Energy Expenditure in Children With Severe Head Injury: Lack of Agreement Between Measured and Estimated Energy Expenditure

Abstract

Background: The purpose of this study was to test the hypotheses that estimates of resting energy expenditure (REE) vary significantly from measured energy expenditure in a population of head-injured children and are not accurate for use in determining nutrition needs in this population. Methods: This is a retrospective study of 30 children with severe head injury, with Glasgow Coma Scale (GCS) score of <8 and needing mechanical ventilation. Measured REE was obtained using indirect calorimetry. Estimated REEs were calculated using Harris-Benedict, World Health Organization (WHO), Schofield, and White formulas. Severity of illness was calculated using Pediatric Risk of Mortality (PRISM) score. Agreement between measured REE and estimated REE was tested using the Bland-Altman method. Correlation coefficient between PRISM score and measured REE was calculated using Spearman test. Results: More than half of the estimates of REE differed from measured REE by >10%. Significant disagreement between estimated REE and measured REE was demonstrated using the Bland-Altman method. There was no correlation between severity of illness and measured REE to explain the inaccuracies of REE estimates. Conclusion: Energy expenditure in critically ill children cannot be estimated accurately; hence, nutrition for critically ill children with head injury should be provided according to measurement of REE to avoid the consequences of overfeeding or malnutrition.

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References

Conroy C, Kraus JF. Survival after brain injury: cause of death, length of survival, and prognostic variables in a cohort of brain-injured people. Neuroepidemiology. 1988 ;7:13– 22.

Slone DS. Nutritional support of the critically ill and injured patient. Crit Care Clin. 2004 ;20:135– 157.

Keusch GT. The history of nutrition: malnutrition, infection and immunity. J Nutr. 2003 ;133:336S– 340S.

Wong PW, Enriquez A, Barrera R. Nutritional support in critically ill patients with cancer. Crit Care Clin. 2001 ;17:743– 767.

Smith LC, Mullen JL. Nutritional assessment and indications for nutritional support. Surg Clin North Am. 1991 ;71:449– 457.

Aarsland A, Chinkes D, Wolfe RR. Contributions of de novo synthesis of fatty acids to total VLDL-triglyceride secretion during prolonged hyperglycemia/hyperinsulinemia in normal man. J Clin Invest. 1996;98:2008– 2017.

Dabrowski GP, Rombeau JL. Practical nutritional management in the trauma intensive care unit. Surg Clin North Am. 2000 ;80:921– 932, x.

Askanazi J, Rosenbaum SH, Hyman AI, Silverberg PA, Milic-Emili J, Kinney JM. Respiratory changes induced by the large glucose loads of total parenteral nutrition. JAMA. 1980 ;243:1444– 1447.

Guenst JM, Nelson LD. Predictors of total parenteral nutrition-induced lipogenesis. Chest. 1994 ;105:553– 559.

10.

Cely CM, Arora P, Quartin AA, Kett DH, Schein RM. Relationship of baseline glucose homeostasis to hyperglycemia during medical critical illness. Chest. 2004;126:879– 887.

11.

Chinsky K. The evolving paradigm of hyperglycemia and critical illness. Chest. 2004 ;126:674– 676.

12.

van den Berghe G, Wouters P, Weekers F, et al. Intensive insulin therapy in the critically ill patients. N Engl J Med. 2001 ;345:1359– 1367.

13.

Avitzur Y, Singer P, Dagan O, et al. Resting energy expenditure in children with cyanotic and noncyanotic congenital heart disease before and after open heart surgery. JPEN J Parenter Enteral Nutr. 2003;27:47– 51.

14.

Harris JA, Benedict FG. A Biometric Study of Basal Metabolism in Man. Washington, DC: Carnegie Institute;1919 .

15.

Schofield WN. Predicting basal metabolic rate: new standards and review of previous work. Hum Nutr Clin Nutr. 1985 ;39(suppl 1):5– 41.

16.

World Health Organization. Energy and protein requirements: report of a joint FAO/WHO/UNU Expert Consultation. World Health Organ Tech Rep Ser. 1985;724:1– 206.

17.

White MS, Shepherd RW, McEniery JA. Energy expenditure in 100 ventilated, critically ill children: improving the accuracy of predictive equations. Crit Care Med. 2000 ;28:2307– 2312.

18.

Adelson PD, Bratton SL, Carney NA, et al. Guidelines for the acute medical management of severe traumatic brain injury in infants, children, and adolescents, chapter 2: trauma systems, pediatric trauma centers, and the neurosurgeon. Pediatr Crit Care Med. 2003 ;4(3 suppl):S5– S8.

19.

Revelly JP, Gardaz JP, Nussberger J, Schutz Y, Chiolero R. Effect of epinephrine on oxygen consumption and delivery during progressive hemorrhage. Crit Care Med. 1995 ;23:1272– 1278.

20.

Pierce EC Jr, Lambertsen CJ, Deutsch S, et al. Cerebral circulation and metabolism during thiopental anesthesia and hyperventilation in man. J Clin Invest. 1962 ;41:1664– 1671.

21.

Kassell NF, Hitchon PW, Gerk MK, Sokoll MD, Hill TR. Alterations in cerebral blood flow, oxygen metabolism, and electrical activity produced by high dose sodium thiopental. Neurosurgery. 1980 ;7:598– 603.

22.

Pollack MM, Ruttimann UE, Getson PR. Pediatric risk of mortality (PRISM) score. Crit Care Med. 1988 ;16:1110– 1116.

23.

Bursztein S, Saphar P, Glaser P, Taitelman U, de Myttenaere S, Nedey R. Determination of energy metabolism from respiratory functions alone. J Appl Physiol. 1977 ;42:117– 119.

24.

Weir JB. New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol. 1949 ;109:1– 9.

25.

McClave SA, Lowen CC, Kleber MJ, et al. Are patients fed appropriately according to their caloric requirements? JPEN J Parenter Enteral Nutr. 1998 ;22:375– 381.

26.

Kaplan AS, Zemel BS, Neiswender KM, Stallings VA. Resting energy expenditure in clinical pediatrics: measured versus prediction equations. J Pediatr. 1995 ;127:200– 205.

27.

Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet. 1986 ;1:307– 310.

28.

Sentongo TA, Tershakovec AM, Mascarenhas MR, Watson MH, Stallings VA. Resting energy expenditure and prediction equations in young children with failure to thrive. J Pediatr. 2000 ;136:345– 350.

29.

Firouzbakhsh S, Mathis RK, Dorchester WL, et al. Measured resting energy expenditure in children. J Pediatr Gastroenterol Nutr. 1993;16:136– 142.

30.

Peerless JR, Epstein CD, Martin JE, Pinchak AC, Malangoni MA. Oxygen consumption in the early postinjury period: use of continuous, on-line indirect calorimetry. Crit Care Med. 2000 ;28:395– 401.

31.

Bruder N, Raynal M, Pellissier D, Courtinat C, Francois G. Influence of body temperature, with or without sedation, on energy expenditure in severe head-injured patients. Crit Care Med. 1998 ;26:568– 572.

32.

Eccles MP, Cole TJ, Whitehead RG. Factors influencing sleeping metabolic rate in infants. Eur J Clin Nutr. 1989 ;43:485– 492.

33.

van Lanschot JJ, Feenstra BW, Vermeij CG, Bruining HA. Accuracy of intermittent metabolic gas exchange recordings extrapolated for diurnal variation. Crit Care Med. 1988 ;16:737– 742.