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Singer P, Robinson E, Hellerman-Itzhaki M. Nutrition during noninvasive respiratory support. Curr Opin Crit Care 2024; 30:311-316. [PMID: 38841984 DOI: 10.1097/mcc.0000000000001171] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024]
Abstract
PURPOSE OF REVIEW The use of noninvasive techniques [noninvasive ventilation (NIV) or high flow nasal cannula (HFNC) oxygen therapy] to support oxygenation and/or ventilation in patients with respiratory failure has become widespread, even more so since the coronavirus disease 2019 pandemic. The use of these modalities may impair the patient's ability to eat. "To breath or to eat" may become a dilemma. In this review, we identify the patients at risk of malnutrition that require medical nutritional therapy and understand the mechanisms of function of the devices to better give adapted nutritional indications for noninvasive ventilation or high flow nasal cannula. RECENT FINDINGS The Global Leadership Initiative for Malnutrition has been validated in the Intensive Care setting and can be used in patients requiring NIV. Many patients are underfed when receiving noninvasive ventilation therapies. HFNC may impair the swallowing ability and increase dysphagia while NIV may improve the swallowing reflexes. New technology preventing reflux and ensuring enteral feeding efficacy may increase the medical nutrition therapy safety and provide near-target energy and protein provision. SUMMARY The patient requiring noninvasive ventilation presents one of the most challenging nutritional challenges. The main steps to improve nutrition administration are to assess nutritional status, evaluate the presence of dysphagia, choose the most adequate tool of respiratory support, and adapt nutritional therapy (oral, enteral, or parenteral) accordingly.
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Affiliation(s)
- Pierre Singer
- Herzlia Medical Center, Intensive Care Unit, Herzlia
- Critical Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Eyal Robinson
- Critical Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Moran Hellerman-Itzhaki
- Critical Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
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2
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D’Oria V, Spolidoro GCI, Agostoni CV, Montani C, Ughi L, Villa C, Marchesi T, Babini G, Scalia Catenacci S, Donà G, Guerrini M, Chidini G, Calderini E, Langer T. Validation of Indirect Calorimetry in Children Undergoing Single-Limb Non-Invasive Ventilation: A Proof of Concept, Cross-Over Study. Nutrients 2024; 16:230. [PMID: 38257123 PMCID: PMC10818402 DOI: 10.3390/nu16020230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 12/28/2023] [Accepted: 01/05/2024] [Indexed: 01/24/2024] Open
Abstract
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 < 6 years weaning from NIV were enrolled. IC was performed during spontaneous breathing (SB), NIV-CPAP, and NIV-PS in each patient. A Bland-Altman analysis was employed to compare REE, VO2, 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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Affiliation(s)
- Veronica D’Oria
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | | | - Carlo Virginio Agostoni
- Department of Clinical Sciences and Community Health, University of Milan, 20122 Milan, Italy;
- Pediatric Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Cinzia Montani
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Ludovica Ughi
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Cristina Villa
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.V.); (G.B.)
| | - Tiziana Marchesi
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Giovanni Babini
- Department of Anesthesiology, Intensive Care and Emergency, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (C.V.); (G.B.)
| | - Stefano Scalia Catenacci
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Giada Donà
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Marta Guerrini
- Department of Healthcare Professions, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
| | - Giovanna Chidini
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Edoardo Calderini
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
| | - Thomas Langer
- Pediatric Intensive Care Unit, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy; (V.D.); (C.M.); (L.U.); (T.M.); (S.S.C.); (G.D.); (G.C.); (E.C.); (T.L.)
