Endotracheal Tube Leak Research Articles

The PhLIP team: Feasibility of a physiotherapy-led intensive prone positioning team initiative during the COVID-19 pandemic

BackgroundThe coronavirus disease 2019 (COVID-19) pandemic resulted in a surge of patients with refractory hypoxaemic respiratory failure being admitted to the intensive care unit (ICU). Prone positioning can improve oxygenation but requires a team of skilled personnel to complete safely. Critical care physiotherapists (PTs) are ideally suited to lead proning teams, due to their expertise in moving critically unwell, invasively ventilated patients. ObjectivesThe aim of this study was to describe the feasibility of implementing a physiotherapy-led intensive proning (PhLIP) team to support the critical care team during surges. MethodsThis study involves descriptive evaluation of feasibility and implementation of the PhLIP team, a novel model of care, during the Delta wave of the COVID-19 pandemic, through a retrospective, observational audit of PhLIP team activity, ICU clinical activity, and a description of clinical outcomes. ResultsBetween 17 September and 19 November 2021, 93 patients with COVID-19 were admitted to the ICU. Fifty-one patients (55%) were positioned prone, a median [interquartile range] 2 [2, 5] times, for a mean (±standard deviation) duration of 16 (±2) h, across 161 episodes. Twenty-three PTs were upskilled and deployed to the PhLIP team, adding 2.0 equivalent full time to the daily service. Ninety-four percent of prone episodes (154) were led by the PhLIP PTs with a median 4 [interquartile range: 2, 8] turns per day. Potential airway adverse events occurred on three occasions (1.8%) and included an endotracheal tube leak, displacement, and obstruction. Each incident was promptly managed without prolonged impact on the patient. No manual handling injuries were reported. ConclusionThe implementation of a physiotherapy-led proning team was safe and feasible and can release critical care-trained medical and nursing staff to other duties in the ICU.

Delivering Low Tidal Volume With Anesthesia and ICU Ventilators in a Neonatal Lung Model.

Mechanical ventilation of the neonate requires ventilators than can deliver precise and accurate tidal volume (VT) and PEEP to avoid lung injury. Due to small neonatal VT and the disproportionate effect of endotracheal tube leak in these patients, accomplishing precise and accurate VT delivery is difficult. Whereas neonatal ICU ventilators are validated in this population, thorough studies testing the performance of anesthesia ventilators in delivering small VT in neonates are lacking. Three anesthesia ventilators, Dräger Apollo, GE Avance, and Getinge Flow-i; and 2 ICU ventilators, Medtronic PB980 and Nihon Kohden NKV-550, were tested under volume control mode at VT of 5, 20, 40, and 60 mL. Three combinations of lung compliance and airway resistance were tested using a Servo ASL 5000 lung simulator. In a scenario without leak, the measured VT was greater than the set VT by > 10% in the Apollo (21.0% [18.8-26.0]); measured VT was less than the set VT by > 10% in the Flow-i (-19% [-20.8 to -18.7]). The Avance, PB980, and NKV-550 presented a volume error < 10% (-9.50% [-10.8 to -4.4], -5.8% [-11.8 to -3.5], and 5.4% [-4.5 to 18.9], respectively). Considering all combinations of set VT, leaks, and respiratory mechanics, none of the anesthesia ventilators were able to deliver a median measured VT within a 10% error. The bias between measured VT and set VT varied widely among ventilators (from 4.27 mL to -10.59 mL). Additionally, in the Apollo ventilator, PEEP was underdelivered with the largest leak value. Our results suggest that in comparison with the 2 neonatal ICU ventilators tested, the anesthesia ventilators did not greatly differ in terms of VT delivery in the presence of a gas leak.

Effect of tidal volume and end tracheal tube leakage on end-tidal CO2 in very low birth weight infants.

ObjectiveTo examine the extents to which low tidal volume (VT) and endotracheal tube (ETT) leakeage influence the accuracy of ETCO2 for estimating arterial PCO2 (PaCO2) in very low birth weight (VLBW) infants with mechanical ventilation.Study designAn observational study. We evaluated a total of 287 paired ETCO2 and PaCO2 values as well as VTs obtained from 22 VLBW infants with ventilation. Deming regression, quadratic discriminant analysis, and Bland–Altman analysis were performed.ResultETCO2 and PaCO2 were correlated (r2 = 0.5897, p < 0.0001). A quadratic discrimination analysis of the VT and the percentage of leak yielded 70.4% [95%CI, 65.1 to 75.7] discrimination for the agreement between ETCO2 and PaCO2. ETCO2 was strongly correlated with PaCO2 in the discriminant function Z > 0 group (r2 = 0.7234, p < 0.0001).ConclusionOur results indicate that ETCO2 is a good surrogate for PaCO2 when VT is high and ETT leak is low.

