Abstract

Objective:

Indirect calorimetry (IC) is considered the gold standard in the accurate determination of energy consumption in intensive care patients. This study compared measured energy expenditure (MEE) with estimated energy expenditure (EEE), calculated from predictive equations, in mechanically ventilated patients.

Materials and Methods:

This study was conducted on 40 patients hospitalized in our medical/surgical intensive care unit. Twenty four-hour energy consumption measured by IC and energy consumption calculated by adding correction factors for actual and corrected weights using Harris-Benedict, Schofield, Ireton-Jones and Swinamer equations were compared.

Results:

MEE was 2697.9±606.0 kcal/day. All of the EEE values, calculated using equations were moderately correlated with MEE and correlations were stronger with adjusted body weights, however, Bland-Altman statistics represent wide limits of agreement. From another perspective, EEE corresponding to between 80% and 110% of MEE was considered an adequate feeding range and provided the best levels of proficiency using adjusted body weight and Long factors; however, at least, 20% of patients remained at under-or overfeeding risk.

Conclusion:

It was concluded that the estimation equations are unreliable in determining energy consumption in mechanically ventilated intensive care patients due to wide limits of agreement. Estimates falling in the range of 80-110% of MEE also indicate the possibility of malnutrition. Our study supports previous studies, which indicated that nutrition management requires an individual approach.

Keywords: Indirect calorimetry, estimating energy expenditure, mechanical ventilation, nutrition, intensive care unit

References

  1. Delsoglio M, Achamrah N, Berger MM, Pichard C. Indirect Calorimetry in Clinical Practice. J Clin Med 2019;8:1387.
  2. Ndahimana D, Kim EK. Energy Requirements in Critically Ill Patients. Clin Nutr Res 2018;7:81-90.
  3. WEIR JB. New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol 1949;109:1-9.
  4. Oshima T, Berger MM, De Waele E, Guttormsen AB, Heidegger CP, Hiesmayr M, et al. Indirect calorimetry in nutritional therapy. A position paper by the ICALIC study group. Clin Nutr 2017;36:651-62.
  5. 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;38:48-79.
  6. McClave SA, Taylor BE, Martindale RG, 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 (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 2016;40:159-211.
  7. Swinamer DL, Phang PT, Jones RL, Grace M, King EG. Twenty-four hour energy expenditure in critically ill patients. Crit Care Med 1987;15:637-43.
  8. Barak N, Wall-Alonso E, Sitrin MD. Evaluation of stress factors and body weight adjustments currently used to estimate energy expenditure in hospitalized patients. JPEN J Parenter Enteral Nutr 2002;26:231-8.
  9. Boullata J, Williams J, Cottrell F, Hudson L, Compher C. Accurate determination of energy needs in hospitalized patients. J Am Diet Assoc 2007;107:393-401.
  10. MacDonald A, Hildebrandt L. Comparison of formulaic equations to determine energy expenditure in the critically ill patient. Nutrition 2003;19:233-9.
  11. Long CL, Schaffel N, Geiger JW, Schiller WR, Blakemore WS. Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. JPEN J Parenter Enteral Nutr 1979;3:452-6.
  12. Reid CL. Poor agreement between continuous measurements of energy expenditure and routinely used prediction equations in intensive care unit patients. Clin Nutr 2007;26:649-57.
  13. Zusman O, Kagan I, Bendavid I, Theilla M, Cohen J, Singer P. Predictive equations versus measured energy expenditure by indirect calorimetry: A retrospective validation. Clin Nutr 2019;38:1206-10.
  14. Frankenfield DC, Coleman A, Alam S, Cooney RN. Analysis of estimation methods for resting metabolic rate in critically ill adults. JPEN J Parenter Enteral Nutr 2009;33:27-36.
  15. Sungurtekin H, Karakuzu S, Serin S. Energy Expenditure in Mechanically Ventilated Patients: Indirect Calorimetry vs Predictive Equations.Turkish Journal of Medical & Surgical Intensive Care Medicine/ Dahili ve Cerrahi Bilimler Yoğun Bakım Dergisi 2019;10.
  16. De Waele E, Opsomer T, Honoré PM, Diltoer M, Mattens S, Huyghens L, et al. Measured versus calculated resting energy expenditure in critically ill adult patients. Do mathematics match the gold standard? Minerva Anestesiol 2015;81:272-82.
  17. Ireton-Jones C. Adjusted body weight, con: why adjust body weight in energy-expenditure calculations? Nutr Clin Pract 2005;20:474-9.
  18. Faisy C, Guerot E, Diehl JL, Labrousse J, Fagon JY. Assessment of resting energy expenditure in mechanically ventilated patients. Am J Clin Nutr 2003;78:241-9.
  19. Vasileiou G, Qian S, Iyengar R, Mulder MB, Gass LM, Parks J, et al. Use of Predictive Equations for Energy Prescription Results in Inaccurate Estimation in Trauma Patients. Nutr Clin Pract 2020;35:927-32.
  20. Brandi LS, Santini L, Bertolini R, Malacarne P, Casagli S, Baraglia AM. Energy expenditure and severity of injury and illness indices in multiple trauma patients. Crit Care Med. 1999;27:2684-9.

Copyright and license

Copyright © 2023 The Author(s). This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite?

1.
Dayıoğlu M, Yosunkaya A. Comparison of Calculated and Measured Energy Expenditure Determination Methods. Turk J Intensive Care. 2023;21(3):212-219. https://doi.org/10.4274/tybd.galenos.2022.24008