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Is Indirect Calorimetry a Necessity or a Luxury in the Pediatric Intensive Care Unit?
Author(s) -
Kyle Ursula G.,
Arriaza Ana,
Esposito Monica,
CossBu Jorge A.
Publication year - 2012
Publication title -
journal of parenteral and enteral nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.935
H-Index - 98
eISSN - 1941-2444
pISSN - 0148-6071
DOI - 10.1177/0148607111415108
Subject(s) - medicine , hypermetabolism , pediatric intensive care unit , parenteral nutrition , intensive care unit , sepsis , underweight , intensive care , pediatrics , intensive care medicine , overweight , body mass index
Background : Critically ill children differ in their energy needs from healthy children in terms of underlying metabolic derangement, comorbidities, energy reserve, and response to illness. This study determined how many pediatric intensive care unit (PICU) patients were candidates for indirect calorimetry (IC), per American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommendations. Methods : Admission diagnosis, demographics, type/amount of nutrition support, length of intensive care unit/hospital stay were collected. Patients were classified as candidates for IC per A.S.P.E.N. guidelines. Results : Mean (SD) age of patients (n = 150) was 6.7 (5.6) years, with PICU length of stay of 3.9 (5.3) days. IC was indicated in 72.0% (108/150) of patients during PICU days 1–7. Patients with miscellaneous (50%), neurological (73%), respiratory (81%), sepsis (83%), and oncology (100%) diagnoses were candidates for IC. Underweight/overweight/obese (32.4%), hypermetabolism (26.4%), and not meeting nutrition goals (13.7%) were the most frequent indications for IC (χ 2 , P < .001). Patients (31%) met ≥2 indications for IC. Patients with neurological disease (relative risk [RR], 4.8; 95% confidence interval [CI], 1.7–14.6), oncology patients (4.2; 1.1–15.9), respiratory patients (5.5; 2.0–16.9), and children with sepsis/septic shock/infection (5.6; 1.9–18.1) were more likely to have ≥2 indications for IC compared to those with other diagnoses. Conclusions : Three of 4 patients were candidates for IC per A.S.P.E.N. guidelines. PICUs might have to prioritize performing IC in patients who are <2 years of age, malnourished (underweight/overweight) on admission, or PICU stay of >5 days. Future studies should determine the cost‐benefit ratios of performing IC in PICU patients.