nach oben

Erschienen in:

01.09.2004 | Neonatal and Pediatric Intensive Care

Nutritional support in 111 pediatric intensive care units: a European survey

verfasst von: Martijn van der Kuip, Michiel J. S. Oosterveld, Marian A. E. van Bokhorst–de van der Schueren, K. de Meer, Harry N. Lafeber, Reinoud J. B. J. Gemke

Erschienen in: Intensive Care Medicine | Ausgabe 9/2004

Einloggen, um Zugang zu erhalten

Abstract

Objective

To study current strategies in nutritional management of pediatric intensive care units (PICUs) in Europe, focusing on energy requirements.

Design and setting

Survey by a 35-item questionnaire sent to representatives of 242 PICUs in 28 countries. Addresses were obtained from national PICU associations and the members’ list of the European Society of Pediatric and Neonatal Intensive Care.

Participants

Staff members of 111 European PICUs (46%) from 24 countries.

Measurements and results

Predominantly physicians were reported to be responsible for nutritional support. In 73% of PICUs a multidisciplinary nutritional team was available. In most PICUs daily energy requirements were estimated using weight, age, predictive equations and correction factors. In 17% of PICUs energy expenditure was regularly measured by indirect calorimetry. Nutritional status was mostly assessed by weight, physical examination, and a wide range of biochemical blood parameters. Approximately 70% of PICUs used dedicated software for nutritional support. A similar percentage of PICUs regarded “nutrition” as a research topic and part of the residents’ training program.

Conclusions

Most European PICUs regard nutritional support as an important aspect of patient care, as shown by the presence of nutritional teams, software, research, and education. However, energy requirements of pediatric intensive care patient were based predominantly on estimations rather than on measurements.

Pollack MM, Wiley JS, Holbrook PR (1981) Early nutritional depletion in critically ill children. Crit Care Med 9:580–583PubMed

Coss-Bu JA, Jefferson LS, Walding D, David Y, Smith EO, Klish WJ (1998) Resting energy expenditure in children in a pediatric intensive care unit: comparison of Harris-Benedict and Talbot predictions with indirect calorimetry values. Am J Clin Nutr 67:74–80PubMed

Briassoulis G, Zavras N, Hatzis T (2001) Malnutrition, nutritional indices, and early enteral feeding in critically ill children. Nutrition 17:548–557CrossRefPubMed

Taylor RM, Preedy VR, Baker AJ, Grimble G (2003) Nutritional support in critically ill children. Clin Nutr 22:365–369CrossRefPubMed

Pollack MM, Ruttimann UE, Wiley JS (1985) Nutritional depletions in critically ill children: associations with physiologic instability and increased quantity of care. JPEN J Parenter Enteral Nutr 9:309–313PubMed

van Bokhorst-de van der Schueren MA, van Leeuwen PA, Kuik DJ, Klop WM, Sauerwein HP, Snow GB, Quak JJ (1999) The impact of nutritional status on the prognoses of patients with advanced head and neck cancer. Cancer 86:519–527CrossRefPubMed

Border JR, Hassett J, LaDuca J, Seibel R, Steinberg S, Mills B, Losi P, Border D (1987) The gut origin septic states in blunt multiple trauma (ISS=40) in the ICU. Ann Surg 206:427–448PubMed

Chwals WJ (1994) Overfeeding the critically ill child: fact or fantasy? New Horiz 2:147–155PubMed

Verhoeven JJ, Hazelzet JA, van der Voort E, Joosten KF (1998) Comparison of measured and predicted energy expenditure in mechanically ventilated children. Intensive Care Med 24:464–468PubMed

10.

Taylor RM, Cheeseman P, Preedy V, Baker AJ, Grimble G (2003) Can energy expenditure be predicted in critically ill children? Pediatr Crit Care Med 4:176–180CrossRefPubMed

11.

Vazquez Martinez JL, Martinez-Romillo PD, Diez SJ, Ruza TF (2004) Predicted versus measured energy expenditure by continuous, online indirect calorimetry in ventilated, critically ill children during the early postinjury period. Pediatr Crit Care Med 5:19–27CrossRefPubMed

12.

Seashore JH (1984) Nutritional support of children in the intensive care unit. Yale J Biol Med 57:111–134PubMed

13.

Schofield WN (1985) Predicting basal metabolic rate, new standards and review of previous work. Hum Nutr Clin Nutr 39 [Suppl 1]:5–41

14.

Fleisch A (1951) Le metabolisme basal standard et se determination au moyen du “Metabocalculator.” Helv Med Acta 23–45

15.

Harris JA, Benedict FG (1919) A biometric study of basic metabolism in man. Publ no 297. Carnegie Institute, Washington

16.

Talbot FB (1938) Basal metabolism standard for children. Am J Dis Child 55:455–459

17.

FAO/WHO/UNU (1985) Energy and protein requirements. In: WHO technical report series 724. World Health Organization, Geneva

18.

White MS, Shepherd RW, McEniery JA (2000) Energy expenditure in 100 ventilated, critically ill children: improving the accuracy of predictive equations. Crit Care Med 28:2307–2312PubMed

19.

