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MON-PO621: Validity of Predictive Equations for Estimation of Resting Energy

Expenditure Among Mechanically Ventilated Critically Ill Patients at Different
Phases of Critical Illne...

Conference Paper in Clinical nutrition (Edinburgh, Scotland) · September 2019

DOI: 10.1016/S0261-5614(19)32454-9

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Universiti Kebangsaan Malaysia International Islamic University Malaysia
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 Abstracts / Clinical Nutrition 38 (2019) S59–S296
Methods: Muscle strength of the tibialis anterior muscle was
measured by increasing electric current intensity stimulation in the
motor point of the muscle. Muscle fatigue was measured by 16 series
of repetitive high frequency stimulations with 70% of maximum
intensity used for muscle strehgth measurement. The air pressure was
measured in the cuff located on the instep of the foot fixed in a solid
plunger. Two measurements were performed on 14 healthy volunteers
over a 2 weeks. Association between measured values and sex, weight,
height, calf circumference and degree of training was measured by the
Pearson product-moment correlation coefficient.
Results: Significant association was found between muscle strength
and calf circumference (Pearson’s correlation coefficient = 0.68, p =
0.02). Other associations were non-significant.
Conclusions: The proposed method measures the force of the muscle
fibers in a cylindrical volume defined by the size and distance of
stimulation electrodes. Since a larger calf volume means a greater
column height of the muscle fibers between the electrodes, this
parameter is positively correlated with the maximum measured force.
On the other hand, other parameters do not affect the strength of a
defined volume of healthy muscle fibers.
Supported by MH CZ – DRO (UHHK, 00179906)- by the grant projects
of the Ministry of Health of the Czech Republic (FN HK 00179906) and
of the Charles University in Prague, Czech Republic (PROGRES Q40) the
project: PERSONMED – Center for the Development of Personalized
Medicine in Age-Related Diseases, Reg. Nr. CZ.02.1.01/0.0/0.0/17_048/
0007441, co-financed by ERDF and state budget of the Czech Republic.
Disclosure of Interest: None declared.
MON-PO620
OR TO BREATHE: ENERGY AND PROTEIN INTAKE IN CRITICALLY ILL
PATIENTS WITH RESPIRATORY FAILURE TREATED BY HIGH FLOW
NASAL CANNULA (HFNC) OXYGENATION.
O. Zerbib1*, S. Rattanachaiwong2, N. Palti3, I. Kagan1, P. Singer1.
1 validity of eight PEs for prediction of REE among critically ill adult
Department of General Intensive Care and Institute for Nutrition
Research, Rabin Medical Center, Tel Aviv, Israel, 2Division of Clinical
Nutrition, Department of Medicine, Thailand, Faculty of Medicine, Khon
Kaen University, Khon Kaen, Thailand, 3of Dietetics and Nutrition, Rabin
Medical Center, Tel Aviv, Israel
* Corresponding author.
Rationale: HFNC oxygenation is more frequently used in the ICU. Since
this treatment can be given for many days and may impair nutritional
intake, we planned to evaluate the energy and protein intake of
patients receiving this therapy.
Methods: Patients requiring HFNC oxygenation after extubation
or to prevent intubation were included consecutively in 2018.
Demographics, route of nutrition (oral, enteral and/or parenteral),
calories and protein prescribed and administered, complications were
noted at the day of observation and until discharge. Statistical analysis
used Chi square or Kruskal Wallis H test. Values are in mean and range
or ±SD.
