMR) were compared to measured REE to evaluate the accuracy of the predictive equations. The mean BCM/HT p Z score for the subject population was À1.0971.28. There was no significant relationship between BCM/HT p Z score and BMI Z score (r ¼ 0.34; P40.05); however there was minimal difference between measured REE and predicted BMR (bias ¼ À117 149 kcal/day). The results of this study demonstrate that children undergoing BMT may have suboptimal nutritional status and that BMI is not an accurate indication of nutritional status in this population. However, Schofield equations were found to be suitable for representing REE in children pre-BMT. Bone Marrow Transplantation (2005) 35, 775-779.

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Section: Discussionmentioning

confidence: 99%

Nutritional status and energy expenditure in children pre-bone-marrow-transplant

White

Murphy

Hastings

et al. 2005

Bone Marrow Transplant

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“…Framson et al 17 described a heterogeneous cohort of mechanically ventilated children in whom the mean V CO 2 and V O 2 were 4.3 and 5.2 mL/kg/min, respectively, with a mean age of 5.2 y and a mean height of 102 cm. In a survey of 100 mechanically ventilated children, White et al 18 reported a mean V CO 2 and V O 2 of 5.3 and 6.3 mL/kg/min, respectively, for a cohort with a mean age of 4.5 y and a mean height of ϳ97 cm. Furthermore, in a slightly younger population with a mean age of 4.2 y, Martinez et al 19 reported a mean V CO 2 and V O 2 of 4.8 and 6.1 mL/kg/min, respectively, for a cohort of mechanically ventilated children recently admitted to the PICU.…”

Section: Discussionmentioning

confidence: 99%

Carbon Dioxide Elimination and Oxygen Consumption in Mechanically Ventilated Children

et al. 2014

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BACKGROUND: Accurate measurement of carbon dioxide elimination (V CO 2 ) and oxygen consumption (V O 2 ) at the bedside may help titrate nutritional and respiratory support in mechanically ventilated patients. Continuous V CO 2 monitoring is now available with many ventilators. However, because normative data are sparsely available in the literature, we aimed to describe the range of V CO 2 and V O 2 values observed in mechanically ventilated children. We also aimed to examine the characteristics of V CO 2 values that are associated with standard steady state (5-min period when V CO 2 and V O 2 variability are < 10%). METHODS: Mechanically ventilated patients who underwent indirect calorimetry testing were eligible for inclusion, and subjects who achieved standard steady state were included. Normalized V CO 2 and V O 2 values (mL/kg/min) were modeled against subject height, and correlation coefficients were computed to quantify the goodness of fit. A steadystate definition using only V CO 2 was developed (V CO 2 variability of < 5% for a 5-min period) and tested against standard steady state using sensitivity and specificity. RESULTS: Steady-state data from 87 indirect calorimetry tests (in 70 subjects) were included. For age groups < 0.5, 0.5-8, and > 8 y, the mean V CO 2 values were 7.6, 5.8, and 3.5 mL/kg/min. Normalized V CO 2 and V O 2 values were inversely related to subject height and age. The relationships between normalized gas exchange values and height were demonstrated by the models: V CO 2 ‫؍‬ 115 ؋ (height in cm) ؊0.71 (R ‫؍‬ 0.61, P < .001) and V O 2 ‫؍‬ 130 ؋ (height in cm) ؊0.72 (R ‫؍‬ 0.61, P < .001). Steady-state V CO 2 predicted standard steady state (sensitivity of 0.84, specificity of 1.0, P < .01). CONCLUSIONS: V CO 2 and V O 2 measurements correlated with subject height and age. Smaller and younger subjects produced larger amounts of CO 2 and consumed more O 2 per unit of body weight. The use of a 5-min period when V CO 2 varied by < 5% predicted standard steady state. Our observations may facilitate greater utility of V CO 2 at the bedside in the pediatric ICU and thereby extend the benefits of metabolic monitoring to a larger group of patients.

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“…Estimating energy expenditure needs based on standard equations has been shown to be inaccurate and can significantly underestimate or overestimate the REE in critically ill children [13,35]. Such under/overestimates expose the critically ill child to potential underfeeding or overfeeding during the ICU stay, with significant morbidity associated with each scenario.…”

Section: Factors Affecting the Estimate Of Energy Provisionmentioning

confidence: 99%

“…The gold standard to quantify energy needs in children and in adults is the measurement of actual energy consumption by indirect calorimetry [13,35]. When large endotracheal tube leaks are present, alternative isotope methods may be used that are not affected by air leaks or the fraction of inspired oxygen (FiO 2 ) [40,41].…”

Section: Estimating Energy Needsmentioning

confidence: 99%

Nutritional management in the critically ill child with acute kidney injury: a review

et al. 2016

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Acute kidney injury (AKI) in critically ill children is frequently a component of the multiple organ failure syndrome. It occurs within the framework of the severe catabolic phase determined by critical illness and is intensified by metabolic derangements. Nutritional support is a must for these children to improve outcomes. Meeting the special nutritional needs of these children often requires nutritional supplementation by either the enteral or the parenteral route. Since critically ill children with AKI comprise a heterogeneous group of subjects with varying nutrient needs, nutritional requirements should be frequently reassessed, individualized and carefully integrated with renal replacement therapy. This article is a state-of-the-art review of nutrition in critically ill children with AKI.

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Energy expenditure in 100 ventilated, critically ill children: Improving the accuracy of predictive equations

Abstract: The new equations provide a more accurate alternative to current predictive methods in assessing energy requirements of ventilated, critically ill children.

Cited by 126 publications

References 20 publications

Nutritional status and energy expenditure in children pre-bone-marrow-transplant

Nutritional status and energy expenditure in children pre-bone-marrow-transplant

Carbon Dioxide Elimination and Oxygen Consumption in Mechanically Ventilated Children

Nutritional management in the critically ill child with acute kidney injury: a review

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