Going Beyond Predictive Energy Equations: The Benefits of Indirect Calorimetry in Critically Ill Patients


Both over- and underfeeding hospitalized patients can have detrimental impacts. Around 33% of hospitalized patients (non-maternal, non-neonatal) have malnutrition, with half of these patients experiencing a worsening of malnutrition severity during their admission. Malnutrition has a significant negative impact on overall patient morbidity, mortality, and quality of life, as well as increased healthcare costs. Predictive equations are the most widely used means to assessing energy needs, yet the equations often lead to under- and overfeeding. Indirect calorimetry (IC) is considered the gold standard for assessing energy needs in hospitalized children and adults; however, most hospitals do not have access to the equipment necessary to perform IC evaluations. This session will review the evidence comparing estimated energy needs from predictive equations and measured resting energy expenditure from indirect calorimetry. It will also review the indicators for testing both pediatric and adult patients. A case study will also be reviewed which will demonstrate how important the use of IC is for adequately feeding critically ill patients and how optimal nutrition can optimize recovery.

Learning Objectives

Explain how to use indirect calorimetry (IC) to evaluate energy expenditure in the critically ill pediatric and adult patient whose requirements are difficult to assess

Identify the optimal candidate criteria for pediatric and adult patients when IC should be used for nutritional assessment

Interpret results of IC from presented case study and integrate data into an effective nutrition intervention

Performance Indicators

10.5 Monitors nutrition care plans to ensure individual health goals are achieved

2.3 Collaborates with inter- and intra-professional team members to achieve common goals and to optimize delivery of services

3.2 Advocates for and participates in activities that support advancement of the profession


Melissa Wallinga

Pediatric ICU Dietitian/Clinical Dietitian II

St. Luke’s Children’s Hospital

Diane Nowak

Registered Dietitian Advanced Practice I

Cleveland Clinic


Anna Busenburg

Neonatal Dietitian

Cincinnati Children's Hospital Medical Center

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