title: Energy expenditure in children after severe traumatic brain injury.
abstract: OBJECTIVE
  To evaluate energy expenditure in a cohort of children with severe traumatic brain injury.
  
  
  METHODS
  A prospective observational study.
  
  
  METHODS
  A pediatric neurotrauma center within a tertiary care institution.
  
  
  METHODS
  Mechanically ventilated children admitted with severe traumatic brain injury (Glasgow Coma Scale < 9) with a weight more than 10 kg were eligible for study. A subset of children was co-enrolled in a phase 3 study of early therapeutic hypothermia. All children were treated with a comprehensive neurotrauma protocol that included sedation, neuromuscular blockade, temperature control, antiseizure prophylaxis, and a tiered-based system for treating intracranial hypertension.
  
  
  METHODS
  Within the first week after injury, indirect calorimetry measurements were performed daily when the patient's condition permitted.
  
  
  RESULTS
  Data from 13 children were analyzed (with a total of 32 assessments). Measured energy expenditure obtained from indirect calorimetry was compared with predicted resting energy expenditure calculated from Harris-Benedict equation. Overall, measured energy expenditure/predicted resting energy expenditure averaged 70.2% ± 3.8%. Seven measurements obtained while children were hypothermic did not differ from normothermic values (75% ± 4.5% vs 68.9% ± 4.7%, respectively, p = 0.273). Furthermore, children with favorable neurologic outcome at 6 months did not differ from children with unfavorable outcome (76.4% ± 6% vs 64.7% ± 4.7% for the unfavorable outcome, p = 0.13).
  
  
  CONCLUSIONS
  Contrary to previous work from several decades ago that suggested severe pediatric traumatic brain injury is associated with a hypermetabolic response (measured energy expenditure/predicted resting energy expenditure > 110%), our data suggest that contemporary neurocritical care practices may blunt such a response. Understanding the metabolic requirements of children with severe traumatic brain injury is the first step in development of rational nutritional support goals that might lead to improvements in outcome.
authors.affiliation: 1Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. 2Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA. 3Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA. 4Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA. 5Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ. 6Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA.
authors.forename: Haifa
authors.initials: H
authors.lastname: Mtaweh
authors.forename: Rebecca
authors.initials: R
authors.lastname: Smith
authors.forename: Patrick M
authors.initials: PM
authors.lastname: Kochanek
authors.forename: Stephen R
authors.initials: SR
authors.lastname: Wisniewski
authors.forename: Anthony
authors.initials: A
authors.lastname: Fabio
authors.forename: Monica S
authors.initials: MS
authors.lastname: Vavilala
authors.forename: P David
authors.initials: PD
authors.lastname: Adelson
authors.forename: Nicole A
authors.initials: NA
authors.lastname: Toney
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Bell
mesh_terms: D000293:Adolescent; D001930:Brain Injuries / Q000378:metabolism* / Q000628:therapy; D002153:Calorimetry, Indirect; D002648:Child; D002675:Child, Preschool; D004734:Energy Metabolism / Q000502:physiology*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D011446:Prospective Studies; D012121:Respiration, Artificial; D063128:Tertiary Health Care