Critical illness demands objective, targeted nutritional therapy to prevent adverse effects of underfeeding/ over feeding. Thus, all recent societal guidelines recommend indirect calorimetry use to determine energy needs.

Among other important risk factors for severe COVID-19 outcomes, obesity has emerged along with undernutrition-malnutrition as a strong predictor of disease risk and severity. Obesity-related excessive body fat may lead to respiratory, metabolic and immune derangements potentially favouring the onset of COVID-19 complications.

The outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has presented a global public health emergency. Although predominantly a pandemic of acute respiratory disease, corona virus infectious disease-19 (COVID-19) results in multi-organ damage that impairs cardiopulmonary function and reduces cardiorespiratory fitness.

Body composition is a sensitive marker of infants’ intra- and extrauterine growth quality that can influence short- and long-term outcomes; including retinopathy of prematurity, bronchopulmonary dysplasia (BPD), metabolic health, cardiovascular and neurodevelopmental outcomes.

A major driver leading to the lack of emphasis on timely ICU nutrition delivery is lack of objective data to guide nutrition care. If we are to ultimately overcome current fundamental challenges to effective ICU nutrition delivery, we must all adopt routine objective, longitudinal measurement of energy targets via indirect calorimetry (IC).