Citation

Mtaweh H, Smith R, Kochanek PM, Wisniewski SR, Fabio A, Vavilala MS, Adelson PD, Toney NA, Bell MJ. Pediatr. Crit. Care Med. 2014; 15(3): 242-249.

Affiliation

1Department of Critical Care Medicine, University of Pittsburgh, Pittsburgh, PA. 2Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, PA. 3Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA. 4Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, WA. 5Barrow Neurological Institute at Phoenix Children's Hospital, Phoenix, AZ. 6Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA.

Copyright

(Copyright © 2014, Lippincott Williams and Wilkins)

DOI

10.1097/PCC.0000000000000041

PMID

24394999

Abstract

OBJECTIVE:: To evaluate energy expenditure in a cohort of children with severe traumatic brain injury. DESIGN:: A prospective observational study. SETTING:: A pediatric neurotrauma center within a tertiary care institution. PATIENTS:: Mechanically ventilated children admitted with severe traumatic brain injury (Glasgow Coma Scale < 9) with a weight more than 10 kg were eligible for study. A subset of children was co-enrolled in a phase 3 study of early therapeutic hypothermia. All children were treated with a comprehensive neurotrauma protocol that included sedation, neuromuscular blockade, temperature control, antiseizure prophylaxis, and a tiered-based system for treating intracranial hypertension. INTERVENTIONS:: Within the first week after injury, indirect calorimetry measurements were performed daily when the patient's condition permitted. MEASUREMENTS AND MAIN RESULTS:: Data from 13 children were analyzed (with a total of 32 assessments). Measured energy expenditure obtained from indirect calorimetry was compared with predicted resting energy expenditure calculated from Harris-Benedict equation. Overall, measured energy expenditure/predicted resting energy expenditure averaged 70.2% ± 3.8%. Seven measurements obtained while children were hypothermic did not differ from normothermic values (75% ± 4.5% vs 68.9% ± 4.7%, respectively, p = 0.273). Furthermore, children with favorable neurologic outcome at 6 months did not differ from children with unfavorable outcome (76.4% ± 6% vs 64.7% ± 4.7% for the unfavorable outcome, p = 0.13). CONCLUSIONS:: Contrary to previous work from several decades ago that suggested severe pediatric traumatic brain injury is associated with a hypermetabolic response (measured energy expenditure/predicted resting energy expenditure > 110%), our data suggest that contemporary neurocritical care practices may blunt such a response. Understanding the metabolic requirements of children with severe traumatic brain injury is the first step in development of rational nutritional support goals that might lead to improvements in outcome.

Language: en