- School of Medicine and Surgery, University of Milan-Bicocca, 20900 Monza, Italy
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Nagy D, Trunic N, Prémusz V, Krutek L, Lipcsik Z, Ács P. Comparison of Metabolic Characteristics of Physically Active Individuals with Different Training Habits during Incremental Treadmill Test. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:70. [PMID: 36612397 PMCID: PMC9819085 DOI: 10.3390/ijerph20010070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/14/2022] [Accepted: 12/19/2022] [Indexed: 06/17/2023]
Abstract
The number of people engaging in self-conducted regular physical activity is increasing, but the effects of home fitness and individually planned workouts on health and metabolism are unknown. We aimed to examine the effects of regular training conducted without the supervision of professionals on exercise metabolism in our cross-sectional observational study. Forty-five physically active volunteers, classified into three groups, based on the type and frequency of their training (group 1 frequent long-term endurance, group 2 three times per week aerobic training, and group 3 two times per week short aerobic and resistance training), fulfilled a vita maxima incremental treadmill test. Aerobic capacity (VO2max), MET (metabolic equivalent of task), and metabolic responses were examined. The results were evaluated by ANOVA and Bonferroni and Scheffe multiple comparison analysis using Microsoft Excel and SPSS 23 programs. (p < 0.05). Significant differences were found between group 1 and 3 in VO2max (p = 0.46) and MET (p = 0.46) between group 1 and 2, in FatmaxHR (heart rate on maximum fat oxidation) (p= 0.04). We concluded self-conducted regular physical activity has positive effects on metabolism and health. Aerobic training performed four times per week showed the most beneficial effects on metabolism and health maintenance. In addition, based on our findings, strength training performed two times per week is recommended.
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Affiliation(s)
- Dóra Nagy
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7624 Pécs, Hungary
- Institute of Physiotherapy and Sport Science, Faculty of Health Sciences, University of Pécs, 7624 Pécs, Hungary
- Physical Activity Research Group, Szentágothai Research Centre, 7624 Pécs, Hungary
| | - Nenad Trunic
- Faculty of Physical Culture and Management in Sports, University Singidunum, 11000 Belgrade, Serbia
| | - Viktória Prémusz
- Institute of Physiotherapy and Sport Science, Faculty of Health Sciences, University of Pécs, 7624 Pécs, Hungary
- Physical Activity Research Group, Szentágothai Research Centre, 7624 Pécs, Hungary
| | - László Krutek
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, 7624 Pécs, Hungary
| | | | - Pongrác Ács
- Institute of Physiotherapy and Sport Science, Faculty of Health Sciences, University of Pécs, 7624 Pécs, Hungary
- Physical Activity Research Group, Szentágothai Research Centre, 7624 Pécs, Hungary
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Viner Smith E, Ridley EJ, Rayner CK, Chapple LAS. Nutrition Management for Critically Ill Adult Patients Requiring Non-Invasive Ventilation: A Scoping Review. Nutrients 2022; 14:1446. [PMID: 35406058 PMCID: PMC9003108 DOI: 10.3390/nu14071446] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/18/2022] [Accepted: 03/22/2022] [Indexed: 12/13/2022] Open
Abstract
Nutrition management is a core component of intensive care medicine. Despite the increased use of non-invasive ventilation (NIV) for the critically ill, a paucity of evidence on nutrition management precludes recommendations for clinical practice. A scope of the available literature is required to guide future research on this topic. Database searches of MEDLINE, Embase, Scopus, Web of Science, and Google Scholar were conducted to identify original research articles and available grey literature in English from 1 January 1990 to 17 November 2021 that included adult patients (≥16 years) receiving NIV within an Intensive Care Unit. Data were extracted on: study design, aim, population, nutrition concept, context (ICU type, NIV: use, duration, interface), and outcomes. Of 1730 articles, 16 met eligibility criteria. Articles primarily included single-centre, prospective, observational studies with only 3 randomised controlled trials. Key concepts included route of nutrition (n = 7), nutrition intake (n = 4), energy expenditure (n = 2), nutrition status (n = 1), and nutrition screening (n = 1); 1 unpublished thesis incorporated multiple concepts. Few randomised clinical trials that quantify aspects of nutrition management for critically ill patients requiring NIV have been conducted. Further studies, particularly those focusing on the impact of nutrition during NIV on clinical outcomes, are required to inform clinical practice.
