title: Validation of ventilator-derived VCO2measurements to determine energy expenditure in ventilated critically ill children.
abstract: Indirect calorimetry (IC) is considered the gold standard to determine resting energy expenditure (REE) but its availability in PICUs worldwide is limited. Ventilator-derived VCO2could potentially improve the possibility of performing REE measurements. We investigated whether ventilator-derived VCO2values are comparable to IC-derived VCO2values and can clinically be used in clinical practice to determine REE.
  
  
  
  VCO2-values were simultaneously collected in mechanically ventilated children from IC (Deltatrac®) and Servo-I®ventilator on a minute base over at least 10 min period of steady state. REE was calculated using the modified Weir formula (for IC) or REE = 5.5*VCO2(L/min)*1440 (for the Servo-I values) and compared with frequently used predictive equations by Schofield and the WHO to calculate REE.
  
  
  
  Measurements were performed in 41 children; median age 2 years. The mean relative difference between VCO2measured by IC and Servo-I®was 15.6% (p = 0.002), and limits of agreement in the Bland-Altman analysis were wide. Comparable measurements, defined as a difference ≤10% between IC and Servo-I®VCO2values, were seen in 18 (44%) children, but this proportion was 70% in children ≥15 kg. In this group, REE could be accurately predicted using Servo-I®derived VCO2values and this method was superior to the use of predictive equations. The Servo-I®derived VCO2values were not sufficiently accurate for the large proportion of children weighing <15 kg.
  
  
  
  In children ≥15 kg, VCO2measurements of the Servo-I®seem sufficiently accurate for use in clinical practice and may be used to determine energy expenditure in the future.
authors.affiliation: Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Dorian
authors.initials: D
authors.lastname: Kerklaan
authors.affiliation: Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Marjolein E
authors.initials: ME
authors.lastname: Augustus
authors.affiliation: Department of Paediatric Gastroenterology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Jessie M
authors.initials: JM
authors.lastname: Hulst
authors.affiliation: Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: van Rosmalen
authors.affiliation: Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands.
authors.forename: Sascha C A T
authors.initials: SCAT
authors.lastname: Verbruggen
authors.affiliation: Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: k.joosten@erasmusmc.nl.
authors.forename: Koen F M
authors.initials: KFM
authors.lastname: Joosten
mesh_terms: D001481:Basal Metabolism; D001835:Body Weight; D002153:Calorimetry, Indirect; D002245:Carbon Dioxide / Q000378:metabolism*; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D015203:Reproducibility of Results; D012121:Respiration, Artificial
chemical_list: D002245:Carbon Dioxide
keywords: Energy expenditure; Indirect calorimetry; Intensive care units; Metabolic assessment; Pediatric; VCO(2)