Uncuffed Endotracheal Tube Experience in Pediatric Patients with Laparotomy and Laparoscopic Surgeries.

Aim The aim of this study is to compare endotracheal tube leak, tube selection, mechanical ventilation, and side effects in the use of uncuffed tubes in both laparoscopic and laparotomy surgeries in pediatric patients. Material and Method. Patients who underwent laparotomy (LT group) or laparoscopic (LS group) surgery between 1 and 60 months. In the selection of uncuffed tubes, it was also planned to start endotracheal intubation with the largest uncuffed tube and to start intubation with a small uncuffed tube if the tube encounters resistance and does not pass. Mechanical parameters, endotracheal tube size, tube changes, and side effects are recorded. Results A total of 102 patients, 38 females and 64 males, with a mean age of 10.9 ± 8.1 months, body weight 7.1 ± 3.7 kg, and height 67 ± 15 cm, were included. 54 patients underwent laparoscopic surgery, and 48 patients underwent laparotomy. Tube exchange was performed in a total of 18 patients. In patients who underwent tube exchange, 11 patients were intubated with a smaller ETT number and others endotracheal intubation; when the MV parameters were TVe < 8 ml/kg and ETT leak > 20%, a larger uncuffed tube was used due to PIP 30 cmH2O pressure. Patients with aspiration were not found in the LT and LS groups. There was no difference in the intergroup evaluation for postoperative side effects such as cough, laryngospasm, stridor, and aspiration. Conclusion There was no significant difference between the groups in terms of tube changes and side effects. So that we can start with the largest possible uncuffed tube to decrease ETT leak, both laparotomy and laparoscopic operations in children can be achieved with safe mechanical ventilation and target tidal volume.

Volume-targeted ventilation with a Fabian ventilator: maintenance of tidal volumes and blood CO2

ObjectiveTo analyse the performance of the Fabian +NCPAP evolution ventilator during volume guarantee (VG) ventilation in neonates at maintaining the target tidal volume and what tidal and minute volumes are...

Leak Compensation During Volume Guarantee With the Dräger Babylog VN500 Neonatal Ventilator.

To investigate how compensating for endotracheal tube leaks by targeting the leak-compensated tidal volume affects measured physiologic and ventilator variables during neonatal mechanical ventilation. Retrospective observational study. A level III Neonatal ICU. We enrolled 30 neonates who were ventilated using synchronized intermittent positive pressure mode with volume guarantee and had at least 12 hours of continuous detailed recording of ventilation variables. Infants were treated using the Dräger VN500 ventilator (Dräger, Lübeck, Germany), which uses a proprietary algorithm to measure and compensate for endotracheal tube leaks. Eleven were ventilated without leak compensation and 19 with leak compensation. Detailed ventilation data were collected and analyzed at 1 Hz, with intermittent blood gas values. The percentage of leak was less than 20% in 73% of leak-compensated inflations, and the volume of the leak compensation was less than 1 mL/kg in 97.3% of inflations. Between the two groups, ventilation variables were comparable, except the percentage of leak that was significantly (p = 0.005) higher in the recordings with leak compensation. Without leak compensation, the mean expired tidal volume was maintained very close to the set level up to 50% leak, but with leaks greater than 50%, it declined progressively. With leak compensation, the mean leak-compensated expired tidal volume was well maintained even with leak greater than 90% although with large variability. Without leak compensation, the difference between the maximum allowed inflating pressure and the peak inflating pressure decreased progressively as the leak increased. This did not occur with leak compensation. The median PCO2 was slightly higher with leak compensation. During volume guarantee ventilation with a Dräger VN500 ventilator, without leak compensation the expired tidal volume declined after 50% leak. With leak compensation, the tidal volume was maintained even with a large leak. With leak compensation, there was a more stable peak inflating pressure, although the PCO2 was slightly higher.

The Effects of Mouth Opening and Throat Pack Placement on Uncuffed Nasal Endotracheal Tube Leakage and Delivered Tidal Volumes in Mechanically Ventilated Pediatric Patients Undergoing Dental Procedures.

