Simple and accurate assessment of energy expenditure in ventilated paediatric intensive care patients.
OBJECTIVE
To assess validity and reliability of energy expenditure measurements with a short Douglas bag protocol compared to the standard metabolic monitor in a paediatric intensive care setting.


METHODS
51 paired measurements were performed in 14 ventilated patients (age 0-18 years) with sepsis, trauma or following major surgery. Measured data were compared mutually and compared to Schofield equations using Bland-Altman analysis.


RESULTS
Comparing Douglas bag (3.21 +/- 1.43 MJ/day) and metabolic monitor (3.15 +/- 1.49 MJ/day) we found bias in energy expenditure of -0.06 (equal to -2%, NS) with limits of agreement of -0.5 to 0.4 MJ/day (equal to -16% to +13%). Intra-measurement variability (coefficient of variation) was within 10% for both methods. Both the metabolic monitor and Douglas bag showed significant bias compared to Schofield equations (3.39 +/-1.64 MJ/day) of -7% (P < 0.01) and -5% (P < 0.05), respectively, with wide limits of agreement: metabolic monitor vs. Schofield: -37% to +22%, Douglas bag vs. Schofield: -37% to +26%.


CONCLUSIONS
The Douglas bag method compared favourably to the metabolic monitor where Schofield equations failed to predict individual energy expenditure. Considering its low cost, this renders the short and simple Douglas bag method a robust measure and a routinely applicable instrument for tailored nutritional assessment in critically ill children.
Department of Paediatrics, VU University Medical Center, PO Box 7057, 1007 MB Amsterdam, The Netherlands. mvanderkuip@vumc.nl
Martijn
M
van der Kuip
Kees
K
de Meer
Michiel J S
MJ
Oosterveld
Harry N
HN
Lafeber
Reinoud J B J
RJ
Gemke
D000293:Adolescent; D000465:Algorithms; D002153:Calorimetry, Indirect; D002648:Child; D002675:Child, Preschool; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D008297:Male; D015596:Nutrition Assessment; D009751:Nutritional Requirements; D010101:Oxygen Consumption / Q000502:physiology; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index