An Exploratory Retrospective Study of Factors Affecting Energy Expenditure in Critically Ill Children.
child
critical illness
energy expenditure
energy metabolism
indirect calorimetry
metabolism
nutrition
pediatric
Journal
JPEN. Journal of parenteral and enteral nutrition
ISSN: 1941-2444
Titre abrégé: JPEN J Parenter Enteral Nutr
Pays: United States
ID NLM: 7804134
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
08
01
2019
accepted:
31
05
2019
pubmed:
4
7
2019
medline:
4
3
2021
entrez:
4
7
2019
Statut:
ppublish
Résumé
Accurate measurement of energy expenditure is not widely available. Patient and clinical factors associated with energy expenditure have been poorly explored, leading to errors in estimation formulae. The objective of this study was to determine clinical factors associated with measured energy expenditure (MEE), expressed in kcal/kg/d, in critically ill children. This was a retrospective study at 2 Canadian pediatric intensive care units (ICUs). Patients were mechanically ventilated children who had 1 or more MEE using indirect calorimetry. Associations between MEE and 28 clinical factors were evaluated in univariate regression and 16 factors in a multivariate regression model accounting for repeated measurements. Data from 239 patients (279 measurements) were analyzed. Median (Q1, Q3) MEE was 34.8 (26.8, 46.2) kcal/kg/d. MEE was significantly associated with weight, heart rate, diastolic blood pressure, ICU day of indirect calorimetry (P = 0.004), minute ventilation, vasoactive inotropic score (P = 0.004), opioids, chloral hydrate, dexmedetomidine, inhaled salbutamol (P = 0.02), and propofol dose (all P < 0.0001 unless otherwise specified) in the final multivariate regression model. This study demonstrated association between MEE (kcal/kg/d) and factors not previously explored in pediatric critical illness. Further evaluation of these factors to confirm associations and more precisely quantify the magnitude of effect is required to support refinement of formulae to estimate energy expenditure.
Sections du résumé
BACKGROUND
Accurate measurement of energy expenditure is not widely available. Patient and clinical factors associated with energy expenditure have been poorly explored, leading to errors in estimation formulae. The objective of this study was to determine clinical factors associated with measured energy expenditure (MEE), expressed in kcal/kg/d, in critically ill children.
METHODS
This was a retrospective study at 2 Canadian pediatric intensive care units (ICUs). Patients were mechanically ventilated children who had 1 or more MEE using indirect calorimetry. Associations between MEE and 28 clinical factors were evaluated in univariate regression and 16 factors in a multivariate regression model accounting for repeated measurements.
RESULTS
Data from 239 patients (279 measurements) were analyzed. Median (Q1, Q3) MEE was 34.8 (26.8, 46.2) kcal/kg/d. MEE was significantly associated with weight, heart rate, diastolic blood pressure, ICU day of indirect calorimetry (P = 0.004), minute ventilation, vasoactive inotropic score (P = 0.004), opioids, chloral hydrate, dexmedetomidine, inhaled salbutamol (P = 0.02), and propofol dose (all P < 0.0001 unless otherwise specified) in the final multivariate regression model.
CONCLUSIONS
This study demonstrated association between MEE (kcal/kg/d) and factors not previously explored in pediatric critical illness. Further evaluation of these factors to confirm associations and more precisely quantify the magnitude of effect is required to support refinement of formulae to estimate energy expenditure.
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
507-515Subventions
Organisme : CIHR
Pays : Canada
Informations de copyright
© 2019 American Society for Parenteral and Enteral Nutrition.
Références
Wong JJ, Han WM, Sultana R, Loh TF, Lee JH. Nutrition delivery affects outcomes in pediatric acute respiratory distress syndrome. JPEN J Parenter Enteral Nutr. 2017;41(6):1007-1013.
Mikhailov TA, Kuhn EM, Manzi J, et al. Early enteral nutrition is associated with lower mortality in critically ill children. JPEN J Parenter Enteral Nutr. 2014;38(4):459-466.
Mehta NM, Bechard LJ, Cahill N, et al. Nutritional practices and their relationship to clinical outcomes in critically ill children-an international multicenter cohort study. Crit Care Med. 2012;40(7):2204-2211.