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Affiliation(s)
- Elizabeth Viner Smith
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia; (C.K.R.); (L.S.C)
- Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Emma J. Ridley
- Australian and New Zealand Intensive Care Research Centre, Monash University, Melbourne, VIC 3004, Australia;
- Nutrition Department, Alfred Health, Melbourne, VIC 3004, Australia
| | - Christopher K. Rayner
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia; (C.K.R.); (L.S.C)
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5005, Australia
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
| | - Lee-anne S. Chapple
- Adelaide Medical School, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, SA 5005, Australia; (C.K.R.); (L.S.C)
- Intensive Care Research Unit, Royal Adelaide Hospital, Adelaide, SA 5000, Australia
- Centre of Research Excellence in Translating Nutritional Science to Good Health, The University of Adelaide, Adelaide, SA 5005, Australia
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Moonen HPFX, Beckers KJH, van Zanten ARH. Energy expenditure and indirect calorimetry in critical illness and convalescence: current evidence and practical considerations. J Intensive Care 2021; 9:8. [PMID: 33436084 PMCID: PMC7801790 DOI: 10.1186/s40560-021-00524-0] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 01/02/2021] [Indexed: 12/11/2022] Open
Abstract
The use of indirect calorimetry is strongly recommended to guide nutrition therapy in critically ill patients, preventing the detrimental effects of under- and overfeeding. However, the course of energy expenditure is complex, and clinical studies on indirect calorimetry during critical illness and convalescence are scarce. Energy expenditure is influenced by many individual and iatrogenic factors and different metabolic phases of critical illness and convalescence. In the first days, energy production from endogenous sources appears to be increased due to a catabolic state and is likely near-sufficient to meet energy requirements. Full nutrition support in this phase may lead to overfeeding as exogenous nutrition cannot abolish this endogenous energy production, and mitochondria are unable to process the excess substrate. However, energy expenditure is reported to increase hereafter and is still shown to be elevated 3 weeks after ICU admission, when endogenous energy production is reduced, and exogenous nutrition support is indispensable. Indirect calorimetry is the gold standard for bedside calculation of energy expenditure. However, the superiority of IC-guided nutritional therapy has not yet been unequivocally proven in clinical trials and many practical aspects and pitfalls should be taken into account when measuring energy expenditure in critically ill patients. Furthermore, the contribution of endogenously produced energy cannot be measured. Nevertheless, routine use of indirect calorimetry to aid personalized nutrition has strong potential to improve nutritional status and consequently, the long-term outcome of critically ill patients.
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Affiliation(s)
| | | | - Arthur Raymond Hubert van Zanten
- Department of Intensive Care Medicine, Gelderse Vallei Hospital, Willy Brandtlaan 10, 6716, RP, Ede, The Netherlands.
- Division of Human Nutrition and Health, Wageningen University & Research, HELIX (Building 124), Stippeneng 4, 6708, WE, Wageningen, The Netherlands.
