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Harnessing Big Data to Count Calories in the ICU

Feeling hungry is a signal from our bodies to our brains that we need fuel to be healthy. But some patients in the intensive care unit (ICU) with traumatic brain injuries or other complications are not able to express or even sense hunger. Often, these patients are connected to tubes that deliver enteral nutrition (EN), a liquid formulation of nutrients delivered to the GI tract.

EN has been shown to have a positive impact on the recovery process, from reducing infections to shortening the length of hospital stays to promoting faster cognitive recovery. But, EN is only beneficial if patients are receiving enough nutrients to counterbalance their energy expenditure – even immobile patients burn calories through normal biological functions like breathing and thinking. However, the average patient only receives about 50 percent of their daily calorie needs, meaning that many patients in the ICU are at risk for malnutrition.  That’s where David Do, MD, a software developer and Neurology resident at Penn, and his fellow researchers come in—they are working on software that will make it easier to track a patient’s nutritional needs and make sure they are getting enough daily calories to help them recover properly.

I sat down with Do to ask him a few questions about the software he is developing and how it will help patients.

Q: Why is nutrition so important for ICU patients?

A: Nutrition is actually a really important part of the recovery process for anyone who is sick. Think about it: even with the common cold, general treatment advice is to rest up and get plenty of food and fluids to help you heal. This is even more important for people who are critically ill and/or in the ICU. 

Patients who are underfed have a higher risk for muscular breakdown and have more trouble fighting off infections. Most of my patients in the Neurointensive Care Unit are in the hospital for a week or longer and in that time it's possible for serious nutrient deficiencies to occur that could ultimately impact the recovery process.

Q:  Why are some ICU patients under-nourished?

A: Normally, our bodies tell us when and how much we need to eat through our sense of hunger. But patients with brain injuries, swallowing malfunctions, or who are on ventilators, can’t tell us when they feel hungry. Instead, they have to rely on clinicians to deliver the right amount of nutrients through feeding tubes.

Q: What challenges to do care teams face when trying to ensure patients receive proper nourishment?

A: Critically ill patients have really complicated medical problems and care teams are often focused on these pressing issues. Unfortunately, sometimes this means that nutrition can fall to the bottom of the list of needs. To make things more complicated, each patient has different needs, meaning they need customized nutrition plans that often require complex calculations. Getting the nutrition levels correct can be challenging for clinicians who are balancing many complicated care needs for several patients. That’s why we created our Enteral Nutrition Calorimeter software—to make it easier for care providers to give patients the nutrients they need to support the recovery process.

Q: How does the software work?

A: This project is really about how we can leverage data that we already have through electronic medical records (EMR) to improve care. In the Calorimeter project, we designed custom monitoring software that tallies the patient’s intake and, based on the nutritional content of the feed, determines how many calories and grams of protein the patient has received. We then estimate each patient’s energy expenditure to determine who received enough. We use this data to provide constant feedback to clinicians by sending automated secure messages to the right person at the right time.

Q: What results have you seen so far?

A: Right now, we are going through the design phase. Our early investigations have helped us map out the obstacles to feeding. We even tried placing a clinician on daily rounds who was dedicated to optimizing nutrition, which improved feeding rates dramatically. While the extra attention may not be sustainable or scalable, we identified several barriers that are addressable through automated methods. We are working on crafting and testing messages to see what makes clinicians respond the most.  

Q: As a resident, how you were supported by Penn faculty to move this project forward?

A: The Neurology faculty have been tremendously supportive of this project, especially the Neurointensive Care faculty who were eager to help design and adopt our solution in their unit. Penn Medicine has become a great environment for interdisciplinary collaborations and innovations, especially for residents. Since I first arrived at Penn more than three and half years ago, I’ve seen a tremendous investment in infrastructure and technology that now allows us to rapidly build and test tech-enabled interventions and applications that will improve patient care. 

Do and his fellow researchers were recently awarded funding for their project through Penn’s Innovation Accelerator Program. Now in its fourth year, the Innovation Accelerator Program from the Penn Medicine Center for Health Care Innovation supports promising ideas from faculty and staff across departments and roles at the University of Pennsylvania Health System in their efforts to develop, test, and implement new approaches to care. This year’s program is co-sponsored by UnitedHealthcare.

The research team includes John Chandler, MD, Neurocritical Care Physician; Joshua Vanderwerf, MD, Neurology Resident; Jennifer McKenna, CNSS, Clinical Dietitian Specialist; Bethany Young, RN, Clinical Nurse Specialist; Susan Kennedy, CNSS, Clinical Dietitian Specialist; Kai Holder, Research Assistant; Davis Hermann, Design Strategist, and Diane Dao, Innovation Intern


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