54-Performance of Various Predictive Equations Compared to Indirect Calorimetry in Ventilated Children
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Pediatrics, GI and Nutrition, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Prithvi Raj Sendi Keshavamurthy

Introduction/Hypothesis: Energy expenditure (EE) is variable in critically ill children. This may lead to underfeeding or overfeeding with serious consequences. Predictive equations are commonly used to assess the nutritional needs of hospitalized children. There is a paucity of data regarding the performance of various predictive equations in critically ill children. Our objective was to evaluate the bias and precision of various predictive equations in estimating EE compared to indirect calorimetry (IC).

Methods: We retrospectively analyzed the performance of four predictive equations to estimate EE; WHO, Schofield, Resting Energy Expenditure by the Institute of Medicine (EER), EE calculation using VCO2 (EEVCO2) and compared them to EE calculated using IC (Ultima CCM indirect calorimeter, MGC Diagnostics) in 40 ventilated children in the intensive care unit. Agreement between two methods was tested by calculating the bias (mean difference) and precision (standard deviation of the bias) for predicted EE from each predictive equation compared to IC using Bland-Altman methodology. We used one-sample-t-testing to determine if bias was significantly different from zero. Linear regression analysis (difference vs mean of the two methods) was performed to evaluate for the presence of a proportional error (evaluates the performance across the range of the values). We used SPSS version 25 for analysis.

Results: Of the 40 ventilated children, 32 were endotracheally intubated, 8 had tracheostomies, 30 were male and 11 were on vasoactive medication. Based on BMI for age, 11 children were underweight, 19 normal weight, and 10 overweight or obese. The mean (+/- SD) age (years), weight (kg), height (m), BMI (kg/m2), VCO2 (ml/min), and IC (Kcal/day) were, 10.8±4.3, 34.6±15.7, 1.34±0.23, 18.6±4.8, 169±56, and 1248±355, respectively. The bias [%, p] (precision) was, Schofield -27 [2.2, p=0.4] (243), WHO -88 [7.3, p=0.049] (269), EEVCO2 151 [11.4, p<0.001] (246), and EER 306 [21.9, p<0.001] (265) Kcal compared to IC. Proportional errors were not present with Schofield and EER.

Conclusions: The Schofield equation compared most favorably across all BMI groups in predicting EE in critically ill ventilated children compared to indirect calorimetry. Studies with separate analyses in different BMI and age categories are needed.



Meta Tag
Content Type Presentation
Knowledge Area Pediatrics
Knowledge Area GI and Nutrition
Knowledge Level Advanced
Membership Level Select
Tag Calorimetry
Year 2021
predictive equations
indirect calorimetry
energy expenditure
ventilated children
Scofield equation


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