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Bertoli S, De Amicis R, Bedogni G, Foppiani A, Leone A, Ravella S, Mastella C, Baranello G, Masson R, Bertini E, D'Amico A, Pedemonte M, Bruno C, Agosto C, Giaquinto E, Bassano M, Battezzati A. Predictive energy equations for spinal muscular atrophy type I children. Am J Clin Nutr 2020; 111:983-996. [PMID: 32145012 DOI: 10.1093/ajcn/nqaa009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Accepted: 01/21/2020] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Knowledge on resting energy expenditure (REE) in spinal muscular atrophy type I (SMAI) is still limited. The lack of a population-specific REE equation has led to poor nutritional support and impairment of nutritional status. OBJECTIVE To identify the best predictors of measured REE (mREE) among simple bedside parameters, to include these predictors in population-specific equations, and to compare such models with the common predictive equations. METHODS Demographic, clinical, anthropometric, and treatment variables were examined as potential predictors of mREE by indirect calorimetry (IC) in 122 SMAI children consecutively enrolled in an ongoing longitudinal observational study. Parameters predicting REE were identified, and prespecified linear regression models adjusted for nusinersen treatment (discrete: 0 = no; 1 = yes) were used to develop predictive equations, separately in spontaneously breathing and mechanically ventilated patients. RESULTS In naïve patients, the median (25th, 75th percentile) mREE was 480 (412, 575) compared with 394 (281, 554) kcal/d in spontaneously breathing and mechanically ventilated patients, respectively (P = 0.009).In nusinersen-treated patients, the median (25th, 75th percentile) mREE was 609 (592, 702) compared with 639 (479, 723) kcal/d in spontaneously breathing and mechanically ventilated patients, respectively (P = 0.949).Both in spontaneously breathing and mechanically ventilated patients, the best prediction of REE was obtained from 3 models, all using as predictors: 1 body size related measurement and nusinersen treatment status. Nusinersen treatment was correlated with higher REE both in spontaneously breathing and mechanically ventilated patients. The population-specific equations showed a lower interindividual variability of the bias than the other equation tested, however, they showed a high root mean squared error. CONCLUSIONS We demonstrated that ventilatory status, nusinersen treatment, demographic, and anthropometric characteristics determine energy requirements in SMAI. Our SMAI-specific equations include variables available in clinical practice and were generally more accurate than previously published equations. At the individual level, however, IC is strongly recommended for assessing energy requirements. Further research is needed to externally validate these predictive equations.
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Affiliation(s)
- Simona Bertoli
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy.,Department of Endocrine and Metabolic Diseases, Obesity Unit and Laboratory of Nutrition and Obesity Research, IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare) Italian Auxologic Institute (IAI), Milan, Italy
| | - Ramona De Amicis
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Giorgio Bedogni
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Andrea Foppiani
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Alessandro Leone
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Simone Ravella
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
| | - Chiara Mastella
- SAPRE (Early Habilitation Service), Child and Adolescent Neuropsychiatric Unit, IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare) Ospedale Maggiore Policlinico Cà Granda Foundation, Milan, Italy
| | - Giovanni Baranello
- GOSH-UCL NIHR (Great Ormond Street Hospital, University College of London, National Institute for Health Research) Biomedical Research Centre, The Dubowitz Neuromuscular Centre, Great Ormond Street Institute of Child Health, London, United Kingdom.,Developmental Neurology Unit, IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare) Neurological Institute Carlo Besta Foundation, Milan, Italy
| | - Riccardo Masson
- Developmental Neurology Unit, IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare) Neurological Institute Carlo Besta Foundation, Milan, Italy
| | - Enrico Bertini
- Department of Neurosciences, Neuromuscular and Neurodegenerative Disorders Unit, Laboratory of Molecular Medicine, IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare) Bambino Gesù Children's Research Hospital, Rome Italy
| | - Adele D'Amico
- Department of Neurosciences, Neuromuscular and Neurodegenerative Disorders Unit, Laboratory of Molecular Medicine, IRCCS (Scientific Institute for Research, Hospitalization, and Healthcare) Bambino Gesù Children's Research Hospital, Rome Italy
