Estimation of Resting Energy Expenditure Using Predictive Equations in Critically Ill Children: Results of a Systematic Review

Chaparro, Corinne Jotterand; Moullet, Clémence; Taffé, Patrick; Depeyre, J.; Perez, Marie-Hélène; Longchamp, David; Cotting, Jacques

doi:10.1002/jpen.1146

Cited by 26 publications

(30 citation statements)

References 57 publications

(126 reference statements)

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“…Formula‐based calculation of REE is found to be very unreliable with variations from −802 kcal/d up to 947 kcal/d in critically ill children . The Schofield equation or Talbot's tables are least inaccurate for predicting REE in critically ill children when IC is not available . Both ASPEN and the latest European Society for Clinical Nutrition and Metabolism guidelines recommend the Schofield equations (Table ), but these are not validated during CRRT.…”

Section: Resultsmentioning

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

Nut in Clin Prac

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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%

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

Nut in Clin Prac

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show abstract

“…Specific recommendations of formula type, volume, concentration, and any needed supplements were included. Recommendations for energy were based on Schofield's equation and protein per the World Health Organization or ASPEN guidelines per the PICU dietitian's standard processes, accounting for stress and level of activity modifications . Formula was delivered using a Smith Medical Syringe Pump (Model 3500, Dublin, OH, USA) or Zevex Enteralite Infinity pump (Moog, Inc., Salt Lake City, UT, USA).…”

Section: Methodsmentioning

confidence: 99%

Bolus vs Continuous Nasogastric Feeds in Mechanically Ventilated Pediatric Patients: A Pilot Study

Brown

Forbes

2018

J Parenter Enteral Nutr

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Background Malnutrition increases the risk of mortality and morbidity in the pediatric intensive care unit (PICU). Barriers to adequate delivery of enteral nutrition (EN) include hemodynamic instability, feeding interruptions and intolerance, and lack of standardized feeding protocols. The most recent guidelines on nutrition support for the critically ill child describe a paucity of evidence around the best method to deliver EN. There is an untested clinical assumption that bolus gastric feeding (B‐GF) in intubated patients is associated with aspiration events, lung injury, and associated morbidity compared with continuous gastric feeding (C‐GF). This study compared the effectiveness and safety of C‐GF vs B‐GF in intubated pediatric patients. Methods We enrolled randomized patients aged 1 month–12 years who were intubated within 24 hours and received EN starting within 48 hours of admission to a C‐GF or B‐GF group. Goal‐directed EN volume and caloric density were increased every 3 and 12 hours, respectively, to target. Feeding interruptions and intolerance events were recorded. Results Twenty‐five subjects were enrolled (B‐GF = 11; C‐GF = 14). At 24 hours, B‐GF was associated with higher energy and protein delivery (P < 0.007) and was associated with faster time to goal volume (median B‐GF = 15 hours; C‐GF = 29.5 hours). No aspiration events resulting in additional lung injury were noted for either group (P = 0.866). Conclusions B‐GF was associated with superior delivery of EN with a comparable safety profile to C‐GF. Further study is needed to compare both EN methods in other PICU populations.

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“…The predictive equations for REE may be accurate if the difference between the predicted and the measured results is less than 10% [34]. For adult subjects, all cases were above this limit.…”

Section: Discussionmentioning

confidence: 99%

Resting Energy Expenditure and Protein Balance in People with Epidermolysis Bullosa

et al. 2019

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Epidermolysis bullosa (EB) is a group of conditions characterized by severe fragility of the skin that causes recurring blistering. The recessive dystrophic subtype of EB (RDEB) has a strong impact on the nutritional status. We evaluated the resting energy expenditure (REE) and presence of protein catabolism in patients with RDEB. REE was assessed in 10 subjects (7 females; age range 4–33 years) by indirect calorimetry and using a predictive equation. Nitrogen balance was calculated by protein intake and 24 h urinary urea excretion estimations. An assessment of body surface area (BSA) with infected and non-infected skin lesions was applied to the nitrogen balance burn equation that was adapted to EB. The REE values predicted by the equation were consistently lower than the ones measured, except for two subjects. All subjects recorded high protein and energy intake, with protein intake being higher than 4 g protein/kg/day for five subjects. Even so, protein catabolism was observed in six subjects, three of whom had infected wounds. This study raises the hypothesis that the clinical and nutritional risks of people with RDEB are associated with an increased REE and negative nitrogen balance, which reinforces the importance of nutritional support.

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Estimation of Resting Energy Expenditure Using Predictive Equations in Critically Ill Children: Results of a Systematic Review

Cited by 26 publications

References 57 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

Bolus vs Continuous Nasogastric Feeds in Mechanically Ventilated Pediatric Patients: A Pilot Study

Resting Energy Expenditure and Protein Balance in People with Epidermolysis Bullosa

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