Results: Forty two HFNC therapies were applied in 40 patients, 2.5
days after admission in mean. HFNC was 51.5 hours (21- = 103.5). Age
was 51 ± 19, BMI was 25.4 kg/m2, 60% were male, APACHE II was 19 ± 6,
SOFA 6.8 ± 2.9. 62.5% were post extubation and 37.5% to defer
intubation. 21 patients treated with tube feeding (TF) received 365
(247–1193) kcal/d and 18.5 (13.9–33.3) g/d protein, while those with
oral feeding (OF) (n = 13) received higher ( p < 0.04) calories: 621 (459–
850) kcal/d and 22 (20–45) g/d protein. Parenteral nutrition alone
(3 pts) or with TF (3 pts) did not provide more than 500 kcal/d (244–
1193). When PN was administered with TF, it provided only 306 (50–
504) kcal/d. Two patients did not receive any nutrition. TF patients
stayed longer ( p < 0.03) (14 days, 8–20) than OF group (4 days, 2–10
range) only). Patients with no nutrition stayed the shorter (5.5 days, 4–
S289
7). Thirteen patients required intubation (8 from TF) and 2 died (1 on
TF and 1 on TF and PN). LOS in the ICU was 8 (5–17) days
Conclusions: OF is more efficient to reach calorie and protein target
when compared to TF in patients receiving HFNC oxygenation.
However, both are underfeeding these patients and energy require-
ment remains to be determined.
Disclosure of Interest: None declared.
MON-PO621
VALIDITY OF PREDICTIVE EQUATIONS FOR ESTIMATION OF RESTING
ENERGY EXPENDITURE AMONG MECHANICALLY VENTILATED
CRITICALLY ILL PATIENTS AT DIFFERENT PHASES OF CRITICAL
ILLNESS
P.C. Tah1,2*, V.-R. Hakumat-Rai3, B.K. Poh4, M.B. Mat Nor5, H. Abdul
Majid6, C.C. Kee7, M.K. Zaman8, Z.-Y. Lee1, M.S. Hasan1. 1Department of
Anesthesiology, Faculty of Medicine, University of Malaya, 2Department of
Dietetics, University of Malaya Medical Centre, Kuala Lumpur, 3School of
Medicine, Taylor’s University, Selangor, 4Nutritional Sciences Programme
& Centre for Community Health, Faculty of Health Sciences, Universiti
Kebangsaan Malaysia, Kuala Lumpur, 5Department of Anesthesiology,
International Islamic University Malaysia, Pahang, 6Department of Social
and Preventive Medicine, Faculty of Medicine, University of Malaya,
7
Epidemiology and Biostatistics Unit, Medical Research Resource Centre,
Institute for Medical Research, Kuala Lumpur, 8Centre of Nutrition and
Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA,
Selangor, Malaysia
* Corresponding author.
Rationale: Several predictive equations (PEs) have been developed for
estimation of resting energy expenditure (REE) but no validity study
has been done among mechanically ventilated critically ill patients in
Southeast Asian population. This study is aimed at determining the
Malaysian patients during acute phase (≤5 days), late phase (6–10
days) and chronic phase (>10 days) in intensive care unit (ICU).
Methods: This was a prospective observational study conducted in a
mixed ICU of University of Malaya Medical Centre, Malaysia from
December 2016 to December 2018. REE was measured among 302
patients (acute phase), 180 patients (late phase) and 91 patients
(chronic phase) by using Indirect Calorimetry (IC). Comparisons were
made with eight commonly used predictive equations (with a total of
21 sub-equations): Harris Benedict (HBE) basic (1919) & variants
(1999), Mifflin St Jeor (MSJ) (1990), Swinamer (1990), Penn State
equations (PSU; 4 variants), American College of Chest Physicians
(ACCP) (1997), Brandi (1999), Faisy (2003) and European Society for
Clinical Nutrition and Metabolism (ESPEN) (2006) to estimate the
energy requirement of the patients. Degree of agreement for REE
estimated by eight PEs (REE-PE) was validated against REE measured
by IC (REE-IC) using intraclass correlation coefficient (ICC) and the
Bland-Altman test. The accuracy is defined as REE-PE values differing
within ±10% range compared to REE-IC.