Haydock DA, Hill GL. Impaired wound healing in surgical patients with varying degrees of malnutrition. JPEN J Parenter Enteral Nutr. 1986;10(6):550-554.
Windsor JA, Hill GL. Risk factors for postoperative pneumonia. The importance of protein depletion. Ann Surg. 1988;208(2):209-214.
van Venrooij LM, Verberne HJ, de Vos R, Borgmeijer-Hoelen MM, van Leeuwen PA, de Mol BA. Postoperative loss of skeletal muscle mass, complications and quality of life in patients undergoing cardiac surgery. Nutrition. 2012;28(1):40-45.
Yeh DD, Fuentes E, Quraishi SA, et al. Adequate nutrition may get you home: effect of caloric/protein deficits on the discharge destination of critically ill surgical patients. JPEN J Parenter Enteral Nutr. 2016;40(1):37-44.
Chwals WJ. Overfeeding the critically ill child: fact or fantasy? New Horiz. 1994;2(2):147-155.
Letton RW, Chwals WJ, Jamie A, Charles B. Early postoperative alterations in infant energy use increase the risk of overfeeding. J Pediatr Surg. 1995;30(7):988-992; discussion 992-983.
van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in critically ill patients. N Engl J Med. 2001;345(19):1359-1367.
Mehta NM, Skillman HE, Irving SY, et al. Guidelines for the provision and assessment of nutrition support therapy in the pediatric critically ill patient: Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr. 2017;41(5):706-742.
Black C, Grocott MP, Singer M. Metabolic monitoring in the intensive care unit: a comparison of the Medgraphics Ultima, Deltatrac II, and Douglas bag collection methods. Br J Anaesth. 2015;114(2):261-268.
Mtaweh H, Tuira L, Floh AA, Parshuram CS. Indirect calorimetry: history, technology, and application. Front Pediatr. 2018;6:257.
McClave SA, Spain DA, Skolnick JL, et al. Achievement of steady state optimizes results when performing indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003;27(1):16-20.
Leteurtre S, Martinot A, Duhamel A, et al. Validation of the paediatric logistic organ dysfunction (PELOD) score: prospective, observational, multicentre study. Lancet. 2003;362(9379):192-197.
Wernovsky G, Wypij D, Jonas RA, et al. Postoperative course and hemodynamic profile after the arterial switch operation in neonates and infants. A comparison of low-flow cardiopulmonary bypass and circulatory arrest. Circulation. 1995;92(8):2226-2235.
Franck LS, Harris SK, Soetenga DJ, Amling JK, Curley MA. The Withdrawal Assessment Tool-1 (WAT-1): an assessment instrument for monitoring opioid and benzodiazepine withdrawal symptoms in pediatric patients. Pediatr Crit Care Med. 2008;9(6):573-580.
Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23(3):293-297.
von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Ann Intern Med. 2007;147(8):573-577.
White MS, Shepherd RW, McEniery JA. Energy expenditure in 100 ventilated, critically ill children: improving the accuracy of predictive equations. Crit Care Med. 2000;28(7):2307-2312.
Meyer R, Kulinskaya E, Briassoulis G, et al. The challenge of developing a new predictive formula to estimate energy requirements in ventilated critically ill children. Nutr Clin Pract. 2012;27(5):669-676.
Framson CM, LeLeiko NS, Dallal GE, Roubenoff R, Snelling LK, Dwyer JT. Energy expenditure in critically ill children. Pediatr Crit Care Med. 2007;8(3):264-267.
Chaparro CJ, Taffe P, Moullet C, et al. Performance of predictive equations specifically developed to estimate resting energy expenditure in ventilated critically ill children. J Pediatr. 2017;184:220-226.e5.
Floh AA, Nakada M, La Rotta G, et al. Systemic inflammation increases energy expenditure following pediatric cardiopulmonary bypass. Pediatr Crit Care Med. 2015;16(4):343-351.
McLean JA, Tobin G. Animal and Human Calorimetry. Cambridge Cambridgeshire, New York: Cambridge University Press; 1987.
de Klerk G, Hop WC, de Hoog M, Joosten KF. Serial measurements of energy expenditure in critically ill children: useful in optimizing nutritional therapy? Intensive Care Med. 2002;28(12):1781-1785.
