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Challenge of predicting resting energy expenditure in children undergoing surgery for congenital heart disease

De Wit, Barbera MSc; Meyer, Rosan PhD; Desai, Ajay MD, MRCP; Macrae, Duncan FRCA, FRCP; Pathan, Nazima MRCPCH, PhD

Pediatric Critical Care Medicine: July 2010 - Volume 11 - Issue 4 - p 496-501
doi: 10.1097/PCC.0b013e3181ce7465
Cardiac Intensive Care

Objectives: To determine pre- and postoperative predictors of energy expenditure in children with congenital heart disease requiring open heart surgery; and to compare measured resting energy expenditure with current predictive equations.

Design: Prospective resting energy expenditure data were collected, using indirect calorimetry, for ventilated children admitted consecutively to the pediatric intensive care unit after surgery for congenital heart disease. A 30-min steady-state measurement was performed in suitable patients. Resting energy expenditure was compared to pre- and postoperative clinical variables, and to predicted energy expenditure, using currently used predictive equations.

Setting: Pediatric intensive care unit at the Royal Brompton Hospital, London.

Patients: Children ventilated in the pediatric intensive care unit post surgery for congenital heart disease.

Interventions: Measurement of energy expenditure by indirect calorimetry.

Measurements and Main Results: Twenty-one mechanically ventilated children (n = 17 boys, 4 girls) were enrolled in the study. Mean ± sd measured resting energy expenditure was 67.8 ± 15.4 kcal/kg/day. Most children had inadequate delivery of nutrients compared with actual requirements. Cardiopulmonary bypass had a significant influence on energy expenditure after surgery; in patients who underwent cardiopulmonary bypass during surgery, mean resting energy expenditure was 73.6 ± 14.45 kcal/kg/day vs. 58.3 ± 10.29 kcal/kg/day in patients undergoing nonbypass surgery. Children who were malnourished preoperatively had greater resting energy expenditure postoperatively. There was also a significant difference between measured energy expenditure and the Schofield (p = .006), World Health Organization (p = .002), and pediatric intensive care unit-specific formula (p < .0001). However, energy expenditure or a relative energy deficit in the early postoperative period was not associated with severity or duration of organ dysfunction.

Conclusions: Poor nutritional status preoperatively and cardiopulmonary bypass were associated with a greater energy expenditure post cardiac surgery. None of the current predictive equations predicted energy requirements within acceptable clinical accuracy.

From the Paediatric Intensive Care Unit (BDW, AD, DM, NP), The Royal Brompton Hospital, London, UK; Department of Paediatrics (BDW), Erasmus University Rotterdam, Erasmus Medical College, Sophia Children's Hospital, Rotterdam, Netherlands; and the Departments of Paediatrics and Cardiac Medicine (RM, NP), Imperial College London, London, UK.

Ms. De Wit and Ms. Meyer contributed equally to this work.

Research was performed in the Paediatric Intensive Care Unit, The Royal Brompton Hospital, London, UK.

The authors have not disclosed any potential conflicts of interest.

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©2010The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies