Yoon Hee Choo1, Jae Hyun Kim2, Hee-Won Jung3, Moinay Kim2, Hanwool Jeon2, Eun Jin Ha4, JIWOONG OH5, Youngbo Shim6, Seung Bin Kim7, Han-Gil Jung8, So Hee Park9, Jung Ook Kim10, Junhyung Kim11, Hyeseon Kim12, Seungjoo Lee1
Abstract
Neurocritical care has emerged as a specialized field addressing the complex needs of patients with acute neurological disorders, such as stroke, brain tumor and traumatic brain injury. The clinical management of these patients necessitates precise, individualized nutritional support due to the significant variability in neurological deficits and resting energy expenditure (REE) based on factors including stroke phase, type (hemorrhagic or ischemic), and intracranial pressure and activity of neuronal cells. This emphasizes the need for accurate, patient-specific nutritional recommendations, achievable through indirect calorimetry. Traditional predictive equations may not accurately capture the diverse nutritional requirements of neurocritical patients. Indirect calorimetry offers a more reliable, personalized approach to determining patients' nutritional needs, crucial for this heterogeneous population. Furthermore, clinical practice often inadequately addresses nutritional needs in neurocritical patients, highlighting the importance of optimizing nutritional support to enhance patient outcomes. Indirect calorimetry also plays a critical role in assessing patients with non-normal body temperatures. Hypothermia affects the body's metabolic rate and overall energy expenditure, making it challenging to evaluate energy requirements during hypothermia treatment. Indirect calorimetry can provide more accurate assessments under such conditions. In conclusion, employing indirect calorimetry in neurocritical care is essential for accurate, individualized nutritional support. By accounting for factors such as stroke type, location, intracranial pressure and body temperature, indirect calorimetry offers valuable insights and improved patient care, emphasizing its indispensability in managing neurocritical patients.
Keywords: Calorimeter; Indirect calorimetry; Nutrition; Increased intracranial pressure; Energy expenditure; Hypothermia.
Fig. 1.
Comparison of direct and indirect calorimeters. Representation illustrating the differences between direct and indirect calorimeters.
This figure provides a side-by-side comparison of direct and indirect calorimeters, showcasing their distinct features and methodologies. It visually highlights the key differences in measuring energy expenditure: direct calorimetry captures heat production through a calorimeter chamber, while indirect calorimetry estimates metabolic rate by analyzing respiratory gas exchange. The figure aims to elucidate the unique aspects of each method, offering a clear understanding of their respective approaches to assessing energy expenditure.
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