Intubation for pediatric patients is frequently performed with an uncuffed endotracheal tube (ETT), which may result in an incomplete tracheal seal, resulting in gas leakage (leak). The purpose of this study was to assess the effect of (1) mouth opening and (2) throat pack placement in sealing and/or minimizing this leak to an acceptable level while providing adequate tidal volumes in mechanically ventilated patients. This prospective study of 2- to 6-year-olds undergoing general anesthesia with nasal intubation for dental procedures in the New York University-Lutheran Medical Center operating room was conducted between March 2015 and October 2015. Three sequential tidal volume (VT) measurements were recorded: postintubation with the neck extended, with mouth opened, and after throat pack placement. Twenty-five subjects were included in the analyses. For subjects in whom no leak was detected, only throat pack placement statistically improved VT. This is in marked contrast to numerically large, statistically significant effects, relative to baseline, for mouth opening (±23.2 mL, p < .009, 21% increase from baseline) and throat pack placement (±46 mL, p < .009, 41% increase from baseline) when a leak was detected. In children 2-6 years of age, nasal intubation with uncuffed ETTs that have incomplete tracheal seal have improved VT with mouth opening and throat pack placement. This finding suggests that the intubation procedure is a process that extends through positioning, mouth opening, and throat pack placement.

Volume guaranteed? Accuracy of a volume-targeted ventilation mode in infants

ObjectivesVolume-targeted ventilation (VTV) is widely used and may reduce lung injury, but this assumes the clinically set tidal volume (VTset) is accurately delivered. This prospective observational study aimed to determine...

Tidal Volume Delivery and Endotracheal Tube Leak during Cardiopulmonary Resuscitation in Intubated Newborn Piglets with Hypoxic Cardiac Arrest Exposed to Different Modes of Ventilatory Support

Background: There are few data available on the interaction of inflations, chest compressions (CC), and delivery of tidal volumes in newborn infants undergoing resuscitation in the presence of endotracheal tube (ET) leaks. Objectives: To determine the effects of different respiratory support strategies along with CC on changes in tidal volume and ET leaks in hypoxic newborn piglets with cardiac arrest. Methods: Asphyxiated newborn piglets, intubated with weight-adapted uncuffed ET, were randomized into three groups and resuscitated according to ILCOR 2010 guidelines: (1) T-piece resuscitator (TPR) group = peak inspiratory pressure (PIP)/positive end-expiratory pressure (PEEP) 25/5 cm H₂O, rate 30/min, inflations interposed between CC (3:1 ratio); (2) self- inflating bag (SIB) group = PIP 25 cm H₂O without PEEP, rate 30/min, inflations interposed between CC (3:1 ratio), and (3) ventilator group = PIP/PEEP of 25/5 cm H₂O, rate 30/min. CC were applied with a rate of 120/min without synchrony to inflations. Results: We observed a significant increase of leak (average increase 11.4%) when CC was added to respiratory support (p = 0.0001). Expired tidal volume was larger in the SIB group than in the two other modes which both applied PEEP. However, tidal volumes caused by CC only were larger in the two groups with PEEP than in the SIB group (without PEEP). Conclusions: There is interaction between lung inflations and CC affecting leak and delivery of tidal volume, which may be influenced by the mode/device used for respiratory support. Leak is larger in the presence of PEEP. However, CC cause additional tidal volume which is larger in the presence of PEEP.

Do PICU patients meet technical criteria for performing indirect calorimetry?

