Verhoeven J J, Hazelzet J A, van der Voort E, Joosten K F
Department of Pediatrics, Sophia Children's Hospital, University Hospital Rotterdam, The Netherlands.
Intensive Care Med. 1998 May;24(5):464-8. doi: 10.1007/s001340050597.
To determine the energy requirements in mechanically ventilated pediatric patients using indirect calorimetry and to compare the results with the predicted metabolic rate.
In 50 mechanically ventilated children with a moderate severity of illness, energy expenditure was measured by indirect calorimetry. Daily caloric intake was recorded for all patients. Total urinary nitrogen excretion was determined in 31 patients.
Although there was a close correlation between the measured total energy expenditure (mTEE) and the predicted basal metabolic rate (pBMR) (r = 0.93, p < 0.001), Bland-Altman analysis showed lack of agreement between individual mTEE and pBMR values. The ratio of caloric intake/mTEE was significantly higher in the patients with a positive nitrogen balance (1.4 +/- 0.07) compared with those with a negative nitrogen balance (0.8 +/- 0.1; p < 0.001).
Standard prediction equations are not appropriate to calculate the energy needs of critically ill, mechanically ventilated children. Individual measurements of energy expenditure and respiratory quotient by means of indirect calorimetry in combination with nitrogen balance are necessary for matching adequate nutritional support.
采用间接测热法测定机械通气儿科患者的能量需求，并将结果与预测的代谢率进行比较。
对50例病情中度严重的机械通气儿童，采用间接测热法测量能量消耗。记录所有患者的每日热量摄入。测定31例患者的尿氮总排泄量。
尽管测得的总能量消耗（mTEE）与预测的基础代谢率（pBMR）之间存在密切相关性（r = 0.93，p < 0.001），但Bland-Altman分析显示个体mTEE和pBMR值之间不一致。氮平衡为正的患者热量摄入/mTEE比值（1.4±0.07）显著高于氮平衡为负的患者（0.8±0.1；p < 0.001）。
标准预测方程不适用于计算重症机械通气儿童的能量需求。通过间接测热法结合氮平衡对能量消耗和呼吸商进行个体测量，对于匹配适当的营养支持是必要的。
