Point-Counterpoint: Indirect Calorimetry Is Essential for Optimal Nutrition Therapy in the Intensive Care Unit
A major driver leading to the lack of emphasis on timely ICU nutrition delivery is lack of objective data to guide nutrition care. If we are to ultimately overcome current fundamental challenges to effective ICU nutrition delivery, we must all adopt routine objective, longitudinal measurement of energy targets via indirect calorimetry (IC).
Key evidence supporting the routine use of IC in the ICU includes:
- universal societal ICU nutrition guidelines recommending IC to determine energy requirements
- data showing predictive equations or body weight calculations that are consistently inaccurate
- recent development and worldwide availability of a new validated, accurate, easy-to-use IC device
- recent data in ICU patients with coronavirus disease 2019 (COVID-19) showing progressive hypermetabolism throughout ICU stay, emphasizing the inaccuracy of predictive equations and marked day-to-day variability in nutrition needs.
The new Q-NRG provides accurate EE and IC measures in an efficient and timely fashion in a range of settings in and out of the ICU. Thus, given the availability of a new validated IC device, these findings emphasize that routine longitudinal IC measures should be considered the new standard of care for ICU and post-ICU nutrition delivery.
It is only with continued implementation of objective nutrition data, such as longitudinal IC measures and ultrasound-derived muscle mass measures, that we will ensure each ICU patient receives personalized nutrition care that delivers the right nutrition, in the right patient, at the right time to optimize clinical outcomes.
Article details:
- Title: Point-Counterpoint: Indirect Calorimetry Is Essential for Optimal Nutrition Therapy in the Intensive Care Unit
- Authors: Paul E. Wischmeyer, Jeroen Molinger MSc, Krista Haines
- Published in: Nutrition in Clinical Practice - Volume 36, Issue 2, April 2021
- Link: https://doi.org/10.1002/ncp.10643