Indirect calorimetry (IC) is considered gold standard for assessing energy needs of critically ill children as predictive equations and clinical status indicators are often unreliable. Accurate assessment of energy requirements in this vulnerable population is essential given the high risk of over or underfeeding and the consequences thereof. The proportion of patients and patient days in pediatric intensive care (PICU) for which energy expenditure (EE) can be measured using IC is currently unknown. In the current study, we aimed to quantify the daily proportion of consecutive PICU patients who met technical criteria to perform indirect calorimetry and describe the technical contraindications when criteria were not met. Prospective, observational, single-centre study conducted in a cardiac and general PICU. All consecutive patients admitted for at least 96h were included in the study. Variables collected for each patient included age at admission, admission diagnosis, and if technical criteria for indirect calorimetry were met. Technical criteria variables were collected within the same 2h each morning and include: provision of supplemental oxygen, ventilator settings, endotracheal tube (ETT) leak, diagnosis of chest tube air leak, provision of external gas support (i.e. nitric oxide), and provision of extracorporeal membrane oxygenation (ECMO). 288 patients were included for a total of 3590 patient days between June 2014 and February 2015. The main reasons for admission were: surgery (cardiac and non-cardiac), respiratory distress, trauma, oncology and medicine/other. The median (interquartile range) patient age was 0.7 (0.3-4.6) years. The median length of PICU stay was 7 (5-14) days. Only 34% (95% CI, 32.4-35.5%) of patient days met technical criteria for IC. For patients less than 6 months of age, technical criteria were met on significantly fewer patient days (29%, p<0.01). Moreover, 27% of patients did not meet technical criteria for IC on any day during their PICU stay. Most frequent reasons for why IC could not be performed included supplemental oxygen, ECMO, and ETT leak. In the current study, technical criteria to perform IC in the PICU were not met for 27% of patients and were not met on 66% of patient days. Moreover, criteria were met on only 29% of days for infants 6 months and younger where children 24 months of age and older still only met criteria on 40% of patient days. This data represents a major gap in the feasibility of current recommendations for assessing energy requirements of this population. Future studies are needed to improve methods of predicting and measuring energy requirements in critically ill children who do not meet current criteria for indirect calorimetry.

Changes in uncuffed endotracheal tube leak during laparoscopic inguinal herniorrhaphy in children.

The present study was conducted to investigate changes in uncuffed endotracheal tube (ETT) leak during laparoscopic surgery. The study included 31 patients aged between 1 and 6years scheduled for elective laparoscopic inguinal herniorrhaphy. Inspiratory and expiratory tidal volumes (TVi and TVe) were measured during mechanical ventilation, and ETT leak was calculated using the formula-ETT leak=(TVi-TVe)/TVi×100(%), assessed at the following time-points-5min after the start of mechanical ventilation (T1, baseline), just before the start of surgery (T2), 5min after the induction of pneumoperitoneum with 15° Trendelenburg tilt (T3), and at the end of surgery (T4). Additionally, leak pressure was assessed after successful tracheal intubation (T0, baseline) at T2, T3 and T4. Uncuffed ETT leak significantly decreased at T3 compared with T1 (baseline). Leak pressure significantly increased at T3 and T4 compared with T0 (baseline). Further studies are needed in order to determine whether the results are universal and associated with clinically significant outcomes.

Intensive care management of children intubated for croup: a retrospective analysis.

Croup remains the commonest reason for acute upper airway obstruction in children, yet there are scarce contemporary data of airway management in those requiring intubation. We performed a retrospective analysis of the intensive care management of children intubated for croup in two quaternary Paediatric Intensive Care Units: Royal Children's Hospital Melbourne, Australia and Alberta Children's Hospital Calgary, Canada. Patients intubated for less than three days were compared with those intubated for greater than three days. Patients less than 10 kg body weight were compared to those greater than 10 kg. Demographic, clinical and microbiological data were recorded. Seventy-seven cases of croup requiring intubation were identified. The median duration of intubation was 60 hours. Parainfluenza was the most common viral aetiology, detected in 30% of cases. Antibiotics were prescribed in 51% of patients. Corticosteroids were prescribed pre intubation in two-thirds of patients and all post intubation, with the median dose being prednisolone 3 mg/kg/day. Primary extubation failure occurred in 6.5% of patients. Neither the duration of intubation nor patient size were associated with extubation failure. An air leak test was performed in 69% of patients and poorly predicted extubation success. One non-urgent tracheostomy was performed and there was one death from hypoxic ischaemic encephalopathy. Endotracheal tube leak is poorly recorded and may not predict successful extubation.

Agreement between lower esophageal and nasopharyngeal temperatures in children ventilated with an endotracheal tube with leak.

