Resting energy expenditure and nitrogen balance in critically ill pediatric patients on mechanical ventilation

Nutritional support is important in critically ill patients, with variable energy and nitrogen requirements (e.g., sepsis, trauma, postsurgical state) in this population. This study investigates how age, severity of illness, and mechanical ventilation are related to resting energy expenditure (REE) and nitrogen balance. Nineteen critically ill children (mean age, 8 ± 6 [SD] y and range 0.4–17.0 y) receiving total parenteral nutrition (TPN) were enrolled. We used indirect calorimetry to measure REE. Expected energy requirements (EER) were obtained from Talbot tables. Pediatric Risk of Mortality (PRISM) and Therapeutic Intervention Scoring System (TISS) scores were calculated. Total urinary nitrogen was measured using the Kjeldahl method. PRISM and TISS scores were 9 ± 5 and 31 ± 6 points, respectively. REE was 62 ± 25 kcal · kg−1 · d−1, EER was 42 ± 11 kcal · kg−1 · d−1, and caloric intake was 49 ± 22 kcal · kg−1 · d−1. Nitrogen intake was 279 ± 125 mg · kg−1 · d−1, total urinary nitrogen was 324 ± 133 mg · kg−1 · d−1, and nitrogen balance was −120 ± 153 mg · kg−1 · d−1. The protein requirement in this population was approximately 2.8 g · kg−1 · d−1. These critically ill children were hypermetabolic, with REE 48% higher (20 kcal · kg−1 · d−1) than expected. Nitrogen balance significantly correlated with caloric and protein intake, urinary nitrogen, and age, but not with severity of illness scores or ventilatory parameters.