Energy Requirements in Critically Ill Patients: How Close Are Our Estimates?

Alberda, Cathy; Snowden, Laura; McCargar, Linda J.; Gramlich, Leah

doi:10.1177/011542650201700138

Cited by 24 publications

(17 citation statements)

References 12 publications

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“…For example, McClave et al (1998) and Alberda et al (2002) have estimated requirements by adding 10 % to REE measured by metabolic cart, whereas Kan et al (2003) have estimated the requirements by adding 20 % to REE. As a result of the differences in how the energy requirements have been estimated, there are considerable differences in the reported rates of 'overfeeding'.…”

Section: Discussionmentioning

confidence: 99%

Controversies in the determination of energy requirements

Weekes

2007

Proc. Nutr. Soc.

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To avoid any negative outcomes associated with under- or overfeeding it is essential to estimate nutrient requirements before commencing nutrition support. The energy requirements of an individual vary with current and past nutritional status, clinical condition, physical activity and the goals and likely duration of treatment. The evidence-base for prediction methods in current use, however, is poor and the equations are thus open to misinterpretation. In addition, most methods require an accurate measurement of current weight, which is problematic in some clinical situations. The estimation of energy requirements is so challenging in some conditions, e.g. critical illness, obesity and liver disease, that it is recommended that expenditure be measured on an individual basis by indirect calorimetry. Not only is this technique relatively expensive, but in the clinical setting there are several obstacles that may complicate, and thus affect the accuracy of, any such measurements. A review of relevant disease-specific literature may assist in the determination of energy requirements for some patient groups, but the energy requirements for a number of clinical conditions have yet to be established. Regardless of the method used, estimated energy requirements should be interpreted with care and only used as a starting point. Practitioners should regularly review the patient and reassess requirements to take account of any major changes in clinical condition, nutritional status, activity level and goals of treatment. There is a need for large randomised controlled trials that compare the effects of different levels of feeding on clinical outcomes in different disease states and care settings.

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Section: Discussionmentioning

confidence: 99%

Controversies in the determination of energy requirements

Weekes

2007

Proc. Nutr. Soc.

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“…Studies of nutrition support in the ICU have confirmed the frequency of over-(25-58%) and underfeeding (12-35%). [45][46][47] Underfeeding has been linked to increased rates of total and infectious complications, 43 nosocomial bloodstream infection, 48 duration of mechanical ventilation, 49 ICU stay, 43 and mortality. 50 Impaired provision of protein increases fatigability, decreases strength and endurance, and promotes depletion of diaphragmatic muscles.…”

Section: General Remarksmentioning

confidence: 99%

Metabolic and Nutrition Support in the Chronic Critical Illness Syndrome

Schulman

Mechanick²

2012

Respir Care

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Technological innovations in the ICU have led to artificially prolonged life, with an associated cost. Chronic critical illness (CCI) occurs in patients with prolonged mechanical ventilation and allostatic overload, and is associated with a discrete and consistent metabolic syndrome. Metabolic interventions are extrapolated from clinical critical care research, scientific theory, and years of CCI patient care experience. Intensive metabolic support (IMS) is a multi-targeted approach consisting of tight glycemic control with intensive insulin therapy, early and adequate nutrition therapy, nutritional pharmacology, management of metabolic bone disease, and meticulous attention to other endocrine/metabolic derangements. Ideally, IMS should be under the supervision of a metabolic support consultative team. Further research specifically focused on the CCI population is needed to validate this current approach.

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“…However, a recent meta-analysis concluded that feeding critically ill patients with 25-66% of measured energy requirements may be sufficient, whereas increased amounts of calories improved clinical outcome in patients on enteral nutrition only [25]. Other authors suggest that patients receiving 90-100% of measured energy requirements should be considered as fed adequately [26], but that parenterally fed, critically ill patients should receive less energy than 36 kcal/kg per day [27].…”

Section: Energy Provision In Critically Ill Patientsmentioning

confidence: 99%