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Nutritional gain versus financial gain: The role of metabolic carts in the surgical ICU.

Abstract

BACKGROUND

Adequate nutritional replacement of critically ill and injured patients is of paramount importance, as it decreases infectious morbidity and mortality. However, multiple methods of determining nutritional requirements exist, including mathematical formulas, weight based calculations, and the use of metabolic cart measurements, the latter of which is associated with significant labor and equipment costs. We hypothesized that metabolic cart measurements, despite increasing the cost of care, would more accurately determine nutritional requirements in a critically ill population than formulaic or weight-based calculations.

METHODS

Consecutive metabolic cart measurements were prospectively obtained on 59 critically ill surgery and trauma patients, and compared with predicted values as determined by the Harris-Benedict equation and weight-based calculations. Comparison was made to actual resting energy expenditure data acquired via indirect calorimetry data obtained from serial metabolic carts.

RESULTS

There were 59 patients who formed the study population, with 37% of the population having two or more metabolic cart readings (total number of cart readings was 106). There was no statistically significant difference between the metabolic cart results, the predicted resting energy expenditure as calculated by the Harris-Benedict equation adjusted with a factor of 1.5, and a weight based calculation at 30 kcal/kg adjusted body weight. Metabolic requirements were stable over time (4-48 days) without significant variation. Nutritional parameters, as evaluated by the visceral proteins prealbumin and transferrin significantly increased with time in injured patients.

CONCLUSIONS

Either 30 kcal/kg adjusted body weight or the resting energy expenditure calculated from the Harris-Benedict equation multiplied by 1.5 adequately predicts the nutritional requirements of critically ill surgery and trauma patients. The addition of metabolic cart data does not provide any additional information in the determination of caloric needs in the critically ill and injured patient. In this population, omission of metabolic cart data would have saved 33,000 dollars without adversely affecting patient outcome.

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  • Authors+Show Affiliations

    ,

    Division of Trauma, Surgical Critical Care and Burns, Loyola University Medical Center, Maywood, Illinois, USA. Kimberly.davis@yale.edu

    , , , ,

    Source

    The Journal of trauma 61:6 2006 Dec pg 1436-40

    MeSH

    Adult
    Aged
    Calorimetry, Indirect
    Critical Care
    Critical Illness
    Energy Metabolism
    Female
    Humans
    Male
    Middle Aged
    Nutritional Requirements
    Predictive Value of Tests
    Reproducibility of Results
    Rest
    Wounds and Injuries

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    17159687

    Citation

    Davis, Kimberly A., et al. "Nutritional Gain Versus Financial Gain: the Role of Metabolic Carts in the Surgical ICU." The Journal of Trauma, vol. 61, no. 6, 2006, pp. 1436-40.
    Davis KA, Kinn T, Esposito TJ, et al. Nutritional gain versus financial gain: The role of metabolic carts in the surgical ICU. J Trauma. 2006;61(6):1436-40.
    Davis, K. A., Kinn, T., Esposito, T. J., Reed, R. L., Santaniello, J. M., & Luchette, F. A. (2006). Nutritional gain versus financial gain: The role of metabolic carts in the surgical ICU. The Journal of Trauma, 61(6), pp. 1436-40.
    Davis KA, et al. Nutritional Gain Versus Financial Gain: the Role of Metabolic Carts in the Surgical ICU. J Trauma. 2006;61(6):1436-40. PubMed PMID: 17159687.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Nutritional gain versus financial gain: The role of metabolic carts in the surgical ICU. AU - Davis,Kimberly A, AU - Kinn,Tamara, AU - Esposito,Thomas J, AU - Reed,R Lawrence,2nd AU - Santaniello,John M, AU - Luchette,Fred A, PY - 2006/12/13/pubmed PY - 2007/1/20/medline PY - 2006/12/13/entrez SP - 1436 EP - 40 JF - The Journal of trauma JO - J Trauma VL - 61 IS - 6 N2 - BACKGROUND: Adequate nutritional replacement of critically ill and injured patients is of paramount importance, as it decreases infectious morbidity and mortality. However, multiple methods of determining nutritional requirements exist, including mathematical formulas, weight based calculations, and the use of metabolic cart measurements, the latter of which is associated with significant labor and equipment costs. We hypothesized that metabolic cart measurements, despite increasing the cost of care, would more accurately determine nutritional requirements in a critically ill population than formulaic or weight-based calculations. METHODS: Consecutive metabolic cart measurements were prospectively obtained on 59 critically ill surgery and trauma patients, and compared with predicted values as determined by the Harris-Benedict equation and weight-based calculations. Comparison was made to actual resting energy expenditure data acquired via indirect calorimetry data obtained from serial metabolic carts. RESULTS: There were 59 patients who formed the study population, with 37% of the population having two or more metabolic cart readings (total number of cart readings was 106). There was no statistically significant difference between the metabolic cart results, the predicted resting energy expenditure as calculated by the Harris-Benedict equation adjusted with a factor of 1.5, and a weight based calculation at 30 kcal/kg adjusted body weight. Metabolic requirements were stable over time (4-48 days) without significant variation. Nutritional parameters, as evaluated by the visceral proteins prealbumin and transferrin significantly increased with time in injured patients. CONCLUSIONS: Either 30 kcal/kg adjusted body weight or the resting energy expenditure calculated from the Harris-Benedict equation multiplied by 1.5 adequately predicts the nutritional requirements of critically ill surgery and trauma patients. The addition of metabolic cart data does not provide any additional information in the determination of caloric needs in the critically ill and injured patient. In this population, omission of metabolic cart data would have saved 33,000 dollars without adversely affecting patient outcome. SN - 0022-5282 UR - https://www.unboundmedicine.com/medline/citation/17159687/Nutritional_gain_versus_financial_gain:_The_role_of_metabolic_carts_in_the_surgical_ICU_ L2 - http://Insights.ovid.com/pubmed?pmid=17159687 DB - PRIME DP - Unbound Medicine ER -