Proefschrift Kerklaan

Chapter 1

Outline of this thesis Part I: Introduction

This thesis aims to provide insight in current nutritional support during stay on the paediatric intensive care unit (PICU), concerning the route, timing and amount of artificial nutrition, with focus on the identification and risk of caloric overfeeding and the use of (supplemental) parenteral nutrition. Part II: Current nutritional practices The second part of this thesis describes daily nutritional practice in the PICU. Chapter 2 highlights the variation in current clinical practice regarding several aspects of nutritional support by an international online survey in 156 PICUs across the world. To compare intended with applied nutritional practice, this survey identifies information on local strategies as well as their execution in patients by use of point prevalence data. Part III: Energy expenditure The third part focuses on the determination of resting energy expenditure (REE) by indirect calorimetry in critically ill children. Chapter 3 aimed to validate an alternative method for measurement of energy expenditurewith indirect calorimetry by use of ventilator-derivedVCO 2 measurements in 41 mechanically ventilated children. In Chapter 4 different internationally used definitions of caloric overfeeding are compared in order to find the most adequate method to identify overfeeding. In order to do so, measurements of REE and respiratory quotient from 79 mechanically ventilated children are studied in relation to caloric intake. Part IV: Supplemental parenteral nutrition In this part the effect of timing of parenteral nutrition in the PICU is investigated. Chapter 5 reviews the current scarce evidence for the use of parenteral nutrition in the PICU, thereby underlining the need for large nutritional RCTs. In Chapter 6 and 7 a multicentre, international RCT in 1440 critically ill children at nutritional risk is described. The strategy of withholding supplemental parenteral nutrition for one week in the PICU is compared to providing early parenteral nutrition. Primary clinical outcomes are the number of patients with new infections and length of PICU stay. Part V: General discussion, including future perspectives, and summary The last part of this thesis is dedicated to the general discussion and suggestions for future research in nutritional support, which can be read in Chapter 8. A summary of the major findings of this thesis can be found in Chapter 9 (English and Dutch).

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