The challenge of developing a new predictive formula to estimate energy requirements in ventilated critically ill children.
BACKGROUND
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.


METHODS
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.


RESULTS
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.


CONCLUSIONS
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.
Department of Paediatrics, Division Medicine, Imperial College, St Mary's Campus, London, UK. rmeyer@imperial.ac.uk
Rosan
R
Meyer
Elena
E
Kulinskaya
George
G
Briassoulis
Rachel M
RM
Taylor
Mehrengise
M
Cooper
Nazima
N
Pathan
Parviz
P
Habibi
D000293:Adolescent; D001481:Basal Metabolism; D001835:Body Weight; D002153:Calorimetry, Indirect; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D007223:Infant; D007442:Intubation, Intratracheal; D008297:Male; D055641:Mathematical Concepts; D009751:Nutritional Requirements; D011446:Prospective Studies; D012044:Regression Analysis; D012121:Respiration, Artificial