• Megan R Beggs, Allison Ashkin, LarsenBodil M KBMKNutrition Services, Alberta Health Services, Edmonton, AB, Canada.Pediatric Intensive Care Unit, Stollery Children's Hospital, Edmonton, AB, Canada.Department of Agricultural, Food and Nutritional Sciences, University of Alberta, Edmonto, and Daniel Garros.
• Nutrition Services, Alberta Health Services, Edmonton, AB, Canada.
• Pediatr Crit Care Me. 2023 Oct 1; 24 (10): e468e475e468-e475.

ObjectivesEnergy requirements following moderate or severe pediatric traumatic brain injury (TBI) have not been fully elucidated. Indirect calorimetry (IC) is the gold standard for measuring resting energy expenditure (MREE) in PICU. However, technical complexity limits its use. We aimed to determine whether MREE differs from standard of care energy estimation and delivery in a cohort of pediatric patients following moderate to severe TBI during PICU admission.DesignRetrospective case series study.SettingSingle-center, 16-bed general PICU in Canada between May 2011 and January 2019.PatientsChildren (0-18 yr) admitted to a PICU for moderate (Glasgow Coma Scale [GCS] 9-12) to severe TBI (GCS < 9) and had an IC study performed while mechanically ventilated.InterventionsNone.Measurements And Main ResultsDuring the study period, 245 patients were admitted with the diagnosis of trauma with TBI. The study includes a convenience sample of 26 patients with severe ( n = 23) and moderate ( n = 3) TBI who underwent a total of 34 IC measurements. MREE varied considerably from 29% to 144% of predicted energy expenditure. Using Bland-Altman comparative analysis, neither Schofield nor World Health Organization predictive equations were in agreement with MREE. Only one measurement revealed that the patient was appropriately fed (energy provided in nutrition support was within 10% of MREE); 10 (38%) measurements revealed overfeeding and 15 (58%) underfeeding at the time of testing.ConclusionsThe present study adds to the small body of literature highlighting the limitations of predictive equations to evaluate energy requirements following moderate to severe pediatric TBI. IC, when feasible, should be used as the preferred method to orient PICU teams to feed such vulnerable patients.Copyright © 2023 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.

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