14 October 2020 - - US-based nutrition therapy company Baxter International Inc. (NYSE: BAX) supports interim findings of an ongoing prospective study, "Persistent Hypermetabolism and Longitudinal Energy Expenditure in Critically Ill Patients with COVID-19 (LEEP-COVID)," demonstrating the role of indirect calorimetry in improving the accuracy of measuring COVID-19 patients' nutritional needs during their intensive care unit stay, the company said.

The study, supported by Baxter through an investigator-initiated grant and recently published in Critical Care, is the first analysis of longitudinal resting energy expenditure in critically ill, mechanically ventilated COVID-19 patients.

The interim findings of 22 US patients assessed over 21 days suggest that predictive equations, which are commonly used to estimate patients' nutritional needs, are largely inaccurate for this patient population.

The authors observed progressive hypermetabolism and considerable variation in REE over the course of patients' stay in the ICU, suggesting that reliance on predictive equations could lead to under-feeding of COVID-19 patients, particularly later in their ICU stay.

This is notable because little is known about the nutritional needs of critically ill COVID-19 patients, and because past studies of ICU patients have associated over- and under-feeding with poor outcomes, including mortality1.

During the study, which was supported by Baxter through an investigator-initiated grant, energy needs were measured by indirect calorimetry every third day and were compared to predicted energy needs according to the Harris-Benedict equation.

Hypermetabolism and wider variability in mREE were observed after the first week in the ICU.

The observed hypermetabolism persisted and mREE increased during the third ICU week with an average mREE of 150% of that predicted.

In some cases, REE was as high as two times greater than that predicted by HBE, which significantly underpredicted REE after the first ICU week.

The study's findings align with previously published literature1,2 on the importance of measuring patients' nutritional needs and tailoring nutrition therapy over the course of a patient's hospitalization, as REE changes during this time.

In partnership with COSMED SRL, Baxter introduced Q-NRG+, a metabolic monitor device utilizing indirect calorimetry technology, in the US earlier this year. Q-NRG+ was previously available in several additional markets in 2019.

IC is considered the "gold standard"3 when assessing a patient's calorie needs, or REE. These readings can help inform prescription and administration of nutrition therapy, which may include parenteral nutrition, the intravenous administration of nutrients.

COVID-19 has challenged how hospitals provide care across many facets of the patient experience, and those challenges extend to safe use of indirect calorimetry.

The recent publication, "Practical guidance for the use of indirect calorimetry during COVID 19 pandemic," offers direction to protect the safety of healthcare providers and the COVID-19 patients they support.

In addition, the manufacturer of Q-NRG+, COSMED, has compiled information explaining how the device is designed to minimize the risk of infections due to contaminated components, including use of disposable filters, along with instructions for properly cleaning and disinfecting reusable parts.

The importance of indirect calorimetry in this population when it can be performed safely is highlighted by the LEEP-COVID study, and is an approach also supported by the European Society for Clinical Nutrition and Metabolism (ESPEN) for ICU patients.

In addition to providing many essential ingredients necessary to create well-balanced formulations of a clinical nutrition regimen, Baxter offers innovative and accessible products and services designed to be used in different healthcare environments, including in the ICU and the hospital, nursing homes, clinics and in homes.