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Resting energy expenditure in non-ventilated, non-sedated patients recovering from serious traumatic brain injury: comparison of prediction equations with indirect calorimetry values.
Clin Nutr 2009; 28(5):526-32CN

Abstract

BACKGROUND & AIMS

Little is known about energy requirements in brain injured (TBI) patients, despite evidence suggesting adequate nutritional support can improve clinical outcomes. The study aim was to compare predicted energy requirements with measured resting energy expenditure (REE) values, in patients recovering from TBI.

METHODS

Indirect calorimetry (IC) was used to measure REE in 45 patients with TBI. Predicted energy requirements were determined using FAO/WHO/UNU and Harris-Benedict (HB) equations. Bland-Altman and regression analysis were used for analysis.

RESULTS

One-hundred and sixty-seven successful measurements were recorded in patients with TBI. At an individual level, both equations predicted REE poorly. The mean of the differences of standardised areas of measured REE and FAO/WHO/UNU was near zero (-9 kcal) but the variation in both directions was substantial (range -591 to +573 kcal). Similarly, the differences of areas of measured REE and HB demonstrated a mean of 1.9 kcal and range -568 to +571 kcal. Glasgow coma score, patient status, weight and body temperature were significant predictors of measured REE (p<0.001; R(2)=0.47).

CONCLUSIONS

Clinical equations are poor predictors of measured REE in patients with TBI. The variability in REE is substantial. Clinicians should be aware of the limitations of prediction equations when estimating energy requirements in TBI patients.

Authors+Show Affiliations

Centre for Public Health, Queens University Belfast, BT12 6BJ, Northern Ireland, UK. c.mcevoy@qub.ac.ukNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

19423202

Citation

McEvoy, Claire T., et al. "Resting Energy Expenditure in Non-ventilated, Non-sedated Patients Recovering From Serious Traumatic Brain Injury: Comparison of Prediction Equations With Indirect Calorimetry Values." Clinical Nutrition (Edinburgh, Scotland), vol. 28, no. 5, 2009, pp. 526-32.
McEvoy CT, Cran GW, Cooke SR, et al. Resting energy expenditure in non-ventilated, non-sedated patients recovering from serious traumatic brain injury: comparison of prediction equations with indirect calorimetry values. Clin Nutr. 2009;28(5):526-32.
McEvoy, C. T., Cran, G. W., Cooke, S. R., & Young, I. S. (2009). Resting energy expenditure in non-ventilated, non-sedated patients recovering from serious traumatic brain injury: comparison of prediction equations with indirect calorimetry values. Clinical Nutrition (Edinburgh, Scotland), 28(5), pp. 526-32. doi:10.1016/j.clnu.2009.04.009.
McEvoy CT, et al. Resting Energy Expenditure in Non-ventilated, Non-sedated Patients Recovering From Serious Traumatic Brain Injury: Comparison of Prediction Equations With Indirect Calorimetry Values. Clin Nutr. 2009;28(5):526-32. PubMed PMID: 19423202.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Resting energy expenditure in non-ventilated, non-sedated patients recovering from serious traumatic brain injury: comparison of prediction equations with indirect calorimetry values. AU - McEvoy,Claire T, AU - Cran,Gordon W, AU - Cooke,Stephen R, AU - Young,Ian S, Y1 - 2009/05/07/ PY - 2008/10/28/received PY - 2009/03/31/revised PY - 2009/04/01/accepted PY - 2009/5/9/entrez PY - 2009/5/9/pubmed PY - 2010/2/2/medline SP - 526 EP - 32 JF - Clinical nutrition (Edinburgh, Scotland) JO - Clin Nutr VL - 28 IS - 5 N2 - BACKGROUND & AIMS: Little is known about energy requirements in brain injured (TBI) patients, despite evidence suggesting adequate nutritional support can improve clinical outcomes. The study aim was to compare predicted energy requirements with measured resting energy expenditure (REE) values, in patients recovering from TBI. METHODS: Indirect calorimetry (IC) was used to measure REE in 45 patients with TBI. Predicted energy requirements were determined using FAO/WHO/UNU and Harris-Benedict (HB) equations. Bland-Altman and regression analysis were used for analysis. RESULTS: One-hundred and sixty-seven successful measurements were recorded in patients with TBI. At an individual level, both equations predicted REE poorly. The mean of the differences of standardised areas of measured REE and FAO/WHO/UNU was near zero (-9 kcal) but the variation in both directions was substantial (range -591 to +573 kcal). Similarly, the differences of areas of measured REE and HB demonstrated a mean of 1.9 kcal and range -568 to +571 kcal. Glasgow coma score, patient status, weight and body temperature were significant predictors of measured REE (p<0.001; R(2)=0.47). CONCLUSIONS: Clinical equations are poor predictors of measured REE in patients with TBI. The variability in REE is substantial. Clinicians should be aware of the limitations of prediction equations when estimating energy requirements in TBI patients. SN - 1532-1983 UR - https://www.unboundmedicine.com/medline/citation/19423202/Resting_energy_expenditure_in_non_ventilated_non_sedated_patients_recovering_from_serious_traumatic_brain_injury:_comparison_of_prediction_equations_with_indirect_calorimetry_values_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0261-5614(09)00080-6 DB - PRIME DP - Unbound Medicine ER -