Nutrition delivery in critical illness – The rise of the machines?

Abstract

Background/aim: In 2021, Grampians Health – Ballarat obtained a QNRG+ Indirect Calorimetry (IC) machine to use within our ICU department. Over the past 3 years, this has been used on a weekly basis for mechanically ventilated (MV) patients. This provides the ICU team with a patients Resting Energy Expenditure (REE) through the O2/VO2 exchange through the ventilator. The aim was to compare the IC measurements with the predictive equations that are commonly used as a Dietitian and to determine the accuracy of the predictive equation when compared to the IC measurements. Population/setting: Mechanically ventilated patients with a critical illness. Methods: QI project rather than this being a published article. Retrospective evaluation of the data over the past 3 years comparing the IC measurements with the predictive equation that is standard practice at GH-Ballarat. Results/findings: We found that over the past 3 years, there was likely to be more risk of overfeeding an MV patient, likely due to the factors impacting a patient's metabolic rate .eg. The amount and type of sedation being used, was the patient paralysed. There was improved glycaemic control, reducing the risk of hyperglycaemia and the ability to help resolve TPN related liver damage due to overfeeding. Conclusion: The use of IC measurements to determine a patient's energy requirement has highlighted the benefits through reducing the risk of overfeeding and the associated complications with overfeeding. Translational impact/implications for future practice: Changes include individualised nutrition delivery with precision and reducing complications associated with overfeeding. Enabled GH-Ballarat to provide best practice as per the recently revised ESPN guidelines. Plan is for guidelines to be developed for Australia and New Zealand in how to best use this in clinical practice.