Samenvatting

Rationale: Nutrition therapy guided by indirect calorimetry (IC) decreases mortality of critically ill patients when compared to energetic targets set by predictive equations which result in over- and underfeeding.

IC has been made feasible in patients undergoing continuous renal replacement therapy (CRRT). During CRRT the energy need possibly equals the measured resting energy expenditure (mREE) minus the bioenenergetic balance (BEB) which consists of the energetic load resulting from the exchange of citrate, glucose and lactate.

This retrospective study aims to evaluate how the BEB influences the nutritional therapy during continuous venovenous hemofiltration (CVVH).

Methods: We included adult ICU patients admitted between 01/01/2022 and 31/12/2022 treated with CVVH who had at least one IC (QNRG+) measurement with a BEB calculation done.

Predicted REE was estimated using ESPEN 2019 weight-based equation and the 1984 Harris-Benedict formula.

Data were analyzed using SPSS version 28.

Results: 45 IC measurements were analysed.

The mean mREE was 1820 (± 386) kcal/day. The mean BEB was 164 (± 363) kcal/day and had a very large variation (-467 to +609 kcal/day). Subgroup analysis of patients treated with citrate anticoagulation showed a mean BEB of -327 (±82)Kcal/day as compared to +439 (±124)kcal/day in patients who were not treated with citrate.

The energetic need showed a statistically acceptable (ICC 0.661, 95% CI, 0.458−0.798; P < 0,001), but clinical poor correlation with the mREE.

The energetic need correlates poorly with both predictive equations (ESPEN 2019: ICC 0.263, 95% CI, -0.051−0.499; P < 0,001 and Harris-Benedict: ICC 0.374, 95% CI, 0.012−0.544; P < 0,001).

Conclusion: The Bio Energetic Balance has a major influence on the energetic targets of ICU patients treated with CVVH.

These findings accentuate the importance to calculate the BEB during CVVH. Further research is needed to investigate the impact on patient centered outcome.

Disclosure of Interest: D. Goethals: None declared, W. Pieteraerens: None declared, E. De Waele: None declared, J. Jonckheer Grant / Research Support from: IIR by baxter
Originele taal-2English
ArtikelnummerLB23-T
Pagina's (van-tot)697
Aantal pagina's1
TijdschriftClinical Nutrition ESPEN
Volume58
DOI's
StatusPublished - 5 dec 2023
EvenementEspen congress on clinical nutrition & Metabolism - Lyon, France
Duur: 11 sep 202314 sep 2023
https://espencongress.com/2023/

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