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Can energy intake alter clinical and hospital outcomes in PICU?
Clin Nutr ESPEN. 2018 04; 24:41-46.CN

Abstract

BACKGROUND & AIMS

Energy is essential for the treatment and recovery of children admitted to Pediatric Intensive Care Units (PICU). There are significant immediate and long-term health consequences of both under- and over-feeding in this population. Energy requirements of critically ill children vary depending on age, nutritional status, sepsis, fever, pharmacotherapy, and duration and stage of critical illness. This study aimed to determine the incidence of over- and under-feeding and to compare hospital outcomes between these feeding categories. Secondary outcomes were collected to describe the association between feeding categories and biochemistries (serum lactate, triglycerides, C-reactive protein).

METHODS

An ethics approved retrospective study of children admitted to PICU was performed. All intubated patients admitted to PICU (2008-2013) were included, except those in which an IC test was not feasible. Data collection included demographics, the primary outcome variable reported as under feeding (<90%MREE), appropriate (MREE ±10%) or overfeeding (>110% MREE) determined through comparison of measured resting energy expenditure (MREE) using indirect calorimetry (IC) to actual energy intake based on predicted basal metabolic rate (PBMR) and clinical outcomes mechanical ventilation and PICU length of stay (LOS). Data were analysed with descriptive methods, ANOVA and linear regression models.

RESULTS

A total of 139 patients aged 10 (range 0.03-204) months were included. Sixty (43%) were female and 77 (55%) were admitted after a surgical procedure. A total of 210 IC tests were conducted showing a statistically significant difference between MREE measurements and PBMR (p = 0.019). Of the 210 measurements, only 26 measures (12.4%) demonstrated appropriate feeding, while 72 (34.3) were underfed and 112 (53.3%) were overfed. Children who were overfed had significantly longer PICU LOS (median 45.5, IQR 47.8 days) compared to those children in the appropriately fed (median 21.0, IQR 54.5 days), and underfed groups (median 16.5, IQR 21.3 days). There was a mean difference between the over and under feeding category and ventilation days after adjusting for age and PRISM score (p = 0.026), suggesting decreased mechanical ventilation days for underfed. Children who were underfed had significantly higher CRP (median 75.5, IQR 152.8 mg/L) compared to those children in the appropriately fed (median 57.8, IQR 90.9 mg/L) and overfed groups (median 22.4, IQR 56.2 mg/L).

CONCLUSIONS

This retrospective study confirms that estimations of energy expenditure in critically ill children are inaccurate leading to unintended under and overfeeding. Importantly under feeding seems to be associated with fewer mechanical ventilation days and PICU LOS. Further research is required to elucidate the role of optimal nutrition in altering clinical variables in this population.

Authors+Show Affiliations

Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada; Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada; Women and Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada; Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada. Electronic address: bodil.larsen@albertahealthservices.ca.Nutrition Services, Alberta Health Services, Edmonton, Alberta, Canada; Women and Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada.Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonton, Alberta, Canada.Women and Children's Health Research Institute (WCHRI), University of Alberta, Edmonton, Alberta, Canada.Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.Department of Pediatrics, University of Alberta, Stollery Children's Hospital, Edmonton, Alberta, Canada.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29576361

Citation

Larsen, Bodil M K., et al. "Can Energy Intake Alter Clinical and Hospital Outcomes in PICU?" Clinical Nutrition ESPEN, vol. 24, 2018, pp. 41-46.
Larsen BMK, Beggs MR, Leong AY, et al. Can energy intake alter clinical and hospital outcomes in PICU? Clin Nutr ESPEN. 2018;24:41-46.
Larsen, B. M. K., Beggs, M. R., Leong, A. Y., Kang, S. H., Persad, R., & Garcia Guerra, G. (2018). Can energy intake alter clinical and hospital outcomes in PICU? Clinical Nutrition ESPEN, 24, 41-46. https://doi.org/10.1016/j.clnesp.2018.02.002
Larsen BMK, et al. Can Energy Intake Alter Clinical and Hospital Outcomes in PICU. Clin Nutr ESPEN. 2018;24:41-46. PubMed PMID: 29576361.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Can energy intake alter clinical and hospital outcomes in PICU? AU - Larsen,Bodil M K, AU - Beggs,Megan R, AU - Leong,Amanda Y, AU - Kang,Sung Hyun, AU - Persad,Rabin, AU - Garcia Guerra,Gonzalo, Y1 - 2018/03/02/ PY - 2018/01/24/received PY - 2018/02/08/accepted PY - 2018/3/27/entrez PY - 2018/3/27/pubmed PY - 2019/7/26/medline KW - Critical care KW - Indirect calorimetry KW - Nutrition KW - Pediatric SP - 41 EP - 46 JF - Clinical nutrition ESPEN JO - Clin Nutr ESPEN VL - 24 N2 - BACKGROUND & AIMS: Energy is essential for the treatment and recovery of children admitted to Pediatric Intensive Care Units (PICU). There are significant immediate and long-term health consequences of both under- and over-feeding in this population. Energy requirements of critically ill children vary depending on age, nutritional status, sepsis, fever, pharmacotherapy, and duration and stage of critical illness. This study aimed to determine the incidence of over- and under-feeding and to compare hospital outcomes between these feeding categories. Secondary outcomes were collected to describe the association between feeding categories and biochemistries (serum lactate, triglycerides, C-reactive protein). METHODS: An ethics approved retrospective study of children admitted to PICU was performed. All intubated patients admitted to PICU (2008-2013) were included, except those in which an IC test was not feasible. Data collection included demographics, the primary outcome variable reported as under feeding (<90%MREE), appropriate (MREE ±10%) or overfeeding (>110% MREE) determined through comparison of measured resting energy expenditure (MREE) using indirect calorimetry (IC) to actual energy intake based on predicted basal metabolic rate (PBMR) and clinical outcomes mechanical ventilation and PICU length of stay (LOS). Data were analysed with descriptive methods, ANOVA and linear regression models. RESULTS: A total of 139 patients aged 10 (range 0.03-204) months were included. Sixty (43%) were female and 77 (55%) were admitted after a surgical procedure. A total of 210 IC tests were conducted showing a statistically significant difference between MREE measurements and PBMR (p = 0.019). Of the 210 measurements, only 26 measures (12.4%) demonstrated appropriate feeding, while 72 (34.3) were underfed and 112 (53.3%) were overfed. Children who were overfed had significantly longer PICU LOS (median 45.5, IQR 47.8 days) compared to those children in the appropriately fed (median 21.0, IQR 54.5 days), and underfed groups (median 16.5, IQR 21.3 days). There was a mean difference between the over and under feeding category and ventilation days after adjusting for age and PRISM score (p = 0.026), suggesting decreased mechanical ventilation days for underfed. Children who were underfed had significantly higher CRP (median 75.5, IQR 152.8 mg/L) compared to those children in the appropriately fed (median 57.8, IQR 90.9 mg/L) and overfed groups (median 22.4, IQR 56.2 mg/L). CONCLUSIONS: This retrospective study confirms that estimations of energy expenditure in critically ill children are inaccurate leading to unintended under and overfeeding. Importantly under feeding seems to be associated with fewer mechanical ventilation days and PICU LOS. Further research is required to elucidate the role of optimal nutrition in altering clinical variables in this population. SN - 2405-4577 UR - https://www.unboundmedicine.com/medline/citation/29576361/Can_energy_intake_alter_clinical_and_hospital_outcomes_in_PICU L2 - https://linkinghub.elsevier.com/retrieve/pii/S2405-4577(17)30520-X DB - PRIME DP - Unbound Medicine ER -