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Feasibility of Using Indirect Calorimetry During Physical Rehabilitation in Critically Ill Patients


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Feasibility of Using Indirect Calorimetry During Physical Rehabilitation in Critically Ill Patients


•Physical rehabilitation (PR) of patients in the intensive care unit (ICU) is recommended to ameliorate ICU-acquired weakness and enhance functional recovery; however optimal dose and physiological effects of rehabilitation practices have not been established

•Indirect Calorimetry (IC) is a method to estimate energy metabolism, which could aid individualisation of exercise interventions
•Few studies have investigated the use of IC within an ICU population with limited data on clinical applicability in this setting
•The aim of this study was to examine the feasibility of IC in patients receiving physical rehabilitation in the ICU, focusing on patient eligibility and enrolment
•Prospective observational study (HRA REC 16/LO/0076)
•Daily screening of patients admitted to a 30-bed mixed medical/surgical ICU; eligible patients included adults with critical illness requiring invasive mechanical ventilation for ≥48hours and having commenced PR
•Exclusion criteria included presence of clinical factors causing potential inaccuracies with IC measurement (e.g. high FiO2) or precluding disconnection of the ventilator (e.g. cardiorespiratory instability), and specialist rehabilitation populations (e.g. neurological injury)
•IC measurement was performed through a commercially available ventilator with an IC cart (Carescape R860, GE Healthcare, US), allowing estimated energy consumption through expired gas analysis
•Measurements were performed at three time points: 1) 30 minutes prior to a PR session, 2) during a PR session; 3) during the post-PR recovery period
•104 patients were admitted during the 5week study period (4th July – 5th Aug 2016), resulting in 859 bed-day screening occasions (Figure 1)
•Ineligibility based on inclusion criteria (748 occasions, 87.1%) was due to not receiving PR (N1, 249/748, 33.3%), insufficient duration of mechanical ventilation (N2, 230/748, 30.7%), or both (269/748, 36.0%)
•Additional presence of exclusion criteria (range 1-5) resulted in further ineligibility on 53 occasions (Table 1)
•Presence of renal replacement therapy within the last 24h (62.5%), far exceeded the frequency of occurrence of all other exclusion criteria
•14 (13.5%) patients were eligible for enrolment (58 screening occasions); 4 patients were enrolled with IC measurement on 6 unique PR sessions
•Non-enrolment was secondary to lack of consent prior to PR session, altered clinical management plan post screening and weekend researcher availability
•Eligibility and enrolment data from this feasibility study demonstrate only a small percentage of critically ill patients met criteria for undergoing IC measurement
•IC may have limited clinical applicability for informing physical rehabilitation in a general ICU population
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