Mtaweh H, Smith R, Kochanek PM, et al. Energy expenditure in children after severe traumatic brain injury. Pediatr Crit Care Med. 2014;15(3):242-249.
Tokutomi T, Morimoto K, Miyagi T, Yamaguchi S, Ishikawa K, Shigemori M. Optimal temperature for the management of severe traumatic brain injury: effect of hypothermia on intracranial pressure, systemic and intracranial hemodynamics, and metabolism. Neurosurgery. 2003;52(1):102-111, discussion 111-102.
Muller MJ, Enderle J, Bosy-Westphal A. Changes in energy expenditure with weight gain and weight loss in humans. Curr Obes Rep. 2016;5(4):413-423.
Farooqi N, Slinde F, Haglin L, Sandstrom T. Assessment of energy intake in women with chronic obstructive pulmonary disease: a doubly labeled water method study. J Nutr Health Aging. 2015;19(5):518-524.
de Meer K, Westerterp KR, Houwen RH, Brouwers HA, Berger R, Okken A. Total energy expenditure in infants with bronchopulmonary dysplasia is associated with respiratory status. Eur J Pediatr. 1997;156(4):299-304.
Jones MO, Pierro A, Hammond P, Lloyd DA. The effect of major operations on heart rate, respiratory rate, physical activity, temperature and respiratory gas exchange in infants. Eur J Pediatr Surg. 1995;5(1):9-12.
Faisy C, Guerot E, Diehl JL, Labrousse J, Fagon JY. Assessment of resting energy expenditure in mechanically ventilated patients. Am J Clin Nutr. 2003;78(2):241-249.
Osuka A, Uno T, Nakanishi J, Hinokiyama H, Takahashi Y, Matsuoka T. Energy expenditure in patients with severe head injury: controlled normothermia with sedation and neuromuscular blockade. J Crit Care. 2013;28(2):218.e219-213.
Ismail J, Bansal A, Jayashree M, Nallasamy K, Attri SV. Energy balance in critically ill children with severe sepsis using indirect calorimetry: a prospective cohort study. J Pediatr Gastroenterol Nutr. 2019;68(6):868-873.
Gebara BM, Gelmini M, Sarnaik A. Oxygen consumption, energy expenditure, and substrate utilization after cardiac surgery in children. Crit Care Med. 1992;20(11):1550-1554.
Frankenfield DC, Omert LA, Badellino MM, et al. Correlation between measured energy expenditure and clinically obtained variables in trauma and sepsis patients. JPEN J Parenter Enteral Nutr. 1994;18(5):398-403.
Briassoulis G, Venkataraman S, Thompson AE. Energy expenditure in critically ill children. Crit Care Med. 2000;28(4):1166-1172.
McCall M, Jeejeebhoy K, Pencharz P, Moulton R. Effect of neuromuscular blockade on energy expenditure in patients with severe head injury. JPEN J Parenter Enteral Nutr. 2003;27(1):27-35.
Yoshimura S, Fujita Y, Hirate H, Kusama N, Azami T, Sobue K. A short period of fasting before surgery conserves basal metabolism and suppresses catabolism according to indirect calorimetry performed under general anesthesia. J Anesth. 2015;29(3):453-456.
Terao Y, Miura K, Saito M, Sekino M, Fukusaki M, Sumikawa K. Quantitative analysis of the relationship between sedation and resting energy expenditure in postoperative patients. Crit Care Med. 2003;31(3):830-833.
Boulanger BR, Nayman R, McLean RF, Phillips E, Rizoli SB. What are the clinical determinants of early energy expenditure in critically injured adults? J Trauma. 1994;37(6):969-974.
Oosterveld MJ, Van Der Kuip M, De Meer K, De Greef HJ, Gemke RJ. Energy expenditure and balance following pediatric intensive care unit admission: a longitudinal study of critically ill children. Pediatr Crit Care Med. 2006;7(2):147-153.
Li J, Zhang G, Herridge J, et al. Energy expenditure and caloric and protein intake in infants following the Norwood procedure. Pediatr Crit Care Med. 2008;9(1):55-61.
Traube C, Silver G, Reeder RW, et al. Delirium in critically ill children: an international point prevalence study. Crit Care Med. 2017;45(4):584-590.