Vazquez Martinez Jose Luis, Martinez-Romillo Paloma Dorao, Diez Sebastian Jesus, Ruza Tarrio Francisco
Pediatric Intensive Care Unit, Hospital Ramón y Cajal, Madrid, Spain.
Pediatr Crit Care Med. 2004 Jan;5(1):19-27. doi: 10.1097/01.PCC.0000102224.98095.0A.
Compare the energy expenditure, predicted by anthropometric equations, with that measured by continuous on-line indirect calorimetry in ventilated, critically ill children during the early postinjury period.
Prospective, clinical study.
Pediatric intensive care unit of a pediatric university hospital.
A total of 43 ventilated, critically ill children during the first 6 hrs after injury.
An indirect calorimeter was used to continuously measure the energy expenditure for 24 hrs.
Clinical data collected were age, gender, actual and ideal weight, height, and body surface. Nutritional status was assessed by Waterlow and Shukla Index. Severity of illness was determined by Pediatric Risk of Mortality, Physiologic Stability Index, and Therapeutic Intervention Scoring System. Energy expenditure was measured (MEE) by continuous on-line indirect calorimetry for 24 hrs. Predicted Energy Expenditure (PEE) was calculated using the Harris-Benedict, Caldwell-Kennedy, Schofield, Food and Agriculture/World Health Organization/United Nation Union, Maffeis, Fleisch, Kleiber, Dreyer, and Hunter equations, using the actual and ideal weight. MEE and PEE were compared using paired Student's t-test, linear correlation (r), intraclass correlation coefficient (pI), and the Bland-Altman method. Mean MEE resulted in 674 +/- 384 kcal/day. Most of the predictive equations overestimated MEE in ventilated, critically ill children during the early postinjury period. MEE and PEE differed significantly (p<.05) except when the Caldwell-Kennedy and the Fleisch equations were used. r2 ranged from 0.78 to 0.81 (p<.05), and pI was excellent (>.75) for the Caldwell-Kennedy, Schofield, Food and Agriculture/World Health Organization/United Nation Union, Fleisch, and Kleiber equations. The Bland-Altman method showed poor accuracy; the Caldwell-Kennedy equation was the best predictor of energy expenditure (bias, 38 kcal/day; precision, +/- 179 kcal/day). The accuracy in the medical group was higher (pI range,.71-.94) than in surgical patients (pI range,.18-.75).
Predictive equations do not accurately predict energy expenditure in ventilated, critically ill children during the early postinjury period; if available, indirect calorimetry must be performed.
比较通过人体测量学方程预测的能量消耗与在受伤后早期接受通气治疗的危重症儿童中通过连续在线间接测热法测得的能量消耗。
前瞻性临床研究。
一所儿科大学医院的儿科重症监护病房。
共43名受伤后最初6小时内接受通气治疗的危重症儿童。
使用间接测热仪连续24小时测量能量消耗。
收集的临床数据包括年龄、性别、实际体重和理想体重、身高以及体表面积。通过沃特洛指数和舒克拉指数评估营养状况。通过儿科死亡风险、生理稳定性指数和治疗干预评分系统确定疾病严重程度。通过连续在线间接测热法测量24小时的能量消耗（MEE）。使用哈里斯-本尼迪克特方程、考德威尔-肯尼迪方程、斯科菲尔德方程、粮食及农业组织/世界卫生组织/联合国联合方程、马费伊斯方程、弗莱施方程、克莱伯方程、德雷尔方程和亨特方程，根据实际体重和理想体重计算预测能量消耗（PEE）。使用配对t检验、线性相关系数（r）、组内相关系数（pI）和布兰德-奥特曼方法比较MEE和PEE。平均MEE为674±384千卡/天。在受伤后早期，大多数预测方程高估了接受通气治疗的危重症儿童的MEE。除使用考德威尔-肯尼迪方程和弗莱施方程时外，MEE和PEE差异显著（p<0.05）。考德威尔-肯尼迪方程、斯科菲尔德方程、粮食及农业组织/世界卫生组织/联合国联合方程、弗莱施方程和克莱伯方程的r²范围为0.78至0.81（p<0.05），pI极佳（>0.75）。布兰德-奥特曼方法显示准确性较差；考德威尔-肯尼迪方程是能量消耗的最佳预测指标（偏差为38千卡/天；精密度为±179千卡/天）。医疗组的准确性（pI范围为0.71 - 0.94）高于外科患者（pI范围为0.18 - 0.75）。
预测方程不能准确预测受伤后早期接受通气治疗的危重症儿童的能量消耗；如有条件，必须进行间接测热法。
