title: Is indirect calorimetry a necessity or a luxury in the pediatric intensive care unit?
abstract: BACKGROUND
  Critically ill children differ in their energy needs from healthy children in terms of underlying metabolic derangement, comorbidities, energy reserve, and response to illness. This study determined how many pediatric intensive care unit (PICU) patients were candidates for indirect calorimetry (IC), per American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.) recommendations.
  
  
  METHODS
  Admission diagnosis, demographics, type/amount of nutrition support, length of intensive care unit/hospital stay were collected. Patients were classified as candidates for IC per A.S.P.E.N. guidelines.
  
  
  RESULTS
  Mean (SD) age of patients (n = 150) was 6.7 (5.6) years, with PICU length of stay of 3.9 (5.3) days. IC was indicated in 72.0% (108/150) of patients during PICU days 1-7. Patients with miscellaneous (50%), neurological (73%), respiratory (81%), sepsis (83%), and oncology (100%) diagnoses were candidates for IC. Underweight/overweight/obese (32.4%), hypermetabolism (26.4%), and not meeting nutrition goals (13.7%) were the most frequent indications for IC (χ(2), P < .001). Patients (31%) met ≥2 indications for IC. Patients with neurological disease (relative risk [RR], 4.8; 95% confidence interval [CI], 1.7-14.6), oncology patients (4.2; 1.1-15.9), respiratory patients (5.5; 2.0-16.9), and children with sepsis/septic shock/infection (5.6; 1.9-18.1) were more likely to have ≥2 indications for IC compared to those with other diagnoses.
  
  
  CONCLUSIONS
  Three of 4 patients were candidates for IC per A.S.P.E.N. guidelines. PICUs might have to prioritize performing IC in patients who are <2 years of age, malnourished (underweight/overweight) on admission, or PICU stay of >5 days. Future studies should determine the cost-benefit ratios of performing IC in PICU patients.
authors.affiliation: Baylor College of Medicine/Texas Children's Hospital, Pediatric Critical Care Medicine, Houston, Texas 77030, USA. ukyle@bcm.tmc.edu
authors.forename: Ursula G
authors.initials: UG
authors.lastname: Kyle
authors.forename: Ana
authors.initials: A
authors.lastname: Arriaza
authors.forename: Monica
authors.initials: M
authors.lastname: Esposito
authors.forename: Jorge A
authors.initials: JA
authors.lastname: Coss-Bu
mesh_terms: D002153:Calorimetry, Indirect; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004734:Energy Metabolism; D005260:Female; D006301:Health Services Needs and Demand; D006801:Humans; D007223:Infant; D015278:Intensive Care Units, Pediatric; D007902:Length of Stay; D008297:Male; D044342:Malnutrition; D009369:Neoplasms; D009422:Nervous System Diseases; D050177:Overweight; D017410:Practice Guidelines as Topic; D012140:Respiratory Tract Diseases; D018805:Sepsis; D012955:Societies, Medical; D013851:Thinness