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Minerva Anestesiologica 2021 Apr 14

DOI: 10.23736/S0375-9393.21.14825-4

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

Metabolism and energy prescription in critically III children

Ben D. ALBERT 1, 2, Giulia C. SPOLIDORO 3, Nilesh M. MEHTA 1, 2, 3, 4

1 Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA, USA; 2 Harvard Medical School, Cambridge, MA, USA; 3 Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy; 4 Center for Nutrition, Boston Children’s Hospital, Boston, MA, USA


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Optimal nutrition therapy can positively influence clinical outcomes in critically ill children. Accurate assessment of nutritional status, metabolic state, macronutrient requirements and substrate utilization allows accurate prescription of nutrition in this population. In response to stress and injury, the body undergoes adaptive physiologic changes leading to dysregulation of the inflammatory response and hyperactivation of the inflammatory cascade. This results in a global catabolic state with modification in oxygen consumption and macronutrient metabolism. A comprehensive understanding of the metabolic response is essential when prescribing nutritional interventions aimed to offset the burden of this adaptive stress response in the critically ill. In this narrative review we aim to provide a comprehensive review of the physiologic basis, recent literature and some emerging concepts related to energy expenditure and the practical aspects of energy delivery in the critically ill child. Based on the unique metabolic characteristics of the critically ill child, we aim to provide a pragmatic approach to providing nutrition therapy.


KEY WORDS: Metabolism; Stress response; Inflammation; Nutrition; Enteral nutrition; Indirect calorimetry; Pediatrics; Critical care; Pediatric intensive care

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