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Summary
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9
Therefore this approach should be implemented in current nutritional practice on PICUs
worldwide.
Chapter 8
This chapter provides a general discussion in which the main findings of this thesis are
evaluated and substantiated by speculations on underlying mechanisms. Based on the
findings and available literature, current gaps in knowledge of nutritional support in critically
ill children are highlighted and are followed by future perspectives on clinical practice and
nutritional research.
Table 1.
Main findings of this thesis
Findings
Chapter 1
Introduction
Understanding the stress response of critical illness and its phases is essential
to provide recommendations on amount, timing and route of nutrition in
critically ill children
Chapter 2
Worldwide survey of
nutritional practices in
PICUs
Current nutritional practices vary widely between PICUs worldwide, especially
on macronutrient targets, estimation of energy requirements and threshold for
the use of (supplemental) PN. Applied nutritional practice deviated from local
protocols or strategies on multiple occasions.
There appears to be wide-spread consensus on the preference for the enteral
route and its early initiation
Chapter 3
Ventilator-derived
VCO
2
measurements to
determine REE
Use of VCO
2
measurements by the Servo-I® ventilator is a feasible and more
precise method to determine REE in mechanically ventilated children >15 kg
than predictive equations. It may be a promising method to compensate for
the limited availability of indirect calorimetry in the future
Chapter 4
Use of indirect
calorimetry to detect
overfeeding
The number of children identified as overfed ranges widely depending on the
definition used. Current definitions of overfeeding fail to take into account
several factors associated with critical illness and are therefore not generally
applicable to the PICU population
Chapter 5
Evidence for the use of
PN in the PICU
There is currently no evidence to support any of the current PN practices for
critically ill children. Available RCTs focus on surrogate outcome measures
instead of hard clinical outcomes. The evidence from high quality RCTs in
critically ill adults no longer supports the early use of PN
Chapter 6 and 7
PEPaNIC trial
Withholding PN for one week in the PICU is clinically superior to early
provision of PN, with fewer new infections, shorter duration of intensive care
dependency and a shorter hospital stay
PICU= Paediatric Intensive Care Unit, REE= Resting Energy Expenditure, PN= Parenteral Nutrition, RCT=
Randomised Controlled Trial