Pp192-Sun Measured Versus Calculated Resting Energy Expenditure in Critically Ill Adult Patients. Do Mathematics Match the Golden Standard?

Waele, Elisabeth De; Opsomer, T.; Mattens, Sabrina; Diltoer, Marc; Honoré, Patrick M.; Spapen, H.; Huyghens, Luc

doi:10.1016/s0261-5614(13)60237-x

Cited by 41 publications

(66 citation statements)

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“…However, indirect calorimetry is not conducted routinely in most intensive care units (ICU) mainly due to the lack of a reliable indirect calorimeter, and manpower with appropriate expertise to conduct and analyze the results [7]. Recent studies comparing currently available calorimeters have demonstrated that the measured EE is variable from one calorimeter to another [8, 9], although they are still more consistent than the EE calculated from predictive equations [10]. …”

Section: Introductionmentioning

confidence: 99%

Can calculation of energy expenditure based on CO2 measurements replace indirect calorimetry?

et al. 2017

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BackgroundMethods to calculate energy expenditure (EE) based on CO2 measurements (EEVCO2) have been proposed as a surrogate to indirect calorimetry. This study aimed at evaluating whether EEVCO2 could be considered as an alternative to EE measured by indirect calorimetry.MethodsIndirect calorimetry measurements conducted for clinical purposes on 278 mechanically ventilated ICU patients were retrospectively analyzed. EEVCO2 was calculated by a converted Weir’s equation using CO2 consumption (VCO2) measured by indirect calorimetry and assumed respiratory quotients (RQ): 0.85 (EEVCO2_0.85) and food quotient (FQ; EEVCO2_FQ). Mean calculated EEVCO2 and measured EE were compared by paired t test. Accuracy of EEVCO2 was evaluated according to the clinically relevant standard of 5% accuracy rate to the measured EE, and the more general standard of 10% accuracy rate. The effects of the timing of measurement (before or after the 7th ICU day) and energy provision rates (<90 or ≥90% of EE) on 5% accuracy rates were also analyzed (chi-square tests).ResultsMean biases for EEVCO2_0.85 and EEVCO2_FQ were -21 and -48 kcal/d (p = 0.04 and 0.00, respectively), and 10% accuracy rates were 77.7 and 77.3%, respectively. However, 5% accuracy rates were 46.0 and 46.4%, respectively. Accuracy rates were not affected by the timing of the measurement, or the energy provision rates at the time of measurements.ConclusionsCalculated EE based on CO2 measurement was not sufficiently accurate to consider the results as an alternative to measured EE by indirect calorimetry. Therefore, EE measured by indirect calorimetry remains as the gold standard to guide nutrition therapy.

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Section: Introductionmentioning

confidence: 99%

Can calculation of energy expenditure based on CO2 measurements replace indirect calorimetry?

et al. 2017

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“…Energy requirements were estimated using different predictive formulae in all but one study, which used indirect calorimetry [63]. This method has been shown to poorly correlate with indirect calorimetry [92], which is considered to be the standard. Based on recent evidence, calorimetry-guided nutrition might be superior to predictive formula-based feeding in improving patient-centered outcomes [63, 89].…”

Section: Discussionmentioning

confidence: 99%

Lower versus higher dose of enteral caloric intake in adult critically ill patients: a systematic review and meta-analysis

et al. 2016

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BackgroundThere is conflicting evidence about the relationship between the dose of enteral caloric intake and survival in critically ill patients. The objective of this systematic review and meta-analysis is to compare the effect of lower versus higher dose of enteral caloric intake in adult critically ill patients on outcome.MethodsWe reviewed MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, and Scopus from inception through November 2015. We included randomized and quasi-randomized studies in which there was a significant difference in the caloric intake in adult critically ill patients, including trials in which caloric restriction was the primary intervention (caloric restriction trials) and those with other interventions (non-caloric restriction trials). Two reviewers independently extracted data on study characteristics, caloric intake, and outcomes with hospital mortality being the primary outcome.ResultsTwenty-one trials mostly with moderate bias risk were included (2365 patients in the lower caloric intake group and 2352 patients in the higher caloric group). Lower compared with higher caloric intake was not associated with difference in hospital mortality (risk ratio (RR) 0.953; 95 % confidence interval (CI) 0.838–1.083), ICU mortality (RR 0.885; 95 % CI 0.751–1.042), total nosocomial infections (RR 0.982; 95 % CI 0.878–1.077), mechanical ventilation duration, or length of ICU or hospital stay. Blood stream infections (11 trials; RR 0.718; 95 % CI 0.519–0.994) and incident renal replacement therapy (five trials; RR 0.711; 95 % CI 0.545–0.928) were lower with lower caloric intake. The associations between lower compared with higher caloric intake and primary and secondary outcomes, including pneumonia, were not different between caloric restriction and non-caloric restriction trials, except for the hospital stay which was longer with lower caloric intake in the caloric restriction trials.ConclusionsWe found no association between the dose of caloric intake in adult critically ill patients and hospital mortality. Lower caloric intake was associated with lower risk of blood stream infections and incident renal replacement therapy (five trials only). The heterogeneity in the design, feeding route and timing and caloric dose among the included trials could limit our interpretation. Further studies are needed to clarify our findings.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-016-1539-3) contains supplementary material, which is available to authorized users.

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“…The data are then combined and introduced in the modified Weir equation to obtain REE. As documented earlier, 14 formula-based calculations of REE were not mutually consistent and underestimated REE by approximately 10-20% as compared with measured REE values.…”

Section: Discussionmentioning

confidence: 79%

Measuring resting energy expenditure during extracorporeal membrane oxygenation: preliminary clinical experience with a proposed theoretical model

Waele

Zwam

Mattens

et al. 2015

Acta Anaesthesiol Scand

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Pp192-Sun Measured Versus Calculated Resting Energy Expenditure in Critically Ill Adult Patients. Do Mathematics Match the Golden Standard?

Cited by 41 publications

References 0 publications

Can calculation of energy expenditure based on CO2 measurements replace indirect calorimetry?

Can calculation of energy expenditure based on CO2 measurements replace indirect calorimetry?

Lower versus higher dose of enteral caloric intake in adult critically ill patients: a systematic review and meta-analysis

Measuring resting energy expenditure during extracorporeal membrane oxygenation: preliminary clinical experience with a proposed theoretical model

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