Briassoulis G, Venkataraman S, Thompson AE (2000) Energy expenditure in critically ill children. Crit Care Med 28:1166–1172

20.

Merritt RJ, Suskind RM (1979) Nutritional survey of hospitalized pediatric patients. Am J Clin Nutr 32:1320–1325PubMed

21.

Preiser JC, Berre J, Carpentier Y, Jolliet P, Pichard C, Van Gossum A, Vincent JL (1999) Management of nutrition in European intensive care units: results of a questionnaire. Working Group on Metabolism and Nutrition of the European Society of Intensive Care Medicine. Intensive Care Med 25:95–101CrossRefPubMed

22.

McMahon SR, Iwamoto M, Massoudi MS, Yusuf HR, Stevenson JM, David F, Chu SY, Pickering LK (2003) Comparison of e-mail, fax, and postal surveys of pediatricians. Pediatrics 111:e299–e303PubMed

23.

Rogers EJ, Gilbertson HR, Heine RG, Henning R (2003) Barriers to adequate nutrition in critically ill children. Nutrition 19:865–868PubMed

24.

Kuip M van der, Hoos MB, Forget PP, Westerterp KR, Gemke RJ, de Meer K (2003) Energy expenditure in infants with congenital heart disease, including a meta-analysis. Acta Paediatr 92:921–927CrossRefPubMed

25.

Mayes T, Gottschlich MM, Khoury J, Warden GD (1996) Evaluation of predicted and measured energy requirements in burned children. J Am Diet Assoc 96:24–29CrossRefPubMed

26.

Phillips R, Ott L, Young B, Walsh J (1987) Nutritional support and measured energy expenditure of the child and adolescent with head injury. J Neurosurg 67:846–851PubMed

27.

Turi RA, Petros AJ, Eaton S, Fasoli L, Powis M, Basu R, Spitz L, Pierro A (2001) Energy metabolism of infants and children with systemic inflammatory response syndrome and sepsis. Ann Surg 233:581–587CrossRefPubMed

28.

Taylor RM, Cheeseman P, Preedy V, Baker AJ, Grimble G (2003) Can energy expenditure be predicted in critically ill children? Pediatr Crit Care Med 4:176–180CrossRefPubMed

29.

Vernon DD, Witte MK (2000) Effect of neuromuscular blockade on oxygen consumption and energy expenditure in sedated, mechanically ventilated children. Crit Care Med 28:1569–1571CrossRefPubMed

30.

Petros S, Engelmann L (2001) Validity of an abbreviated indirect calorimetry protocol for measurement of resting energy expenditure in mechanically ventilated and spontaneously breathing critically ill patients. Intensive Care Med 27:1164–1168CrossRef

31.

Frankenfield DC, Sarson GY, Blosser SA, Cooney RN, Smith JS (1996) Validation of a 5-minute steady state indirect calorimetry protocol for resting energy expenditure in critically ill patients. J Am Coll Nutr 15:397–402PubMed

32.

Joosten KF, Verhoeven JJ, Hop WC, Hazelzet JA (1999) Indirect calorimetry in mechanically ventilated infants and children: accuracy of total daily energy expenditure with 2 hour measurements. Clin Nutr 18:149–152PubMed

33.

Klerk G de, Hop WC, de Hoog M, Joosten KF (2002) Serial measurements of energy expenditure in critically ill children: useful in optimizing nutritional therapy? Intensive Care Med 28:1781–1785CrossRefPubMed

34.

Witte MK (1996) Metabolic measurements during mechanical ventilation in the pediatric intensive care unit. Respir Care Clin N Am 2:573–586PubMed

35.

Kuip M van der, de Meer K, Oosterveld MJ, Lafeber HN, Gemke RJ (2004) Simple and accurate assessment of energy expenditure in ventilated paediatric intensive care patients. Clin Nutr 24 (in press)

36.

Wells JC, Mok Q, Johnson AW, Lanigan JA, Fewtrell MS (2002) Energy requirements and body composition in stable pediatric intensive care patients receiving ventilatory support. Food Nutr Bull 23:95–98

37.

Ellis KJ (2000) Human body composition: in vivo methods. Physiol Rev 80:649–680PubMed

38.

Butte NF, Moon JK, Wong WW, Hopkinson JM, Smith EO (1995) Energy requirements from infancy to adulthood. Am J Clin Nutr 62:1047S–1052SPubMed

Titel: Nutritional support in 111 pediatric intensive care units: a European survey
verfasst von: Martijn van der Kuip
Michiel J. S. Oosterveld
Marian A. E. van Bokhorst–de van der Schueren
K. de Meer
Harry N. Lafeber
Reinoud J. B. J. Gemke
Publikationsdatum: 01.09.2004
Verlag: Springer-Verlag
Erschienen in: Intensive Care Medicine / Ausgabe 9/2004
Print ISSN: 0342-4642
Elektronische ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-004-2356-8

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren

Springer Medizin

Nutritional support in 111 pediatric intensive care units: a European survey