Energy expenditure and nutritional practices in mechanically ventilated children

Abstract

Objective To identify metabolism and feeding patterns by measurement of resting energy expenditure(MREE) in mechanically ventilated children, and examine the metabolic response in relation to clinical characteristics. Methods Thirty-seven children who fulfilled the criteria for indirect calorimetry were enrolled in this prospective observational study.MREE were obtained on days 1, 4, 7, 10, 14, 21, respectively.Patients were classified as hypometabolic, normal metabolic, and hypermetabolic when MREE were 110% of the predicted resting energy expenditure calculated by Schofield-HTWT equation, respectively.Actual energy intake was recorded, energy intake was classified as underfeeding( 110%). Results On the first day of mechanical ventilation, 40.5% of all children were hypometabolic, 24.3% normal metabolic, and 35.1% hypermetabolic.Only after 7 days, the hypermetabolic pattern dominated(46.7%). Eighty-two measurements were performed in 30 patients(81.1%), who received nutrition support.The mean energy intake was(33.4±22.2) kcal/(kg·d). This was significantly lower than mean MREE, which was(53.7±17.4) kcal/(kg·d)(P<0.01). Underfeeding, adequate feeding, and overfeeding occurred on 75.6%, 9.8%, and 14.6%, respectively. Conclusion The energy metabolism varies widely in mechanically ventilated children during hospitalization.Nearly 90% of the duration in PICU are underfeeding or overfeeding. Key words: Mechanically ventilated children; Indirect calorimetry; Energy expenditure; Feeding patterns,