Nutrients (Jan 2024)

Validation of Indirect Calorimetry in Children Undergoing Single-Limb Non-Invasive Ventilation: A Proof of Concept, Cross-Over Study

  • Veronica D’Oria,
  • Giulia Carla Immacolata Spolidoro,
  • Carlo Virginio Agostoni,
  • Cinzia Montani,
  • Ludovica Ughi,
  • Cristina Villa,
  • Tiziana Marchesi,
  • Giovanni Babini,
  • Stefano Scalia Catenacci,
  • Giada Donà,
  • Marta Guerrini,
  • Giovanna Chidini,
  • Edoardo Calderini,
  • Thomas Langer

DOI
https://doi.org/10.3390/nu16020230
Journal volume & issue
Vol. 16, no. 2
p. 230

Abstract

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Background. The accurate assessment of resting energy expenditure (REE) is essential for personalized nutrition, particularly in critically ill children. Indirect calorimetry (IC) is the gold standard for measuring REE. This methodology is based on the measurement of oxygen consumption (VO2) and carbon dioxide production (VCO2). These parameters are integrated into the Weir equation to calculate REE. Additionally, IC facilitates the determination of the respiratory quotient (RQ), offering valuable insights into a patient’s carbohydrate and lipid consumption. IC validation is limited to spontaneously breathing and mechanically ventilated patients, but it is not validated in patients undergoing non-invasive ventilation (NIV). This study investigates the application of IC during NIV-CPAP (continuous positive airway pressure) and NIV-PS (pressure support). Methods. This study was conducted in the Pediatric Intensive Care Unit of IRCCS Ca’ Granda, Ospedale Maggiore Policlinico, Milan, between 2019 and 2021. Children 2, VCO2, and RQ measured by IC. Results. Fourteen patients (median age 7 (4; 18) months, median weight 7.7 (5.5; 9.7) kg) were enrolled. The REE, VO2, VCO2, and RQ did not differ significantly between the groups. The Limits of Agreement (LoA) and bias of REE indicated good agreement between SB and NIV-CPAP (LoA +28.2, −19.4 kcal/kg/day; bias +4.4 kcal/kg/day), and between SB and NIV-PS (LoA −22.2, +23.1 kcal/kg/day; bias 0.4 kcal/kg/day). Conclusions. These preliminary findings support the accuracy of IC in children undergoing NIV. Further validation in a larger cohort is warranted.

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