Should indirect calorimetry be used as part of nutritional assessment?

The use of indirect calorimetry in the design of nutritional support regime ns is poorly appreciated by clinicians, who fail to recognize the importanc e of providing a sufficient volume of enteral feeding to critically ill pat ients. Tn contrast to the overfeeding that routinely occurred in the past w ith the provision of total parenteral nutrition, patients placed on the ent eral route of support tend to be underfed because of problems with intolera nce and frequent cessation. Clearly identifying and coming as close as poss ible to the caloric goal may be required to achieve the therapeutic endpoin ts of enteral tube feeding (which include maintenance of gut integrity, att enuation of the stress response, prophylaxis against stress-induced gastrop athy, and stimulation of immune function). indirect calorimetry is a-conven ient, accessible, and highly accurate instrument for the measurement of cal oric requirements and is a valuable tool for the optimization of nutritiona l support in the intensive care unit.