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Poor agreement between continuous measurements of energy expenditure and routinely used prediction equations in intensive care unit patients.

Abstract

BACKGROUND & AIMS

A wide variation in 24h energy expenditure has been demonstrated previously in intensive care unit (ICU) patients. The accuracy of equations used to predict energy expenditure in critically ill patients is frequently compared with single or short-duration indirect calorimetry measurements, which may not represent the total energy expenditure (TEE) of these patients. To take into account this variability in energy expenditure, estimates have been compared with continuous indirect calorimetry measurements.

METHODS

Continuous (24h/day for 5 days) indirect calorimetry measurements were made in patients requiring mechanical ventilation for 5 days. The Harris-Benedict, Schofield and Ireton-Jones equations and the American College of Chest Physicians recommendation of 25 kcal/kg/day were used to estimate energy requirements.

RESULTS

A total of 192 days of measurements, in 27 patients, were available for comparison with the different equations. Agreement between the equations and measured values was poor. The Harris-Benedict, Schofield and ACCP equations provided more estimates (66%, 66% and 65%, respectively) within 80% and 110% of TEE values. However, each of these equations would have resulted in clinically significant underfeeding (<80% of TEE) in 16%, 15% and 22% of patients, respectively, and overfeeding (>110% of TEE) in 18%, 19% and 13% of patients, respectively.

CONCLUSIONS

Limits of agreement between the different equations and TEE values were unacceptably wide. Prediction equations may result in significant under or overfeeding in the clinical setting.

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  • Publisher Full Text
  • Authors+Show Affiliations

    University Department of Anaesthesia, University of Cambridge, Box 93, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK. clr42@cam.ac.uk

    Source

    MeSH

    APACHE
    Adolescent
    Adult
    Age Factors
    Aged
    Body Weight
    Calorimetry, Indirect
    Critical Care
    Critical Illness
    Energy Metabolism
    Female
    Humans
    Male
    Mathematics
    Middle Aged
    Nutritional Requirements
    Oxygen Consumption
    Predictive Value of Tests
    Reproducibility of Results
    Sensitivity and Specificity
    Sex Factors

    Pub Type(s)

    Journal Article
    Research Support, Non-U.S. Gov't

    Language

    eng

    PubMed ID

    17418917

    Citation

    Reid, Clare L.. "Poor Agreement Between Continuous Measurements of Energy Expenditure and Routinely Used Prediction Equations in Intensive Care Unit Patients." Clinical Nutrition (Edinburgh, Scotland), vol. 26, no. 5, 2007, pp. 649-57.
    Reid CL. Poor agreement between continuous measurements of energy expenditure and routinely used prediction equations in intensive care unit patients. Clin Nutr. 2007;26(5):649-57.
    Reid, C. L. (2007). Poor agreement between continuous measurements of energy expenditure and routinely used prediction equations in intensive care unit patients. Clinical Nutrition (Edinburgh, Scotland), 26(5), pp. 649-57.
    Reid CL. Poor Agreement Between Continuous Measurements of Energy Expenditure and Routinely Used Prediction Equations in Intensive Care Unit Patients. Clin Nutr. 2007;26(5):649-57. PubMed PMID: 17418917.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Poor agreement between continuous measurements of energy expenditure and routinely used prediction equations in intensive care unit patients. A1 - Reid,Clare L, Y1 - 2007/04/06/ PY - 2006/10/06/received PY - 2007/02/16/revised PY - 2007/02/20/accepted PY - 2007/4/10/pubmed PY - 2008/2/12/medline PY - 2007/4/10/entrez SP - 649 EP - 57 JF - Clinical nutrition (Edinburgh, Scotland) JO - Clin Nutr VL - 26 IS - 5 N2 - BACKGROUND & AIMS: A wide variation in 24h energy expenditure has been demonstrated previously in intensive care unit (ICU) patients. The accuracy of equations used to predict energy expenditure in critically ill patients is frequently compared with single or short-duration indirect calorimetry measurements, which may not represent the total energy expenditure (TEE) of these patients. To take into account this variability in energy expenditure, estimates have been compared with continuous indirect calorimetry measurements. METHODS: Continuous (24h/day for 5 days) indirect calorimetry measurements were made in patients requiring mechanical ventilation for 5 days. The Harris-Benedict, Schofield and Ireton-Jones equations and the American College of Chest Physicians recommendation of 25 kcal/kg/day were used to estimate energy requirements. RESULTS: A total of 192 days of measurements, in 27 patients, were available for comparison with the different equations. Agreement between the equations and measured values was poor. The Harris-Benedict, Schofield and ACCP equations provided more estimates (66%, 66% and 65%, respectively) within 80% and 110% of TEE values. However, each of these equations would have resulted in clinically significant underfeeding (<80% of TEE) in 16%, 15% and 22% of patients, respectively, and overfeeding (>110% of TEE) in 18%, 19% and 13% of patients, respectively. CONCLUSIONS: Limits of agreement between the different equations and TEE values were unacceptably wide. Prediction equations may result in significant under or overfeeding in the clinical setting. SN - 0261-5614 UR - https://www.unboundmedicine.com/medline/citation/17418917/Poor_agreement_between_continuous_measurements_of_energy_expenditure_and_routinely_used_prediction_equations_in_intensive_care_unit_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0261-5614(07)00042-8 DB - PRIME DP - Unbound Medicine ER -