ROME--(BUSINESS WIRE)--Baxter International Inc. (NYSE:BAX), a global leader in nutrition therapy, supports interim findings of an ongoing prospective study, “Persistent Hypermetabolism and Longitudinal Energy Expenditure in Critically Ill Patients with COVID-19 (LEEP-COVID),” demonstrating the role of indirect calorimetry (IC) in improving the accuracy of measuring COVID-19 patients’ nutritional needs during their intensive care unit (ICU) stay. The study, supported by Baxter through an investigator-initiated grant and recently published in Critical Care, is the first analysis of longitudinal resting energy expenditure (REE) in critically ill, mechanically ventilated COVID-19 patients. The interim findings of 22 U.S. patients assessed over 21 days suggest that predictive equations, which are commonly used to estimate patients’ nutritional needs, are largely inaccurate for this patient population. The authors observed progressive hypermetabolism and considerable variation in REE over the course of patients’ stay in the ICU, suggesting that reliance on predictive equations could lead to under-feeding of COVID-19 patients, particularly later in their ICU stay. This is notable because little is known about the nutritional needs of critically ill COVID-19 patients, and because past studies of ICU patients have associated over- and under-feeding with poor outcomes, including mortality1.
During the study, energy needs were measured by indirect calorimetry (mREE) every third day and were compared to predicted energy needs according to the Harris-Benedict equation (HBE). Hypermetabolism and wider variability in mREE were observed after the first week in the ICU. The observed hypermetabolism persisted and mREE increased during the third ICU week with an average mREE of 150 percent of that predicted. In some cases, REE was as high as two times greater than that predicted by HBE, which significantly underpredicted REE after the first ICU week. The study’s findings align with previously published literature1,2 on the importance of measuring patients’ nutritional needs and tailoring nutrition therapy over the course of a patient’s hospitalization, as REE changes during this time.
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1 Zusman et al. Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study. Critical Care (2016) 20:367. DOI: 10.1186/s13054-016-1538-4.
2 Zusman et al. Predictive equations versus measured energy expenditure by indirect calorimetry: A retrospective validation. Clinical Nutrition (2019) Jun;38(3):1206-1210. DOI: 10.1016/j.clnu.2018.04.020. Epub 2018 May 8.