title: Metabolic assessment and individualized nutrition in children dependent on mechanical ventilation at home.
abstract: OBJECTIVE
  To evaluate the nutritional and metabolic status and body composition of children on long-term mechanical ventilation using a home-based model.
  
  
  METHODS
  Children on home mechanical ventilation, for at least 12 hours a day, were eligible. We performed anthropometry, bioelectrical impedance analysis (BIA), actual energy intake (AEI), and indirect calorimetry in the subject's home. Agreement between measured energy expenditure (MEE) from indirect calorimetry, and estimated energy expenditure by the Schofield equation and a novel volumetric carbon dioxide production-based equation was examined. Agreement between fat mass estimates from anthropometry and BIA was examined and compared with population norms.
  
  
  RESULTS
  We enrolled 20 children, 11 (55%) male; mean age 8.4 years (SD 4.8). Mean weight for age z-score was -0.26 (SD 1.48); 9/20 had z-scores <-1 or >+1. Thirteen were underfed (AEI:MEE <90%) or overfed (AEI:MEE >110%); 11 of 19 had protein intake that was less than recommended by guidelines. Fifteen subjects were hypo- or hypermetabolic. Mean (SD) fat mass % was 33.6% (8.6) by anthropometry, which was significantly greater than matched population norms (mean 23.0%, SD 6.1, P < .001). The estimated energy expenditure by a volumetric carbon dioxide production-based equation was in stronger agreement with the MEE than the Schofield equation (mean bias 0.06%, limits -15.98% to 16.16% vs mean bias -1.31%, limits -74.3% to 72%, respectively). BIA and anthropometric fat mass values were not in agreement.
  
  
  CONCLUSIONS
  A majority of children on home ventilation are characterized by malnutrition, altered metabolic status, and suboptimal macronutrient intake, in particular low protein intake. A multidisciplinary home-based model facilitates individualized energy and protein delivery and may improve outcomes in this cohort.
authors.affiliation: Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Enid E
authors.initials: EE
authors.lastname: Martinez
authors.affiliation: Respiratory Care Department, Boston Children's Hospital, Boston, MA.
authors.forename: Craig D
authors.initials: CD
authors.lastname: Smallwood
authors.affiliation: Center for Nutrition, Boston Children's Hospital, Boston, MA.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Bechard
authors.affiliation: Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Graham
authors.affiliation: Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine, Boston Children's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Center for Nutrition, Boston Children's Hospital, Boston, MA. Electronic address: nilesh.mehta@childrens.harvard.edu.
authors.forename: Nilesh M
authors.initials: NM
authors.lastname: Mehta
mesh_terms: D000293:Adolescent; D001823:Body Composition; D002648:Child; D002664:Child Nutritional Physiological Phenomena; D002675:Child, Preschool; D017097:Electric Impedance; D002149:Energy Intake; D004734:Energy Metabolism; D005260:Female; D006699:Home Care Services; D006801:Humans; D007223:Infant; D008297:Male; D009752:Nutritional Status; D011446:Prospective Studies; D012121:Respiration, Artificial