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Indirect calorimetry reveals that better monitoring of nutrition therapy in pediatric intensive care is needed.
JPEN J Parenter Enteral Nutr. 2015 Mar; 39(3):344-52.JJ

Abstract

BACKGROUND

Monitoring nutrition therapy is essential in the care of critically ill children, but the risk of nutrition failure seems to remain. The aims of the present study were to examine the prevalence of underfeeding, adequate feeding, and overfeeding in mechanically ventilated children and to identify barriers to the delivery of nutrition support.

MATERIALS AND METHODS

Children aged 0-14 years who fulfilled the criteria for indirect calorimetry were enrolled in this prospective, observational study and were studied for up to 5 consecutive days. Actual energy intake was recorded and compared with the required energy intake (measured energy expenditure plus 10%); energy intake was classified as underfeeding (<90% of required energy intake), adequate feeding (90%-110%), or overfeeding (>110%). The reasons for interruptions to enteral and parenteral nutrition were recorded.

RESULTS

In total, 104 calorimetric measurements for 140 total days were recorded for 30 mechanically ventilated children. Underfeeding, adequate feeding, and overfeeding occurred on 21.2%, 18.3%, and 60.5% of the 104 measurement days, respectively. There was considerable variability in the measured energy expenditure between children (median, 37.2 kcal/kg/d; range, 16.81-66.38 kcal/kg/d), but the variation within each child was small. Respiratory quotient had low sensitivity of 21% and 27% for detecting underfeeding and overfeeding, respectively. Fasting for procedures was the most frequent barrier that led to interrupted nutrition support.

CONCLUSION

The high percentage of children (~61%) who were overfed emphasizes the need to measure energy needs by using indirect calorimetry.

Authors+Show Affiliations

Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway mdokken@ous-hf.no.Division of Emergencies and Critical Care, Department of Research and Development, Ullevål, Oslo University Hospital, Oslo, Norway Unit of Nursing Science, Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway.Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway Faculty of Medicine, University of Oslo, Oslo, Norway.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

24255088

Citation

Dokken, Mette, et al. "Indirect Calorimetry Reveals That Better Monitoring of Nutrition Therapy in Pediatric Intensive Care Is Needed." JPEN. Journal of Parenteral and Enteral Nutrition, vol. 39, no. 3, 2015, pp. 344-52.
Dokken M, Rustøen T, Stubhaug A. Indirect calorimetry reveals that better monitoring of nutrition therapy in pediatric intensive care is needed. JPEN J Parenter Enteral Nutr. 2015;39(3):344-52.
Dokken, M., Rustøen, T., & Stubhaug, A. (2015). Indirect calorimetry reveals that better monitoring of nutrition therapy in pediatric intensive care is needed. JPEN. Journal of Parenteral and Enteral Nutrition, 39(3), 344-52. https://doi.org/10.1177/0148607113511990
Dokken M, Rustøen T, Stubhaug A. Indirect Calorimetry Reveals That Better Monitoring of Nutrition Therapy in Pediatric Intensive Care Is Needed. JPEN J Parenter Enteral Nutr. 2015;39(3):344-52. PubMed PMID: 24255088.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Indirect calorimetry reveals that better monitoring of nutrition therapy in pediatric intensive care is needed. AU - Dokken,Mette, AU - Rustøen,Tone, AU - Stubhaug,Audun, Y1 - 2013/11/19/ PY - 2013/11/21/entrez PY - 2013/11/21/pubmed PY - 2015/12/15/medline KW - barriers KW - energy expenditure KW - enteral nutrition KW - indirect calorimetry KW - malnutrition KW - parenteral nutrition KW - pediatric intensive care unit SP - 344 EP - 52 JF - JPEN. Journal of parenteral and enteral nutrition JO - JPEN J Parenter Enteral Nutr VL - 39 IS - 3 N2 - BACKGROUND: Monitoring nutrition therapy is essential in the care of critically ill children, but the risk of nutrition failure seems to remain. The aims of the present study were to examine the prevalence of underfeeding, adequate feeding, and overfeeding in mechanically ventilated children and to identify barriers to the delivery of nutrition support. MATERIALS AND METHODS: Children aged 0-14 years who fulfilled the criteria for indirect calorimetry were enrolled in this prospective, observational study and were studied for up to 5 consecutive days. Actual energy intake was recorded and compared with the required energy intake (measured energy expenditure plus 10%); energy intake was classified as underfeeding (<90% of required energy intake), adequate feeding (90%-110%), or overfeeding (>110%). The reasons for interruptions to enteral and parenteral nutrition were recorded. RESULTS: In total, 104 calorimetric measurements for 140 total days were recorded for 30 mechanically ventilated children. Underfeeding, adequate feeding, and overfeeding occurred on 21.2%, 18.3%, and 60.5% of the 104 measurement days, respectively. There was considerable variability in the measured energy expenditure between children (median, 37.2 kcal/kg/d; range, 16.81-66.38 kcal/kg/d), but the variation within each child was small. Respiratory quotient had low sensitivity of 21% and 27% for detecting underfeeding and overfeeding, respectively. Fasting for procedures was the most frequent barrier that led to interrupted nutrition support. CONCLUSION: The high percentage of children (~61%) who were overfed emphasizes the need to measure energy needs by using indirect calorimetry. SN - 1941-2444 UR - https://www.unboundmedicine.com/medline/citation/24255088/Indirect_calorimetry_reveals_that_better_monitoring_of_nutrition_therapy_in_pediatric_intensive_care_is_needed_ DB - PRIME DP - Unbound Medicine ER -