| | - Marina Pedemonte
- Italian Department of Neurosciences and Rehabilitation, Institute "G. Gaslini," Genoa, Italy
| | - Claudio Bruno
- Italian Department of Neurosciences and Rehabilitation, Institute "G. Gaslini," Genoa, Italy
| | - Caterina Agosto
- Department of Women's and Children's Health, University of Padua, Padua, Italy
| | - Ester Giaquinto
- M. Bufalini Hospital, Dietetic and Nutrition Unit, Cesena, Italy
| | - Michela Bassano
- M. Bufalini Hospital, Dietetic and Nutrition Unit, Cesena, Italy
| | - Alberto Battezzati
- International Center for the Assessment of Nutritional Status (ICANS), Department of Food Environmental and Nutritional Sciences (DeFENS), University of Milan, Milan, Italy
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Rogobete AF, Grintescu IM, Bratu T, Bedreag OH, Papurica M, Crainiceanu ZP, Popovici SE, Sandesc D. Assessment of Metabolic and Nutritional Imbalance in Mechanically Ventilated Multiple Trauma Patients: From Molecular to Clinical Outcomes. Diagnostics (Basel) 2019; 9:diagnostics9040171. [PMID: 31683927 PMCID: PMC6963656 DOI: 10.3390/diagnostics9040171] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 10/25/2019] [Accepted: 10/31/2019] [Indexed: 12/26/2022] Open
Abstract
The critically ill polytrauma patient is characterized by a series of metabolic changes induced by inflammation, oxidative stress, sepsis, and primary trauma, as well as associated secondary injuries associated. Metabolic and nutritional dysfunction in the critically ill patient is a complex series of imbalances of biochemical and genetic pathways, as well as the interconnection between them. Therefore, the equation changes in comparison to other critical patients or to healthy individuals, in which cases, mathematical equations can be successfully used to predict the energy requirements. Recent studies have shown that indirect calorimetry is one of the most accurate methods for determining the energy requirements in intubated and mechanically ventilated patients. Current research is oriented towards an individualized therapy depending on the energy consumption (kcal/day) of each patient that also takes into account the clinical dynamics. By using indirect calorimetry, one can measure, in real time, both oxygen consumption and carbon dioxide production. Energy requirements (kcal/day) and the respiratory quotient (RQ) can be determined in real time by integrating these dynamic parameters into electronic algorithms. In this manner, nutritional therapy becomes personalized and caters to the patients’ individual needs, helping patients receive the energy substrates they need at each clinically specific time of treatment.
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Affiliation(s)
- Alexandru Florin Rogobete
- Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital "Pius Brinzeu",300041 Timisoara 300723, Romania.
| | - Ioana Marina Grintescu
- Faculty of Medicine, "Carol Davila" University of Medicine and Pharmacy, 020021 Bucharest, Romania.
| | - Tiberiu Bratu
- Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
| | - Ovidiu Horea Bedreag
- Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital "Pius Brinzeu",300041 Timisoara 300723, Romania.
| | - Marius Papurica
- Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital "Pius Brinzeu",300041 Timisoara 300723, Romania.
| | | | - Sonia Elena Popovici
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital "Pius Brinzeu",300041 Timisoara 300723, Romania.
| | - Dorel Sandesc
- Faculty of Medicine, "Victor Babes" University of Medicine and Pharmacy, 300041 Timisoara, Romania.
- Clinic of Anaesthesia and Intensive Care, Emergency County Hospital "Pius Brinzeu",300041 Timisoara 300723, Romania.
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8
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Singer P, Rattanachaiwong S. To eat or to breathe? The answer is both! Nutritional management during noninvasive ventilation. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2018; 22:27. [PMID: 29409542 PMCID: PMC5801680 DOI: 10.1186/s13054-018-1947-7] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/28/2017] [Accepted: 01/09/2018] [Indexed: 01/04/2023]
Abstract
Treating respiratory distress is a priority when managing critically ill patients. Non-invasive ventilation (NIV) is increasingly used as a tool to prevent endotracheal intubation. Providing oral or enteral nutritional support during NIV may be perceived as unsafe because of the possible risk of aspiration so that these patients are frequently denied adequate caloric and protein intake. Newly available therapies, such as high-flow nasal oxygen (HFNO) may allow for more appropriate oral feeding.
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Affiliation(s)
- Pierre Singer
- Department of General Intensive Care and Institute for Nutrition Research, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Jabotinski St, Petah Tiqwa, 49100, Israel.
