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. 2024 Jun;28(6):587-594.
doi: 10.5005/jp-journals-10071-24737.

Comparison between Effect of Indirect Calorimetry vs Weight-based Equation (25 kcal/kg/day)-guided Nutrition on Quadriceps Muscle Thickness as Assessed by Bedside Ultrasonography in Medical Intensive Care Unit Patients: A Randomized Clinical Trial

Aravind Chandrasekaran  1 , Divya Pal  2 , Rahul Harne  2 , Sweta J Patel  2 , K N Jagadeesh  2 , Anant V Pachisia  2 , Pooja Tyagi  2 , Keerti Brar  2 , Swagat Pattajoshi  2 , Parimal B Patel  2 , Ronak Zatakiya  2 , Deepak Govil  2
Affiliations

Comparison between Effect of Indirect Calorimetry vs Weight-based Equation (25 kcal/kg/day)-guided Nutrition on Quadriceps Muscle Thickness as Assessed by Bedside Ultrasonography in Medical Intensive Care Unit Patients: A Randomized Clinical Trial

Aravind Chandrasekaran et al. Indian J Crit Care Med. 2024 Jun.

Abstract

Aim and background: Sarcopenia is a substantial contributor to intensive care unit (ICU)-acquired weakness and is associated with significant short- and long-term outcomes. It can, however, be mitigated by providing appropriate nutrition. Indirect calorimetry (IC) is believed to be the gold standard in determining caloric targets in the dynamic environment of critical illness. We conducted this study to compare the effect of IC vs weight-based (25 kcal/kg/day) feeding on quadriceps muscle thickness (QMT) by ultrasound in critically ill patients.

Materials and methods: A prospective study was conducted on 60 mechanically ventilated patients randomized to two groups [weight-based equation (WBE) group or the IC group] in medical ICU after obtaining institutional ethics committee approval, and fed accordingly. The right QMT measurement using ultrasound and caloric targets were documented on day 1, 3 and 7 and analyzed statistically. The IC readings were obtained from the metabolic cart E-COVX ModuleTM.

Results: The baseline demographics, APACHE-II, NUTRIC score, and SOFA scores on day 1, 3, and 7 were comparable between the two groups. The resting energy expenditure (REE) obtained in the IC group was significantly less than the WBE energy targets and the former were fed with significantly less calories. A significantly less percent reduction of QMT in the IC group compared with the WBE group was observed from day 1 to day 3, day 3 to day 7, and day 1 to day 7.

Conclusion: From our study, we conclude that IC-REE-based nutrition is associated with lesser reduction in QMT and lesser calories fed in critically ill mechanically ventilated patients compared from WBE. CTRI registration-CTRI/2023/01/049119.

How to cite this article: Chandrasekaran A, Pal D, Harne R, Patel SJ, Jagadeesh KN, Pachisia AV, et al. Comparison between Effect of Indirect Calorimetry vs Weight-based Equation (25 kcal/kg/day)-guided Nutrition on Quadriceps Muscle Thickness as Assessed by Bedside Ultrasonography in Medical Intensive Care Unit Patients: A Randomized Clinical Trial. Indian J Crit Care Med 2024;28(6):587-594.

Keywords: Caloric target; Critically ill; Indirect calorimetry; Intensive care unit–acquired weakness; Muscle wasting; Nutrition; Quadriceps muscle thickness; Sarcopenia; Ultrasound.

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Conflict of interest statement

Source of support: Nil Conflict of interest: Dr Deepak Govil is associated as Associate Editor of this journal and this manuscript was subjected to this journal's standard review procedures, with this peer review handled independently of the Associate Editor and his research group.

Figures

Fig. 1
Fig. 1
Flow diagram of the study
Fig. 2
Fig. 2
Assessment of quadriceps muscle thickness (RF, rectus femoris plus; VI, vastus intermedius; VM, vastus medialis) using ultrasound
Fig. 3
Fig. 3
Reference points for measurement of quadriceps muscle thickness. At the junction of upper 2/3rd and lower 1/3rd of the distance between anterior superior iliac spine and superior border of patella
Fig. 4
Fig. 4
ECOV-X module with D-lite gas sampling line and sensor, attachment to the patient
Fig. 5
Fig. 5
Comparison of energy target (kcal/kg) between indirect calorimetry and weight-based equation
Fig. 6
Fig. 6
Comparison of percentage reduction in quadriceps muscle thickness from day 1 to day 3 between indirect calorimetry and weight-based equation
Fig. 7
Fig. 7
Comparison of percentage reduction in quadriceps muscle thickness from day 3 to day 7 between indirect calorimetry and weight-based equation
Fig. 8
Fig. 8
Comparison of percentage reduction in quadriceps muscle thickness from day 1 to day 7 between indirect calorimetry and weight-based equation
See this image and copyright information in PMC

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