24394999

PMC4703075

Objective

To evaluate energy expenditure in a cohort of children with severe traumatic brain injury (TBI).

Design

A prospective observational study.

Setting

A pediatric neurotrauma center within a tertiary care institution.

Patients

Mechanically-ventilated children admitted with severe traumatic brain injury (GCS<9) with a weight greater than 10 kg were eligible for study. A subset of children was co-enrolled in a phase 3 study of early, therapeutic hypothermia. All children were treated with a comprehensive neurotrauma protocol that included sedation, neuromuscular blockade, temperature control, anti-seizure prophylaxis and a tiered-based system for treating intracranial hypertension.

Interventions

Within the first week after injury, indirect calorimetry measurements were performed daily when the patient’s condition permitted.

Measurements and Main Results

Data from 13 children were analyzed (with a total of 32 assessments). Measured energy expenditure (MEE) obtained from indirect calorimetry was compared to resting energy expenditure (pREE) calculated from Harris-Benedict equation. Overall, MEE/pREE averaged 70.2 ± 3.8%. Seven measurements obtained while children were hypothermic did not differ from normothermic values (75 ± 4.5% vs. 68.9 ± 4.7% respectively, p = 0.273). Moreover, children with favorable neurologic outcome at 6 months did not differ from children with unfavorable outcome (76.4 ± 6% vs. 64.7 ± 4.7% for the unfavorable outcome, p = 0.13).

Conclusions

Contrary to previous work from several decades ago that suggested severe pediatric TBI is associated with a hypermetabolic response (MEE/pREE > 110%); our data suggest that contemporary neurocritical care practices may blunt such a response. Understanding the metabolic requirements of children with severe TBI is the first step in development of rational nutritional support goals that might lead to improvements in outcome.

CDC Public Access

U01 CE001630/CE/NCIPC CDC HHS/United States
R01 NS072308/NS/NINDS NIH HHS/United States
NS070003/NS/NINDS NIH HHS/United States
R21 NS070003/NS/NINDS NIH HHS/United States
R01 NS069247/NS/NINDS NIH HHS/United States
F32 HD008003/HD/NICHD NIH HHS/United States
U01 NS052478/NS/NINDS NIH HHS/United States
T32 HD040686/HD/NICHD NIH HHS/United States