A temperature probe placed in the lower third of the esophagus accurately reflects core temperature in anesthetized children. Temperature probes are commonly placed in the nasopharynx in children, but when utilizing an uncuffed endotracheal tube (ETT) with a softly audible leak, ventilated gases from the trachea can escape upwards toward the nasopharynx, thereby potentially causing a cooling effect in the nasopharynx. We sought to establish if nasopharyngeal and lower esophageal temperatures are in agreement in children undergoing general anesthesia, both in scenarios of ventilation with a cuffed ETT that has minimal or no leak (cuff up), as well as an ETT with leak (cuff down). A prospective, crossover agreement study was performed on anesthetized children. Children were intubated with a MicroCuff(®) ETT and had temperature probes inserted into both the nasopharynx and lower esophagus. Under standardized ventilator and gas flow settings, temperatures were recorded with the ETT cuff inflated, and with the cuff deflated. Bland-Altman plots were utilized to assess agreement of temperatures. Fifty patients successfully completed this study. The mean difference between esophageal and nasopharyngeal temperature was found to be -0.03°C in the presence of minimal or no leak around the ETT (cuff up), with 95% limits of agreement (LOA) of -0.22 to 0.15°C. The mean difference between esophageal and nasopharyngeal temperature was found to be 0.1°C when a larger leak existed around the ETT (cuff down), with LOA of -0.31 to 0.51°C. Nasopharyngeal temperature accurately reflects lower esophageal temperature when there is minimal or no ETT leak. When a larger ETT leak is present, nasopharyngeal temperature is on average 0.1°C cooler than lower esophageal temperature. As the nasopharyngeal temperature probe site confers the advantage of simplicity of accurate placement compared to its esophageal counterpart, our findings support the use of nasopharyngeal temperature probes in children ventilated with both cuffed and uncuffed ETTs.

Effect of endotracheal tube leakage on respiratory function monitoring: Comparison of three neonatal ventilators.

In preterm infants, lung function monitoring is important for lung-protective mechanical ventilation. In this study, we used a neonatal lung model to investigate the effect of endotracheal tube (ETT) leakage on the monitoring of tidal volume (VT) and lung mechanics using different ventilators. A neonatal lung model was ventilated via a 3 mm ETT using three ventilators, Babylog 8000, Leoni, and Stephanie. ETT leakage was simulated by open silicone tubes with different lengths. The volume delivered to the lung model was measured and compared with the displayed expiratory VT of the three ventilators. The effect of ETT leakage on lung mechanical parameters displayed by the ventilators was investigated for respiratory rates from 20 min-1 to 70 min-1 and a constant inspiratory time: expiratory time ratio of 1:1. The displayed ETT leakage depended on the size of the leak, ventilator settings, and the ventilator used. In the presence of ETT leakages, for all three ventilators, the displayed VT underestimated the true volume delivered to the lung. With increasing ETT leakage, displayed compliance was overestimated by Babylog 8000 and Stephanie, whereas Leoni underestimated compliance. The displayed resistance increased with increasing ETT leakage for the three ventilators, but quite different. The effect of ETT leakage on displayed VT and lung mechanical parameters is ventilator-dependent. ETT leakage can lead to incorrect measurements that indicate reduced VT, improvement of lung compliance, or ETT obstruction.

Endotracheal tube leak: What should we do?

Endotracheal tube leak: What should we do?

Use of Transpore TM tape to provide a temporary seal to a leaking endotracheal tube in a remote environment

SummaryWe report a case of a 65‐year‐old lady who developed an endotracheal tube leak during transfer to the CT scanner from the intensive care unit. The leak was controlled by the application of TransporeTM tape to avoid endotracheal tube exchange under unfavourable conditions in a remote environment.

Cuffed Endotracheal Tubes Are Okay for Neonates

I have read the article by Sathyamoorthy et al.1 and was surprised to hear that they have noticed a higher than expected incidence of stridor after using the Microcuff (Kimberly-Clark, Roswell, GA) endotracheal tube (ETT) in neonates. They reported that on three neonates who after being intubated with these cuffed ETTs, each had significant postoperative stridor. Most interesting to me was that in each of the cases, no attempt was made to establish whether there was a functional leak at ventilation pressures above 20 cm H2O after intubation. In two of these cases, air was injected into the ETT cuff, and still no measurement was made as to how much ventilation pressure the tube sealed at. After intubation in all pediatric cases, it has always been the standard of care to make sure that the ETT leaks above 20 cm H2O to ensure that the tube is the correct fit. This is regardless of whether you are using a cuffed or uncuffed ETT. The only difference being that when using a cuffed ETT, you select a smaller size than the traditional formula2 and inflate the cuff until the leak is at 20 cm H2O. If there is no leak, then the ETT is replaced with the next smaller size and the process is repeated. Recommendations or formulas are only a rough guideline to ETT sizing, and the functional test is always the proper way to minimize errors. In all three of the cases from Sathyamoorthy et al.,1 the likely problem is that the ETT was too large for the given patient. The conclusion by Sathyamoorthy et al. to “exercise caution” in using the Microcuff ETTs until evidence confirms they are safe for neonates is not warranted. It would appear that their technique is more likely to be at fault than the Microcuff ETT.

