Dorian Kerklaan1, Marjolein E Augustus1, Jessie M Hulst2, Joost van Rosmalen3, Sascha C A T Verbruggen1, Koen F M Joosten4. 1. Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands. 2. Department of Paediatric Gastroenterology, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands. 3. Department of Biostatistics, Erasmus MC, Rotterdam, The Netherlands. 4. Intensive Care Unit, Department of Paediatrics and Paediatric Surgery, Erasmus MC - Sophia Children's Hospital, Rotterdam, The Netherlands. Electronic address: k.joosten@erasmusmc.nl.
Abstract
BACKGROUND & AIMS: Indirect calorimetry (IC) is considered the gold standard to determine resting energy expenditure (REE) but its availability in PICUs worldwide is limited. Ventilator-derived VCO2 could potentially improve the possibility of performing REE measurements. We investigated whether ventilator-derived VCO2 values are comparable to IC-derived VCO2 values and can clinically be used in clinical practice to determine REE. METHODS: 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. RESULTS: Measurements were performed in 41 children; median age 2 years. The mean relative difference between VCO2 measured 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® VCO2 values, 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 VCO2 values and this method was superior to the use of predictive equations. The Servo-I® derived VCO2 values were not sufficiently accurate for the large proportion of children weighing <15 kg. CONCLUSIONS: In children ≥15 kg, VCO2 measurements of the Servo-I® seem sufficiently accurate for use in clinical practice and may be used to determine energy expenditure in the future.
BACKGROUND & AIMS: Indirect calorimetry (IC) is considered the gold standard to determine resting energy expenditure (REE) but its availability in PICUs worldwide is limited. Ventilator-derived VCO2 could potentially improve the possibility of performing REE measurements. We investigated whether ventilator-derived VCO2 values are comparable to IC-derived VCO2 values and can clinically be used in clinical practice to determine REE. METHODS: 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. RESULTS: Measurements were performed in 41 children; median age 2 years. The mean relative difference between VCO2 measured 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® VCO2 values, 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 VCO2 values and this method was superior to the use of predictive equations. The Servo-I® derived VCO2 values were not sufficiently accurate for the large proportion of children weighing <15 kg. CONCLUSIONS: In children ≥15 kg, VCO2 measurements of the Servo-I® seem sufficiently accurate for use in clinical practice and may be used to determine energy expenditure in the future.
Authors: Milan Kratochvíl; Jozef Klučka; Eva Klabusayová; Tereza Musilová; Václav Vafek; Tamara Skříšovská; Jana Djakow; Pavla Havránková; Denisa Osinová; Petr Štourač Journal: Children (Basel) Date: 2022-07-11