Aims & Objectives:
Background: There is controversy regarding nutrition goals in Traumatic Brain Injury (TBI). Indirect calorimetry (IC) is the gold standard to measure resting energy expenditure (MREE) in the PICU, however technical complexity limit its use therefore guidelines recommend the Schofield and WHO equations. There are metabolic consequences of both under- and over- feeding.
Aims: This retrospective study aimed to determine whether MREE differed from standard of care in a cohort of patients following TBI in PICU.
Methods: In a TBI population we analyzed the energy received and compared MREE to predicted, and then categorized patients as: 1) underfed (U), intake met <90% MREE; 2) overfed (O), intake met >110% MREE and 3) Appropriately (A) fed. Predictive equations for comparison were the Schofield and WHO methods. Repeated measures ANOVA was used to assess predicted versus MREE.
Results: Thirty IC tests (24 patients); 12 (TBI alone); 12 (multi-trauma); 16 were male, median (IQR) age in U was 14.2 (7.87) and O was 8.63 (12.83) years; 6 patients died; all but one child had GCS < to 9; Prism III median (IQR) were 7(14) and 11(16). IC were performed on day 2(2) and 4(2); for U (19 tests) and O (11 tests) groups respectively. Predicted energy requirements by both Schofield and WHO were significantly different from MREE (P < 0.05) but predicted energy requirements as 75% WHO were not (P = 0.47). One patient was appropriately fed.
Conclusion: During the acute phase of TBI, clinical practice and MREE do not match currently suggested guidelines.