Results: Mean REE-IC for all critically ill patients was 1762 ± 447 kcal
(acute phase), 1884 ± 508 kcal (late phase) and 1856 ± 445 kcal
(chronic phase). In the acute phase, both Penn State equations [PSU
(HBE) 2003a] and [PSU (m) 2003b] showed the highest agreement
with REE-IC (ICC 0.655, 95% CI 0.585–0.715) and (ICC 0.655, 95% CI
0.557–0.731) respectively, p < 0.001. For late phase, Brandi (1999)
equation showed highest agreement with REE-IC (ICC 0.701, 95%CI
0.615–0.770; p < 0.001). During chronic phase, Faisy (2003) equation
showed the highest agreement with REE-IC (ICC 0.745, 95%CI 0.614–
0.831; p < 0.001). Based on the Bland-Altman test, good agreement
was also observed between these REE-PE and REE-IC which char-
acterized by a narrow interval. Percentage of accuracy for these REE-PE
were approximately 40%. The equations that consistently showed good
S290 Abstracts / Clinical Nutrition 38 (2019) S59–S296
agreement (ICC 0.6–0.8) for all of the three phases were Brandi (1999),
Faisy (2003), Swinamer (1990) and Harris Benedict (1919) × 1.25. None
of the REE-PE had excellent agreement (ICC > 0.8).
Conclusions: PEs tend to over or underestimate the energy require-
ment of critically ill patients. This occurs at different phases of critical
illness. The usage of IC is important for patient care. When IC is not
available, a PE that is developed from the relevant population should
be used.
Disclosure of Interest: None declared.
MON-PO622
L-CITRULLINE REDUCES AMMONIUM ACETATE INDUCED
HYPERAMMONEMIA IN MICE
P. Girard1*, M.-C. Coppé1, P. Cloarec1, M. Verleye1. 1Pharmacologie,
BIOCODEX, Compiègne, France
* Corresponding author.
Rationale: Urea cycle disorders disrupt the conversion of toxic
ammonia into urea inducing hyperammonemia that affect the
central nervous system (Summar and Mew, 2018). Our goal is to
evaluate the beneficial effect of the urea cycle intermediate L-citrulline
(LC, Biocodex-Gentilly-France) in the ammonium acetate (AA) induced
hyperammonemia model in mice.
Methods: For this purpose, two studies were performed in male CD1
mice according to the method of O’Connor et al. (1984): a lethal dose of
AA (12 mmol/kg) was administered to assess the impact of LC on the
neurological score and on the percentage of death, and a non-lethal
dose of AA (8 mmol/kg) to evaluate its impact on the blood ammonia
level. Behaviour was assessed according to Stephens and Levy (1994).
Data are expressed as means±SEM, and statistical analysis are based on
ANOVA. ED50 (dose inducing an effect in 50% of animals) was
determined according to Tallarida s’ method (2001).
Results: Intraperitoneal administration of 12 mmol/kg AA rapidly
produces behavioural troubles and death occurs in 90–100% of mice.
LC intravenous administration (2 mmol/kg) significantly reduces the
neurological score and the percentage of death (8%). Oral administra-
tion of LC (4 mmol/kg) also significantly decreases the neurological
score and the percentage of death (25%). Concerning protection from
death, LC ED50s values are of 0.79 ± 0.16 and 0.98 ± 0.10 mmol/kg by
intravenous or oral route, respectively. LC intravenous or oral
administration significantly reduces hyperammonemia by 52 and
62% respectively.
Conclusions: These results show that intravenous or oral administra-
tion of L-citrulline effectively reduce both death frequency and
neurological troubles induced by a lethal dose of ammonium acetate
and decrease blood hyperammonemia induced by a non-lethal dose of
AA in mice. L-citrulline confirms to be an efficient compound to reduce
clinical manifestation of hyperammonemia in this animal model.
References
1. O’Connor et al., 1984, Neurochem. Res., 9, 563–570.
2. Stephens and Levy, 1994, Epilepsia 35, 164–171.
3. Summar and Mew, 2018, Pediatr. Clin. North Am., 65, 231–246.
4. Tallarida 2001, J.Pharmacol. Exp. Ther., 298, 865–872.
Disclosure of Interest: P. Girard Other: Biocodex employee, M.-C.
Coppé Other: Biocodex employee, P. Cloarec Other: Biocodex
employee, M. Verleye Other: Biocodex employee.
