• Alejandro A Floh, Masayuki Nakada, Gustavo La Rotta, Kandice Mah, Joann E Herridge, Glen Van Arsdell, and Steven M Schwartz.
• 1Labatt Family Heart Centre, Department of Critical Care Medicine, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada. 2Labatt Family Heart Centre, Division of Cardiology, Cardiac Critical Care, Physiology and Experimental Medicine, The Hospital for Sick Children, Toronto, ON, Canada. 3Labatt Family Heart Centre, Division of Cardiology, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada. 4Labatt Family Heart Centre, Division of Cardiovascular Surgery, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada.
• Pediatr Crit Care Me. 2015 May 1;16(4):343-51.

ObjectivesTo examine the association between cardiopulmonary bypass-related systemic inflammation and resting energy expenditure in pediatric subjects following cardiac surgery.DesignSingle-center, prospective cohort study.SettingPediatric cardiac critical care unit in Toronto, Canada.PatientsChildren with congenital heart disease undergoing cardiopulmonary bypass surgery.InterventionsResting energy expenditure was determined by indirect calorimetry and the modified Weir equation, using VO2 and VCO2 measured by in-line respiratory mass spectrometry. Measurements were taken at baseline and 6-hour intervals from separation from cardiopulmonary bypass for a maximum of 72 hours. Plasma interleukin-6, glucose delivery, feeding status, and cardiac output (calculated by Fick equation) were monitored at each resting energy expenditure measurement.Measurements And Main ResultsWe studied 111 subjects at a median (interquartile range) age of 5.3 months (0.8-10.5 mo), weighing 5.7 kg (3.9-8.1 kg), of whom 88% underwent biventricular repair. Resting energy expenditure decreased from 51 kcal/kg/d to 45 kcal/kg/d during the study period. Resting energy expenditure was positively associated with increased plasma interleukin-6 (estimate variable, 1.76; p = 0.001) and inversely associated with preoperative methylprednisolone use (estimate variable, -6.7; p = 0.003) even after accounting for other predictors. Increase in cardiac output was also associated (estimate variable, 13.7; p < 0.0001) with higher resting energy expenditure.ConclusionsResting energy expenditure ranges between 40 and 60 kcal/kg/d and decreases progressively in children following cardiopulmonary bypass surgery. It is directly associated with increased inflammation and higher cardiac output and inversely associated with anti-inflammatory strategies. Further studies are required to predict the appropriate caloric delivery in this cohort.

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