Indirect Calorimetry during the COVID-19 Pandemic: Practical Guidance for Infection Control

Document Type : Short Communication


1 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran

2 Department of Nutrition, School of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran


Introduction: Indirect calorimetry (IC) is the optimal tool for the assessment of the resting energy expenditure, as well as the reference standard for energy expenditure measurement. During the outbreak of coronavirus, performing respiratory tests such as IC has become challenging. The current guidance was designed to prevent the virus spread at calorimetry centers. Methods: This protocol was devised in accordance with the latest recommendations of the World Health Organization (WHO) and Centers for Disease Control (CDC), as well as the related articles. Conclusion: Due to the specific features of COVID-19, unnecessary ICs should be avoided in the hotspots of the disease. If these tests must be performed, adherence to the validated infection control recommendations is critical.


1. Gralinski LE, Menachery VD. Return of the coronavirus: 2019-nCoV. Vol. 12, Viruses. 2020. p. 1–8.
2. World Health Organization. Transmission of SARS-CoV-2: implications for infection prevention precautions. Scientific brief, 09 July 2020. 2020;(March):1–10.
3. Lai C, Hung Y, Wang C. Asymptomatic carrier state, acute respiratory disease, and pneumonia due to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2): Facts and myths. J Microbiol Immunol Infect. 2020.
4. Bai Y, Yao L, Wei T, Tian F, Jin D-Y, Chen L, et al. Presumed asymptomatic carrier transmission of COVID-19. Jama. 2020;323(14):1406–7.
5. World Health Organization. Clinical management of severe acute respiratory infection when novel coronavirus (‎‎‎‎‎‎2019-nCoV)‎‎‎‎‎‎ infection is suspected: interim guidance 28 January 2020. Who [Internet]. 2020;10. Available from: WHO/2019-nCoV/clinical/2020.5%0ACC BY-NC-SA 3.0 IGO%0AWHO/2019-nCoV/clinical/2020.5%0ACC BY-NC-SA 3.0 IGO%0A
6. Centers for Disease Control and Prevention. Infection Control Guidance for Healthcare Professionals about Coronavirus (COVID-19) [Internet]. CDC. 2020. Available from:
7. U.S. Department of Labor. Guidance on Preparing Workplaces for COVID-19. Occup Saf Heal Adm - Osha [Internet]. 2020;18–20. Available from:
8. Delsoglio M, Achamrah N, Berger MM. Indirect Calorimetry in Clinical Practice. Clin Med (Northfield Il). 2019;1–19.
9. Oshima T, Berger MM, Waele E De, Berit A. Indirect calorimetry in nutritional therapy . A position paper by the ICALIC study group Indirect calorimetry in nutritional therapy . A position paper by the ICALIC study group. Clin Nutr [Internet]. 2016;(June). Available from:
10. McClave SA, Taylor BE, Martindale R, Warren MM, Johnson DR, Braunschweig C, et al. Guidelines for the provision and assessment of nutrition support therapy in the adult critically ill patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (ASPEN). J Parenter Enter Nutr. 2016;40(2):159–211.
11. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr. 2019;38(1):48–79.
12. Mtaweh H, Tuira L, Floh AA, Parshuram CS. Indirect calorimetry: History, technology, and application. Front Pediatr. 2018;6(September):1–8.
13. Martindale R, Patel JJ, Taylor B, Warner M, McClave SA. Nutrition therapy in the patient with COVID‐19 disease requiring ICU care. Nutr Soc Crit Care Med Am Soc Parenter Enter Nutr. 2020.
14. Barazzoni R, Bischoff SC, Breda J, Wickramasinghe K, Krznaric Z, Nitzan D, et al. ESPEN expert statements and practical guidance for nutritional management of individuals with SARS-CoV-2 infection. Elsevier; 2020.
15. Chapple LS, Fetterplace K, Asrani V, Burrell A, Cheng AC, Collins P, et al. Nutrition management for critically and acutely unwell hospitalised patients with coronavirus disease 2019 (COVID‐19) in Australia and New Zealand. Nutr Diet. 2020;77(4):426–36.
16. Lai C, Shih T, Ko W, Tang H, Hsueh P. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and coronavirus disease-2019 ( COVID-19 ): The epidemic and the challenges. Int J Antimicrob Agents. 2020;55(3):105924.
17. Crimi C, Impellizzeri P, Campisi R, Nolasco S, Spanevello A, Crimi N. Practical considerations for spirometry during the COVID-19 outbreak : Literature review and insights. Pulmonology. 2020;(xx).
18. Lo J, Wang S, Lee H, Lee S, Lee H. Proactive COVID-19 Infection Prevention Measures in a Hyperbaric Oxygen Therapy Center. Medicina (B Aires). :5–7.
19. Gemicioğlu B, Azap Ö. Turkish Thoracic Society Experts Consensus Report : Recommendations for Pulmonary Function Tests During and After COVID 19 Pandemic. 2020;21(3):193–200.
20. Crimi C, Impellizzeri P, Campisi R, Spicuzza L, Vancheri C, Crimi N. Resumption of respiratory outpatient services in the COVID-19 era: Experience from Southern Italy. Am J Infect Control [Internet]. 2020; Available from:
21. Covid- WHO. Advice on the use of masks in the context of COVID-19. Who [Internet]. 2020;(April):1–5. Available from:
22. Mss MSI, Mbbs KMR, Mph YS, Mba MOQ, Mph IA, Mbbs AAC, et al. Current knowledge of COVID-19 and infection prevention and control strategies in healthcare settings : A global analysis. Infect Control Hosp Epidemiol. 2020;1–11.
23. WHO. Rational use of personal protective equipment for coronavirus disease 2019 (COVID-19) and considerations during severe shortages. Who [Internet]. 2020;(April):1–28. Available from:
24. Hull JH, Lloyd JK, Cooper BG. Lung function testing in the COVID-19 endemic. Lancet Respir Med. 2020.
25. Cirrincione L, Plescia F, Ledda C, Rapisarda V, Martorana D, Moldovan RE, et al. COVID-19 Pandemic: Prevention and protection measures to be adopted at the workplace. Sustain. 2020;12(9):1–18.
26. WHO. 2020. Infection prevention and control during health care when novel coronavirus ( nCoV) infection is suspected: interim guidance J 2020 U https://tinyurl. com/r7w9ke. [accessed 2020-05-29]. Infection prevention and control during health care when COVID-19 is suspected. Who [Internet]. 2020;(i):1–5. Available from:
27. World Health Organization (WHO). Cleaning and Disinfection of Environmental Surfaces in the context of COVID-19: Interim guidance. Who. 2020;(May):7.
28. The US Centers for Disease Control and Prevention. Guidance for Cleaning and Disinfecting. Cdc [Internet]. 2020;1–9. Available from:
29. Singer P, Pichard C, De Waele E. Practical guidance for the use of indirect calorimetry during COVID 19 pandemic. Clin Nutr Exp. 2020;33:18–23.
30. Bertoli S, Leone A, De Amicis R, Foppiani A, Osio D, Battezzati A. Effects of wearing a FFP2 mask on indirect calorimetry measurements: A pilot study. Clin Nutr ESPEN. 2020.