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Hypermetabolism has been described in stress states such as trauma, sepsis, acute respiratory distress syndrome, and severe burn injuries. We hypothesize that patients with Coronavirus disease 2019 (COVID‐19) may develop a hypermetabolic state, which may be a major contributing factor to the extraordinary ventilatory and oxygenation demands in patients with COVID‐19.

Resting energy expenditure (REE), carbon dioxide production (VCO₂), and oxygen consumption (VO₂) were measured by indirect calorimetry on 7 critically ill patients with COVID‐19.

The median measured REE was 4044 kcal/d, which was 235.7% ± 51.7% of predicted. The median VCO₂ was 452 mL/min (range, 295–582 mL/min), and the median VO₂ was 585 mL/min (range, 416–798 mL/min).

Critically ill patients with COVID‐19 are in an extreme hypermetabolic state. This may explain the …