MON-PO623
ASSESSMENT OF FEEDING INTOLERANCE DEFINITIONS IN THE
PEDIATRIC INTENSIVE CARE UNIT
R. Eveleens1*, J. van Brakel1, B. de Koning2, J. Hulst2,3, I. Vanhorebeek4,
G. Van den Berghe4, K. Joosten1, S. Verbruggen1. 1Intensive Care,
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Department of Pediatrics and Pediatric Surgery, 2Pediatric
Gastroenterology, Department of Pediatrics, Erasmus MC – Sophia
Children’s Hospital, Rotterdam, Netherlands, 3Division of Paediatric
Gastroenterology, Hepatology and Nutrition, Hospital for Sick Children,
Toronto, Canada, 4From the Department of Cellular and Molecular
Medicine, Clinical Division and Laboratory of Intensive Care Medicine,
KU Leuven University Hospital, Leuven, Belgium
* Corresponding author.
Rationale: Intolerance, or presumed intolerance, to enteral nutrition is
one of the main factors for not reaching target caloric goals in critically
ill children. Feeding intolerance (FI) is inconsistently defined in current
literature. Our aim was to evaluate the association between FI and
clinical outcomes using different definitions of FI and to determine the
most predictive definition.
Methods: Prospectively collected data obtained in the PEPaNIC RCT
study of patients with an admission of ≥4 days and complete GI
assessment were used. Clinical endpoints were new acquired infection
and PICU mortality. Assessment of FI definitions were performed by
adding the presence of FI in multiple regression models including
baseline variables, severity of illness, centre and early PN randomiza-
tion on admission day 4. The FI definitions analysed were: 1) large
gastric residual volume (GRV) (defined as ≥5 ml/kg/day); 2) Percent of
enteral intake compared to resting energy expenditure (REE); 3)
Presence of one or multiple GI symptoms (GRV, vomiting, diarrhoea
and abdominal distention); 4) Combination of GI symptoms and
percentage of enteral intake to REE. The considered enteral intake
thresholds were set arbitrarily based on the literature, or derived from
ROC analysis.
Results: In total, 431 patients were included with a median age of 0.9
years [IQR 0.1–6.0], PRISM score of 9 [IQR 5–15] and PICU length of stay
of 9 days [IQR 5–16]. New infection occurred in 122 (28%) patients and
22 (5%) died during PICU admission. The FI definition that was most
predictive for new infection was defined as having enteral intake ≤ 35%
of REE ( p = 0.004; OR 2.07 (95%CI1.27–3.38)). No significant associa-
tions were found between PICU mortality and the different FI
definitions.
Conclusions: On day 4 of admission, feeding intolerance defined as
enteral intake ≤ 35% of REE was most associated with the primary
outcome measure new infection. This definition might provide a
stepping stone for future research.
Disclosure of Interest: None declared.
MON-PO624
HYPERGLYCEMIA AND MODIFIED NUTRIC SCORE IN CRITICAL
PATIENTS HOSPITALIZED IN AN INTENSIVE CARE UNIT
L.A.P. Souza1, L.F.M. Oliveira1, R.L. Ferretti1*. 1University of Taubate,
Taubaté, Brazil
* Corresponding author.
Rationale: Hyperglycemia is common in hospitalized patients,
especially those who are critically ill. The NUTRIC score is a nutritional
risk assessment tool for critically ill patients. The main objective of this
study was to verify the association between hyperglycemia and
modified NUTRIC score in critical patients hospitalized in an Intensive
Care Unit at a hospital in the city of Taubaté/SP
Methods: A cross-sectional study with secondary data of critical
patients in an Intensive Care Unit, from August 2017 to June 2018,
contemplating male and female patients aged 18 years or older. The
variables of interest are age, sex, clinical diagnosis, APACHE II, SOFA,
number of comorbidities, length of hospital stay before admission to
the ICU, and type of nutritional therapy to evaluate the NUTRIC score,
which was considered high (>5 points) and low (0–4 points).
Hyperglycemia was considered when blood glucose was higher than