The Balance trial: Individualized precision nutrition therapy in critical ill patients treated with continuous venovenous hemofiltration: The impact of indirect calorimetry and bioenergetic balance on energetic need
Abstract
BACKGROUND AND AIMS
Personalized precision nutrition therapy is associated with better outcomes but is challenging to achieve. One of the reasons is that indirect calorimetry (IC), the gold standard for measuring the resting energy expenditure (REE), is not yet common practice. Predictive equations are used but have found to be inaccurate. The ICU environment also introduces several sources of non-nutritional energy (NNE) which have to be accounted for in order to avoid overfeeding. Patients undergoing continuous venovenous hemofiltration (CVVH) are especially impacted by this NNE as often citrate is added and the filter acts as a siphon of energy due to the loss of lactate and glucose in the effluent. This complex interaction, of which the net effect is called the bioenergetic balance (BEB), can lead to both a net positive gain or net negative loss of energy. We aimed to validate the correlation between energetic need, measured REE with IC, and predicted REE in our CVVH population. Additionally, this study aimed to evaluate the extent to which the BEB influenced the energetic need of patients undergoing CVVH. Finally, a new predictive model using anthropometric and biochemical data was built and evaluated.
PATIENTS AND METHODS
We analyzed adult ICU patients who underwent CVVH, with at least one IC and BEB measurement between 01/01/2021 and 31/12/2022. Demographics, treatment modalities, blood analysis and data from measured REE, predicted REE and BEB were collected.…
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