Is indirect calorimetry a necessity or a luxury in the pediatric intensive care unit?

Abstract

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 (Χ2, P <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. © 2012 The American Society for Parenteral and Enteral Nutrition.