Caloric requirements in critically ill trauma patients as measured by indirect calorimetry: Changes over time and effect of clinical factors

Abstract text (incl. references and figure legends)

Introduction: Nutrition is of paramount importance in critically ill trauma patients. However, adequate supply is difficult to achieve, as actual caloric requirements are not known and may change. Therefore, the current study aimed to investigate (1) caloric requirements over time and (2) the effect of clinical factors on requirements in critically ill trauma patients. Methods: Retrospective cohort study at tertiary trauma center including critically ill trauma patients who underwent indirect calorimetry (IC) 2012 - 2019. Caloric requirements were assessed as resting energy expenditure (REE) for 28 days during the ICU stay. REE over time and factors affecting REE were analyzed in cluster linear regression. Results were reported as regression coefficients (RC) with p-values. Results: A total of 129 patients were included. Median age was 56 y, 80% were male, BMI 26 kg/m2, and ISS 36. Median ICU length of stay was 12 days and 30-d mortality 11%. REE initially increased and subsequently decreased over time. (Fig. 1) Median REE per day was 2265 kcal (IQR 1934-2686). In univariable analysis, ISS was not significantly associated with REE over time (RC 0.03, p=0.600). Multivariable analysis revealed a significant REE increase (RC 0.62, p<0.001) and subsequent decrease (RC -0.03, p<0.001) over time, as well as age <65 y (RC 2.07, p=0.018), male sex (RC 4.38, p<0.001), no severe head trauma (RC 2.10, p=0.030) and BMI ≥35 kg/m2 (RC 6.94, p<0.001) as independent predictors for higher REE over time. Conclusion: In critically ill trauma patients, caloric requirements as measured by IC significantly increased and subsequently decreased over time. Younger age, male sex, no severe head trauma, and higher BMI were identified as independent predictors for higher caloric requirements over time, whereas for injury severity, no significant association was found. These results may help to improve nutrition through the use of IC to estimate caloric requirements in critically ill trauma patients.

Disclosure: Do you have a significant financial interest, consultancy or other relationship with products, manufacturer(s) of products or providers of services related to this abstract? (If not, please enter "No" in the text field.)

No