| | - Sornwichate Rattanachaiwong
- Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand
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9
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Do PICU patients meet technical criteria for performing indirect calorimetry? Clin Nutr ESPEN 2016; 15:80-84. [PMID: 28531789 DOI: 10.1016/j.clnesp.2016.06.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Revised: 06/01/2016] [Accepted: 06/13/2016] [Indexed: 11/21/2022]
Abstract
BACKGROUND & AIMS Indirect calorimetry (IC) is considered gold standard for assessing energy needs of critically ill children as predictive equations and clinical status indicators are often unreliable. Accurate assessment of energy requirements in this vulnerable population is essential given the high risk of over or underfeeding and the consequences thereof. The proportion of patients and patient days in pediatric intensive care (PICU) for which energy expenditure (EE) can be measured using IC is currently unknown. In the current study, we aimed to quantify the daily proportion of consecutive PICU patients who met technical criteria to perform indirect calorimetry and describe the technical contraindications when criteria were not met. METHODS Prospective, observational, single-centre study conducted in a cardiac and general PICU. All consecutive patients admitted for at least 96 h were included in the study. Variables collected for each patient included age at admission, admission diagnosis, and if technical criteria for indirect calorimetry were met. Technical criteria variables were collected within the same 2 h each morning and include: provision of supplemental oxygen, ventilator settings, endotracheal tube (ETT) leak, diagnosis of chest tube air leak, provision of external gas support (i.e. nitric oxide), and provision of extracorporeal membrane oxygenation (ECMO). RESULTS 288 patients were included for a total of 3590 patient days between June 2014 and February 2015. The main reasons for admission were: surgery (cardiac and non-cardiac), respiratory distress, trauma, oncology and medicine/other. The median (interquartile range) patient age was 0.7 (0.3-4.6) years. The median length of PICU stay was 7 (5-14) days. Only 34% (95% CI, 32.4-35.5%) of patient days met technical criteria for IC. For patients less than 6 months of age, technical criteria were met on significantly fewer patient days (29%, p < 0.01). Moreover, 27% of patients did not meet technical criteria for IC on any day during their PICU stay. Most frequent reasons for why IC could not be performed included supplemental oxygen, ECMO, and ETT leak. CONCLUSIONS In the current study, technical criteria to perform IC in the PICU were not met for 27% of patients and were not met on 66% of patient days. Moreover, criteria were met on only 29% of days for infants 6 months and younger where children 24 months of age and older still only met criteria on 40% of patient days. This data represents a major gap in the feasibility of current recommendations for assessing energy requirements of this population. Future studies are needed to improve methods of predicting and measuring energy requirements in critically ill children who do not meet current criteria for indirect calorimetry.
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Singer P, Singer J. Clinical Guide for the Use of Metabolic Carts: Indirect Calorimetry--No Longer the Orphan of Energy Estimation. Nutr Clin Pract 2015; 31:30-8. [PMID: 26703959 DOI: 10.1177/0884533615622536] [Citation(s) in RCA: 40] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Critically ill patients often require nutrition support, but accurately determining energy needs in these patients is difficult. Energy expenditure is affected by patient characteristics such as weight, height, age, and sex but is also influenced by factors such as body temperature, nutrition support, sepsis, sedation, and therapies. Using predictive equations to estimate energy needs is known to be inaccurate. Therefore, indirect calorimetry measurement is considered the gold standard to evaluate energy needs in clinical practice. This review defines the indications, limitations, and pitfalls of this technique and gives practice suggestions in various clinical situations.
