{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T21:08:32Z","timestamp":1788469712740,"version":"build-2803163510"},"reference-count":34,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2022,10,10]],"date-time":"2022-10-10T00:00:00Z","timestamp":1665360000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nutrients"],"abstract":"<jats:p>Optimal energy provision, guided by measured resting energy expenditure (REE) and determined by indirect calorimetry (IC), is fundamental in Intensive Care Units (ICU). Because IC availability is limited, methods to predict REE based on carbon dioxide production (VCO2) measurements (REEVCO2) alone have been proposed as a surrogate for REE measured by IC (REEIC). The study aimed at externally and internally validating the accuracy of the REEVCO2 as an alternative to REEIC in mechanically ventilated children. A ventilator\u2019s integrated gas exchange module (E-COVX) was used to prospectively measure REEIC and predict REEVCO2 on 107 mechanically ventilated children during the first 24 h of admission. The accuracy of the REEVCO2 compared to REEIC was assessed through the calculation of bias and precision, paired median differences, linear regression, and ROC analysis. Accuracy within \u00b110% of the REEIC was deemed acceptable for the REEVCO2 equation. The calculated REEVCO2 based on respiratory quotient (RQ) 0.89 resulted in a mean bias of \u221272.7 kcal\/day (95% limits of agreement \u2212321.7 to 176.3 kcal\/day) and a high coefficient of variation (174.7%), while 51.4% of the calculations fell outside the \u00b110% accuracy rate. REEVCO2 derived from RQ 0.80 or 0.85 did not improve accuracy. Only measured RQ (Beta 0.73, p &lt; 0.001) and no-recorded neuromuscular blocking agents (Beta \u22120.13, p = 0.044) were independently associated with the REEVCO2\u2212REEIC difference. Among the recorded anthropometric, metabolic, nutrition, or clinical variables, only measured RQ was a strong predictor of REEVCO2 inaccuracy (p &lt; 0.001). Cutoffs of RQ = 0.80 predicted 89% of underestimated REEIC (sensitivity 0.99; specificity 0.89) and RQ = 0.82 predicted 56% of overestimated REEIC (sensitivity of 0.99; specificity 0.56). REEVCO2 cannot be recommended as an alternative to REEIC in mechanically ventilated children, regardless of the metabolic, anthropometric, or clinical status at the time of the evaluation.<\/jats:p>","DOI":"10.3390\/nu14194211","type":"journal-article","created":{"date-parts":[[2022,10,11]],"date-time":"2022-10-11T00:50:01Z","timestamp":1665449401000},"page":"4211","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["External Validation with Accuracy Confounders of VCO2-Derived Predicted Energy Expenditure Compared to Resting Energy Expenditure Measured by Indirect Calorimetry in Mechanically Ventilated Children"],"prefix":"10.3390","volume":"14","author":[{"given":"Panagiotis","family":"Briassoulis","sequence":"first","affiliation":[{"name":"Pediatric Intensive Care Unit, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece"},{"name":"Department of Anaesthesiology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, 12462 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0936-368X","authenticated-orcid":false,"given":"Stavroula","family":"Ilia","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece"},{"name":"Postgraduate Program \u201cEmergency and Intensive Care in Children Adolescents and Young Adults\u201d, School of Medicine, University of Crete, Voutes, 71003 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Efrossini","family":"Briassouli","sequence":"additional","affiliation":[{"name":"Infectious Diseases Department \u201cMAKKA\u201d, First Department of Paediatrics, \u201cAghia Sophia\u201d Children\u2019s Hospital, Athens Medical School, 11527 Athens, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0928-6183","authenticated-orcid":false,"given":"George","family":"Briassoulis","sequence":"additional","affiliation":[{"name":"Pediatric Intensive Care Unit, University Hospital, School of Medicine, University of Crete, 71110 Heraklion, Greece"},{"name":"Postgraduate Program \u201cEmergency and Intensive Care in Children Adolescents and Young Adults\u201d, School of Medicine, University of Crete, Voutes, 71003 Heraklion, Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,10]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"12","DOI":"10.1002\/jpen.2267","article-title":"Guidelines for the Provision of Nutrition Support Therapy in the Adult Critically Ill Patient: The American Society for Parenteral and Enteral Nutrition","volume":"46","author":"Compher","year":"2022","journal-title":"JPEN J. 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