scholarly journals Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Hanneke Pierre Franciscus Xaverius Moonen ◽  
Karin Josephina Hubertina Beckers ◽  
Arthur Raymond Hubert van Zanten
Keyword(s):  
Critical Illness ◽  
Energy Expenditure ◽  
Critically Ill ◽  
Indirect Calorimetry ◽  
Critically Ill Patients ◽  
Energy Production ◽  
Nutrition Support ◽  
Current Evidence ◽  
Term Outcome ◽  
Long Term Outcome

AbstractThe use of indirect calorimetry is strongly recommended to guide nutrition therapy in critically ill patients, preventing the detrimental effects of under- and overfeeding. However, the course of energy expenditure is complex, and clinical studies on indirect calorimetry during critical illness and convalescence are scarce. Energy expenditure is influenced by many individual and iatrogenic factors and different metabolic phases of critical illness and convalescence. In the first days, energy production from endogenous sources appears to be increased due to a catabolic state and is likely near-sufficient to meet energy requirements. Full nutrition support in this phase may lead to overfeeding as exogenous nutrition cannot abolish this endogenous energy production, and mitochondria are unable to process the excess substrate. However, energy expenditure is reported to increase hereafter and is still shown to be elevated 3 weeks after ICU admission, when endogenous energy production is reduced, and exogenous nutrition support is indispensable. Indirect calorimetry is the gold standard for bedside calculation of energy expenditure. However, the superiority of IC-guided nutritional therapy has not yet been unequivocally proven in clinical trials and many practical aspects and pitfalls should be taken into account when measuring energy expenditure in critically ill patients. Furthermore, the contribution of endogenously produced energy cannot be measured. Nevertheless, routine use of indirect calorimetry to aid personalized nutrition has strong potential to improve nutritional status and consequently, the long-term outcome of critically ill patients.

Energy requirements and the use of predictive equations versus indirect calorimetry in critically ill patients

2015 ◽  
Vol 40 (2) ◽  
pp. 207-210 ◽  
Author(s):  
Sanit Wichansawakun ◽  
Liisa Meddings ◽  
Cathy Alberda ◽  
Sarah Robbins ◽  
Leah Gramlich
Keyword(s):  
Energy Expenditure ◽  
Critically Ill ◽  
Indirect Calorimetry ◽  
Critically Ill Patients ◽  
Positive Impact ◽  
Energy Requirement ◽  
Nutrition Therapy ◽  
Nutrition Support ◽  
Predictive Equations ◽  
Energy Assessment

Nutrition support has been shown to have a positive impact on critically ill patients who meet their defined goals of nutrition therapy. However, inappropriate energy assessment can contribute to under- or overfeeding resulting in deleterious effects. Thus, assessment of energy expenditure in critically ill patients is crucial to prevent negative impacts from inappropriate feeding. Currently, the optimal energy requirement and appropriate energy assessment in these patients is controversial. Indirect calorimetry or predictive equations have been suggested to evaluate energy expenditure in critically ill patients. Indirect calorimetry is a gold standard for evaluating energy expenditure, but it is not always available and has some limitations. Many predictive equations, therefore, have been developed to predict energy expenditure in critically ill patients. However, these equations cannot be used generally in these patients since they were developed in a unique patient population. Many studies compared measured energy expenditure with predictive energy expenditure, but the data regarding accuracy is not robust. Therefore, clinicians should consider using these equations carefully based on the current supporting data. Indirect calorimetry is recommended for use in evaluating energy expenditure in critically ill patients if it is available.

LONG-TERM OUTCOME AFTER ACUTE KIDNEY INJURY IN CRITICALLY-ILL PATIENTS

2007 ◽  
Vol 62 (sup2) ◽  
pp. 337-340 ◽  
Author(s):  
S. Oeyen ◽  
D. Vandijck ◽  
D. Benoit ◽  
J. Decruyenaere ◽  
L. Annemansc ◽  
...  
Keyword(s):  
Acute Kidney Injury ◽  
Critically Ill ◽  
Critically Ill Patients ◽  
Kidney Injury ◽  
Term Outcome ◽  
Long Term Outcome

scholarly journals Energy expenditure in critically ill patients estimated by population-based equations, indirect calorimetry and CO2-based indirect calorimetry

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Mark Lillelund Rousing ◽  
Mie Hviid Hahn-Pedersen ◽  
Steen Andreassen ◽  
Ulrike Pielmeier ◽  
Jean-Charles Preiser
Keyword(s):  
Energy Expenditure ◽  
Critically Ill ◽  
Indirect Calorimetry ◽  
Critically Ill Patients ◽  
Population Based

A new method for the estimation of the components of energy expenditure in patients with major trauma

1994 ◽  
Vol 267 (6) ◽  
pp. E1002-E1009 ◽  
Author(s):  
G. Franch-Arcas ◽  
L. D. Plank ◽  
D. N. Monk ◽  
R. Gupta ◽  
K. Maher ◽  
...  
Keyword(s):  
Body Composition ◽  
Energy Expenditure ◽  
Critically Ill ◽  
Indirect Calorimetry ◽  
Critically Ill Patients ◽  
Major Trauma ◽  
Calorie Intake ◽  
Total Body Potassium ◽  
Body Protein ◽  
Total Body

