None listed
Conditions
Brief summary
Since implementation in 2023, the QNRG+ (COSMED, Italy) indirect calorimetry (IC) device has been used regularly in the paediatric critical care unit (PCC) at Perth Children’s Hospital (PCH) as standard of care to guide nutritional targets on invasively mechanically ventilated (IMV) patients. However, feasibility of this device is yet to be described in paediatrics. This observational cohort study aims to 1) describe the implementation and feasibility of IC in PCC to inform practice / resources for other centres nationally and internationally, 2) determine if correlation exists between measured energy requirements and common PCC factors, such as level of sedation, and 3) determine if correlation exists between proportion of IC-guided energy targets delivered and changes in body composition. To describe IC feasibility, we will screen all invasively mechanically ventilated patients daily for an 18-month data collection period, aiming to recruit and screen a minimum of 250 patients, to assess proportion of patients and PCC days where both technical and stability criteria are met, to be able to perform IC. IC tests will be performed on all eligible participants, with proportion of successful vs unsuccessful rests reported. To describe measured energy expenditure (MEE) variability in invasively mechanically ventilated paediatric patients, we will document factors, such as level of sedation, temperature and nutrition, provided during each IC test. Updates to COSMED firmware in 2026 will allow opportunity for IC testing in children who weigh <10kg, and both feasibility and MEE data in this population will be crucial. To describe changes in body composition, skeletal muscle ultrasound and bio-impedance devices will be utilised, as per current PCC standard of care, and daily nutrition data will be collected. Recruitment will continue for a total of 36-months or more to ensure adequate participant numbers, and to capture data on infants and children who are <10kg.
Interventions
The core interest in this observational study is indirect calorimetry testing in invasively ventilated paediatric patients in critical care.
Observing: 1) proportion of patients in PICU who meet technical and stability criteria to have indirect calorimetry performed while receiving invasive mechanical ventilation 2) Variability of measured energy expenditure (via indirect calorimetry) during invasive ventilation 3) changes in muscle and fat mass during PICU admission (in relation to percentage
The core interest in this observational study is indirect calorimetry testing in invasively ventilated paediatric patients in critical care. Observing: 1) proportion of patients in PICU who meet technical and stability criteria to have indirect calorimetry performed while receiving invasive mechanical ventilation 2) Variability of measured energy expenditure (via indirect calorimetry) during invasive ventilation 3) changes in muscle and fat mass during PICU admission (in relation to percentage of indirect calorimetry-derived targets met) There is no direct involvement from participants, beyond standard clinical care. Indirect calorimetry and body composition assessment will be performed as per usual clinical practice. Data will be collected prospectively from medical devices and digital medical records during and post assessments. The duration of observation will be from day of intubation of mechanical ventilation until day of PICU discharge. If participants are readmitted during the study period, IC will continue to be performed, and data collected (if meet eligibility criteria). The same participant identification code will be used. No data on body composition will be collected for subsequent admissions.
Sponsors
Child and Adolescent Heatlh Service
Eligibility
Sex/Gender
All
Age
0 to 18 Years
Healthy volunteers
No
Inclusion criteria
All children 0-18 years of age who are invasively mechanically ventilated in PICU
Exclusion criteria
Any patient who is actively palliated. Body composition assessment has additional exclusion criteria as follows: Predicted length of stay <72 hours and / or inability to access anterior thigh for ultrasound measurement.
Outcome results
None listed