Cumulative Energy Imbalance in the Pediatric Intensive Care Unit: Role of Targeted Indirect Calorimetry

Abstract

Introduction: Failure to accurately estimate energy requirements may result in underfeeding or overfeeding. In this study, a dedicated multidisciplinary nutrition team measured energy expenditure in critically ill children. Methods: Steady‐state indirect calorimetry was used to obtain measured resting energy expenditure, which was compared with equation‐estimated energy expenditure and the total energy intake for each subject. The children's metabolic status was examined in relation to standard clinical characteristics. Results: Sixteen measurements were performed in 14 patients admitted to the multidisciplinary pediatric intensive care unit over a period of 12 months. Mean age of subjects in this cohort was 11.2 years (range 1.6 months to 32 years) and included 7 males and 7 postoperative patients. Altered metabolism was detected in 13 of 14 subjects and in 15 of 16 (94%) measurements. There was no correlation between the metabolic status of subjects and their clinical characteristics. Average daily energy balance was 200 kcal/d (range –518 to +859 kcal/d). Agreement between measured resting energy expenditure and equation‐estimated energy expenditure was poor, with mean bias of 72.3 ± 446 kcal/d (limits of agreement –801.9 to + 946.5 kcal/d). Conclusions: A disparity was observed between equation‐estimated energy expenditure, measured resting energy expenditure, and total energy intake, with a high incidence of underfeeding or overfeeding. A wide range of metabolic alterations were recorded, which could not be accurately predicted using standard clinical characteristics. Targeted indirect calorimetry on high‐risk patients selected by a dedicated nutrition team may prevent cumulative excesses and deficits in energy balance.