Effect of endotracheal tube leak on capnographic measurements in a ventilated neonatal lung model

Uncuffed endotracheal tubes (ET) are commonly used for mechanically ventilated infants to protect airways, but this bears the risk of an air leak around the ET. In contrast to the measurements of tidal volume and respiratory mechanics, very little is known about the effect of ET leaks on capnographic measurements. To investigate the relationship between ET leakage and the CO2 measuring error of the exhaled breathing gas a neonatal lung model was used consisting of two silicon bellows. A constant but very low flow of pure CO2 was injected so that the exhaled breathing gas contained an adjustable CO2 plateau. This lung model was ventilated via a 3 mm inner diameter ET with different respiratory rates (RR) (20, 40 and 60 min−1). ET leaks (0–80%) were simulated by a needle valve. The end-expiratory CO2 partial pressure (PetCO2) was reduced up to zero when an air leak was simulated. Provided that the exhaled CO2 reached a plateau before entering the CO2 washout of the sample chamber by the leak flow, the magnitude of the CO2 decreased independently of RR, and only slightly with increasing ET leak. For ET leaks of up to 20% the CO2 plateau error was <10%. However, in newborns with stiff lungs and a short alveolar plateau capnographic measurements should be interpreted with caution if the ET leak is considerable.

Inadvertent Triggering of the Ventilator Caused By Surgically Placed Pacer Wires

Inadvertent ventilator triggering can occur for various reasons. Leaks in the ventilator circuit, endotracheal tube leaks, tracheal cuff leaks, cardiac oscillations, water condensate causing oscillations in the circuit tubing, ventilator expiratory valve integrity, and overly sensitive triggering mechanism settings may precipitate this phenomena. We present a case of inadvertent ventilator triggering caused by electrical stimulation of the diaphragm from surgically placed pacing wires post cardiothoracic surgery. A 47-year-old woman underwent surgical placement of a left (LVAD) and right (RVAD) ventricular assist device for severe end stage cardiomyopathy, as a bridge to cardiac transplantation. The patient was observed to have inadvertent ventilator triggering while deeply sedated postoperatively. The ventilator set respiratory rate was 16 breaths/min, with patient respiratory rate of 30 breaths/min while deeply sedated. Upon assessment of ventilator waveforms and arterial blood gas revealing a profound respiratory alkalosis, the pressure/time waveform demonstrated a -2 cm H(2)O decrease in pressure prior to each cycled breath. The ventilator was subsequently changed from flow trigger sensitivity of 3 L/min to pressure trigger sensitivity of -3 cm H(2)O to eliminate the autotriggering. Later in the patient's ICU stay, inadvertent ventilator triggering was again observed. Further adjustment of the pressure trigger sensitivity to -3 cm H(2)O eliminated the autotriggering. Clinical assessment found the pacing wires were responsible for stimulating the patient's diaphragm, therefore causing airway pressure decreases and premature breath delivery. Once the electrical amplitude of the pacemaker was decreased, the inadvertent ventilator triggering resolved and normal trigger sensitivity and pH was restored.

The Challenge of Developing a New Predictive Formula to Estimate Energy Requirements in Ventilated Critically Ill Children

Traditionally, energy requirements have been calculated using predictive equations. These methods have failed to calculate energy expenditure accurately. Routine indirect calorimetry has been suggested, but this method is technically demanding and costly. This study aimed to develop a new predictive equation to estimate energy requirements for critically ill children. This prospective, observational study on ventilated children included patients with an endotracheal tube leak of < 10% and fractional inspired oxygen of < 60%. An indirect calorimetry energy expenditure measurement was performed and polynomial regression analysis was used to develop new predictive equations. The new formulas were then compared with existing prediction equations. Data from 369 measurements were included in the formula design. Only weight and diagnosis influenced energy expenditure significantly. Three formulas (A, B, C) with an R² > 0.8 were developed. When we compared the new formulas with commonly used equations (Schofield, Food and Agriculture Organization/World Health Organization/United Nations University, and White equation), all formulas performed very similar, but the Schofield equation seemed to have the lowest SD. All 3 new pediatric intensive care unit equations have R² values of > 0.8; however, the Schofield equation still performed better than other predictive methods in predicting energy expenditure in these patients. Still, none of the predictive equations, including the new equations, predicted energy expenditure within a clinically accepted range, and further research is required, particularly for patients outside the technical scope of indirect calorimetry.