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Affiliation(s)
- Pierre Singer
- General Intensive Care Department and Institute for Nutrition Research, Rabin Medical Center, Beilinson Hospital, Petah Tikva, Israel
| | - Joelle Singer
- Endocrinonlogy Institute, Diabetes Services, Sackler School of Medicine, Tel Aviv University, Israel
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Prentice RL, Neuhouser ML, Tinker LF, Pettinger M, Thomson CA, Mossavar-Rahmani Y, Thomas F, Qi L, Huang Y. An exploratory study of respiratory quotient calibration and association with postmenopausal breast cancer. Cancer Epidemiol Biomarkers Prev 2013; 22:2374-83. [PMID: 24108790 PMCID: PMC3864792 DOI: 10.1158/1055-9965.epi-13-0511] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The respiratory quotient (RQ), defined as the ratio of carbon dioxide exhaled to oxygen uptake, reflects substrate utilization when energy is expended. Fat and alcohol have RQ values of approximately 0.7, compared with 1.0 for carbohydrate, and approximately 0.8 for protein. Here, the association between RQ and postmenopausal breast cancer risk is studied. METHODS Paired RQ measurements were obtained, separated by approximately 6 months, for women in the reliability subset of a Women's Health Initiative (WHI) Nutrition and Physical Activity Assessment Study. Linear regression of the average of the paired log RQ assessments on a corresponding log food quotient (FQ) average and other study subject characteristics, including age, body mass index, race, and education, yielded calibration equations for predicting RQ. RESULTS Calibration equations, using any of food frequency, food record, or dietary recall data, explained an appreciable fraction of measured log RQ variation, and these were used to compute calibrated RQ estimates throughout WHI cohorts. Calibrated RQ estimates using 4-day food record (4DFR) data related inversely (P = 0.004) to (invasive) breast cancer risk in the WHI Dietary Modification trial comparison group, and corresponding RQ estimates using food-frequency data related inversely (P = 0.002) to breast cancer incidence in this cohort combined with the larger WHI observational study. CONCLUSION Although preliminary, these analyses suggest a substantially higher postmenopausal breast cancer risk among women having relatively low RQ. IMPACT RQ elevation could provide a novel target for breast cancer risk reduction.
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Affiliation(s)
- Ross L. Prentice
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Marian L. Neuhouser
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Lesley F. Tinker
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Mary Pettinger
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
| | - Cynthia A. Thomson
- Division of Health Promotion Sciences, Zuckerman College of Public Health, University of Arizona, Tucson, AZ
| | - Yasmin Mossavar-Rahmani
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY
| | - Fridtjof Thomas
- Department of Preventive Medicine, University of Tennessee Health Sciences Center, Memphis, TN
| | - Lihong Qi
- Department of Public Health Sciences, University of California, Davis, CA
| | - Ying Huang
- Division of Public Health Sciences, Fred Hutchinson Cancer Research Center, Seattle, WA
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Fraipont V, Preiser JC. Energy estimation and measurement in critically ill patients. JPEN J Parenter Enteral Nutr 2013; 37:705-13. [PMID: 24113283 DOI: 10.1177/0148607113505868] [Citation(s) in RCA: 90] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
The estimation of caloric needs of critically ill patients is usually based on energy expenditure (EE), while current recommendations for caloric intake most often rely on a fixed amount of calories. In fact, during the early phase of critical illness, caloric needs are probably lower than EE, as a substantial proportion of EE is covered by the non-inhibitable endogenous glucose production. Hence, the risk of overfeeding is higher during the early phase than the late phase, while the risk of underfeeding is higher during the late phase of critical illness. Therefore, an accurate measurement of EE can be helpful to prevent early overfeeding and late underfeeding. Available techniques to assess EE include predictive equations, calorimetry, and doubly labeled water, the reference method. The available predictive equations are often inaccurate, while indirect calorimetry is difficult to perform for several reasons, including a shortage of reliable devices and technical limitations. In this review, the authors intend to discuss the different techniques and the influence of the method used on the interpretation of the results of clinical studies.
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Smallwood CD, Mehta NM. Accuracy of Gas Exchange Monitoring During Noninvasive Ventilation. JPEN J Parenter Enteral Nutr 2013; 38:86-91. [DOI: 10.1177/0148607113483179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
| | - Nilesh M. Mehta
- Division of Critical Care Medicine, Department of Anesthesiology, Perioperative and Pain Medicine at Children’s Hospital
- Harvard Medical School, Boston, MA
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Response to Value of indirect calorimetry in non-invasive ventilation. J Clin Monit Comput 2013. [DOI: 10.1007/s10877-012-9406-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Indirect calorimetry during non invasive mechanical ventilation. Is the next step for gas exchange monitoring? J Clin Monit Comput 2012; 27:99-100. [DOI: 10.1007/s10877-012-9396-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Accepted: 09/01/2012] [Indexed: 10/27/2022]
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