Energy expenditure and balance following pediatric intensive care unit admission.pdfVIP

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2017-04-13 发布于江苏
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Energy expenditure and balance following pediatric intensive care unit admission.pdf

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Energy expenditure and balance following pediatric intensive care unit admission

Clinical Investigations Energy expenditure and balance following pediatric intensive care unit admission: A longitudinal study of critically ill children Michiel J. S. Oosterveld, MD; Martijn Van Der Kuip, MD, PhD; Kees De Meer, MD, PhD; Henrik J. M. M. De Greef, MSc; Reinoud J. B. J. Gemke, MD, PhD Nutritional support is a basiccomponent of clinical man-agement in the pediatric in-tensive care unit (PICU). Ad- equate nutrition is associated with physiologic stability and outcome for critically ill children (1, 2), whereas both malnutrition (3) and overfeeding (4) are associated with poor outcome (2). Assessment of energy requirements is essential for nutritional management. In a recent survey of nutritional management across Europe, most PICUs reported using weight or predictive equations to estimate energy demands (5). Most of these predictive equations, such as those published by Schofield (6), were based on energy expendi- ture (EE) data for healthy infants and chil- dren. In the critically ill child however, EE may vary considerably from predicted EE val- ues (7–10). This can be attributed partly to the special conditions imposed by treatment in the intensive care setting, such as a tem- perature-controlled environment, immobil- ity, use of sedatives or muscle relaxants, and mechanical ventilation (7, 11, 12). Also, crit- ical illness itself may alter EE. For instance, EE is elevated in children with burns (13), neonatal septicemia (14), congenital heart disease (15), or head injury (16). Finally, EE may vary during the course of the PICU stay, from an early acute phase to convalescence (17, 18). Hence, discrepancies between esti- mated and actual EE on the individual- patient level will contribute to a mismatch of nutritional intake and nutritional require- ments. Although several studies have ad- dressed this (7–10, 19), few have explored other possible barriers to adequate nutrition by longitudinal analysis. Among adult inten- sive care unit patients, inadeq