The management of critically ill patients would be better understood if the total energy expenditure (TEE) and its components are known. To quantify the different components of energy expenditure in patients with major trauma, we used a technique combining measurements of body composition and oxygen consumption. We determined changes in body weight, total body water, total body protein, total body potassium, total body fat, and bone mineral content every 5 days over a 10-day period in a group of nine multiply injured patients. Resting energy expenditure was measured by indirect calorimetry (REEm), and a predicted value was obtained from total body potassium (REEp). TEE was assessed by adding the total calorie intake to the changes in body energy stores, and the activity energy expenditure (AEE) was calculated by subtracting REEm from TEE. Mean daily values for REEm, REEp, TEE, and AEE were 2,236 +/- 140, 1,683 +/- 82, 3,029 +/- 276, and 793 +/- 213 kcal/day, respectively, over the 10-day study period. Although not statistically significant, the mean AEE was four times smaller for the first 5 days of study than for the second 5 days (298 +/- 400 vs. 1,254 +/- 588 kcal/day). The technique of combining indirect calorimetry and body composition measurements offers a new approach to evaluate energy expenditure and a new way to study metabolic disorders and therapeutic strategies in critically ill patients.

scholarly journals How to Feed the Critically Ill—A Review

2020 ◽  
Vol 49 (8) ◽  
pp. 573-581
Author(s):  
Charles CH Lew ◽  
Chengsi Ong ◽  
Amartya Mukhopadhyay ◽  
Andrea Marshall ◽  
Yaseen M Arabi
Keyword(s):  
Body Composition ◽  
Intensive Care ◽  
Critically Ill ◽  
Indirect Calorimetry ◽  
Critically Ill Patients ◽  
Assessment Tools ◽  
Nutrition Support ◽  
Clinical Practices ◽  
Icu Stay ◽  
Key Words Critical Care

Introduction: Number of recently published studies on nutritional support in the intensive care unit (ICU) have resulted in a paradigm shift of clinical practices. This review summarises the latest evidence in four main topics in the ICU, namely: (1) function of validated nutrition screening/assessment tools, (2) types and validity of body composition measurements, (3) optimal energy and protein goals, and (4) delivery methods. Methods: Recent studies that investigated the above aims were outlined and discussed. In addition, recent guidelines were also compared to highlight the similarities and differences in their approach to the nutrition support of critically ill patients. Results: Regardless of nutritional status and body composition, all patients with >48 hours of ICU stay are at nutrition risk and should receive individualised nutrition support. Although a recent trial did not demonstrate an advantage of indirect calorimetry over predictive equations, it was recommended that indirect calorimetry be used to set energy targets with better accuracy. Initiation of enteral nutrition (EN) within 24–48 hours was shown to be associated with improved clinical outcomes. The energy and protein goals should be achieved gradually over the first week of ICU stay. This practice should be protocolised and regularly audited as critically ill patients receive only part of their energy and protein goals. Conclusions: Metabolic demands of critically ill patients can be variable and nutrition support should be tailored to each patient. Given that many nutrition studies are on-going, we anticipate improvements in the individualisation of nutrition support in the near future. Key words: Critical care, Critical illness, Intensive care, Nutrition, Nutritional intake, Nutrition support

scholarly journals The association between culture positivity and long-term mortality in critically ill surgical patients

2021 ◽  
Vol 9 (1) ◽  
Author(s):  
Yu-Cheng Wu ◽  
Li-Ting Wong ◽  
Chieh-Liang Wu ◽  
Wen-Cheng Chao
Keyword(s):  
Critically Ill ◽  
Critically Ill Patients ◽  
Positive Culture ◽  
Surgical Patients ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Culture Positivity ◽  
Critically Ill Surgical Patients ◽  
Long Term Mortality

Abstract Background The long-term outcome is an essential issue in critically ill patients, and the identification of early determinant is needed for risk stratification of the long-term outcome. In the present study, we investigate the association between culture positivity during admission and long-term outcome in critically ill surgical patients. Methods We linked the 2015–2019 critical care database at Taichung Veterans General Hospital with the nationwide death registration files in Taiwan. We described the long-term mortality and proportion of culture positivity among enrolled subjects. We used a log-rank test to estimate survival curves between patients with and without positive cultures and a multivariable Cox proportional hazards regression model to determine hazard ratio (HR) and 95% confidence interval (CI). Results A total of 6748 critically ill patients were enrolled, and 32.5% (2196/6749) of them died during the follow-up period, with the overall follow-up duration was 1.8 ± 1.4 years. We found that 31.4% (2122/6748) of critically ill patients had at least one positive culture during the index admission, and the number of patients with positive culture in the blood, respiratory tract, urinary tract, skin and soft tissue and abdomen were 417, 1702, 554, 194 and 139, respectively. We found that a positive culture from any sites was independently associated with high long-term mortality (aHR 1.579, 95% CI 1.422–1.754) after adjusting relevant covariates, including age, sex, body-mass index, comorbidities, severity score, shock, early fluid overload, receiving mechanical ventilation and the need of renal replacement therapy for critical illness. Conclusions We linked two databases to identify that a positive culture during admission was independently correlated with increased long-term mortality in critically ill surgical patients. Our findings highlight the need for vigilance among patients with a positive culture during admission, and more studies are warranted to validate our findings and to clarify underlying mechanisms.

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