Assessment of energy metabolism and nutritional supply in children with mechanical ventilation

Abstract

To determine the resting energy expenditure on mechanical ventilation in pediatric intensive care unit (PICU) by indirect calorimetry, and analyze the distribution of metabolic states. The nutrition supply was assessed according to the resting energy expenditure. An observational study which was held in PICU of Beijing Children's Hospital from November 2013 to April 2014. Critically ill children with mechanical ventilation were enrolled in this study. The inclusion criteria included the following: (1) pediatric critical illness score < 90, or meet the United States PICU admission criteria; (2) age > 29 days, < 18 years old; (3) time of mechanical ventilation > 24 hours; (4) volume of mechanical ventilation > 60 ml. Resting energy expenditure was determined by US Med Graphic Company CCM/D energy metabolism test system. Predictive resting energy expenditure was calculated for each subject with age-appropriate equation (Schofield-HTWT). According to the actual energy intake records and required energy intake (10% higher than the measured value) to define the nutritional status. The selected subjects were grouped according to gender, age, types of disease and nutritional status, and compared the metabolic status and nutritional supply of different groups. Sixty-eight children were enrolled in this study, 46 were boys and 22 were girls, including 25 cases of pneumonia with respiratory failure, 23 cases of central nervous system diseases complicated with respiratory failure and 20 cases of postoperative tracheal intubation. The ratio of boys and girls was 2:1. The results showed 36 patients in a low metabolic state, accounting for 53%, 23 patients in a high metabolic state, accounting for 34% and 9 patients (13%) in the metabolism of the normal state. In the male children, 12 cases (26%) were in the high metabolism and 26 cases (57%) were in the low metabolism, and 8 cases (17%) were in the normal metabolism. In the female children, 11 cases (50%) were classified into high metabolism; 10 cases (45%) into low metabolism and 1 case (5%) was classified into normal metabolism. There was no significant difference in the distribution of metabolic status among different gender(χ(2) = 4.176, P = 0.095). In terms of ages, 15 cases (63%) were mainly in high metabolism in the patients at age < 3 years, 19 and 11 patients in 3-9 and 10-18 years age group respectively are mostly in low metabolism. As to the diseases, pneumonia complicated with respiratory failure and central nervous system diseases complicated with respiratory failure with mechanical ventilation (respectively 15 cases (60%) and 12 cases (52%)) were in low metabolism mainly; 11 cases of postoperative tracheal intubation were in high metabolism states, accounting for 55%. The distribution of metabolic status in different age and clinical diagnosis had significant difference. Thirty-one patients had normal nutrients supply, accounting for 46%, 37 patients had inappropriate nutrition supply, accounting for 54%, including insufficient supplies of nutrients in 22 cases, accounting for 32%, excessive supplies of nutrients were seen in 15 cases(22%). There were no statistically significant differences among the different types of diseases. There are differences in the metabolic state of the mechanical ventilation in critically ill patients, mainly in low metabolic state. The age and types of diseases can affect the metabolic status of patients. Empirical nutritional support is not applicable to patients.