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Are Predictive Energy Expenditure Equations in Ventilated Surgery Patients Accurate?
J Intensive Care Med. 2019 May; 34(5):426-431.JI

Abstract

BACKGROUND:

While indirect calorimetry (IC) is the gold standard used to calculate specific calorie needs in the critically ill, predictive equations are frequently utilized at many institutions for various reasons. Prior studies suggest these equations frequently misjudge actual resting energy expenditure (REE) in medical and mixed intensive care unit (ICU) patients; however, their utility for surgical ICU (SICU) patients has not been fully evaluated. Therefore, the objective of this study was to compare the REE measured by IC with REE calculated using specific calorie goals or predictive equations for nutritional support in ventilated adult SICU patients.

MATERIALS AND METHODS:

A retrospective review of prospectively collected data was performed on all adults (n = 419, 18-91 years) mechanically ventilated for >24 hours, with an Fio2 ≤ 60%, who met IC screening criteria. Caloric needs were estimated using Harris-Benedict equations (HBEs), and 20, 25, and 30 kcal/kg/d with actual (ABW), adjusted (ADJ), and ideal body (IBW) weights. The REE was measured using IC.

RESULTS:

The estimated REE was considered accurate when within ±10% of the measured REE by IC. The HBE, 20, 25, and 30 kcal/kg/d estimates of REE were found to be inaccurate regardless of age, gender, or weight. The HBE and 20 kcal/kg/d underestimated REE, while 25 and 30 kcal/kg/d overestimated REE. Of the methods studied, those found to most often accurately estimate REE were the HBE using ABW, which was accurate 35% of the time, and 25 kcal/kg/d ADJ, which was accurate 34% of the time. This difference was not statistically significant.

CONCLUSION:

Using HBE, 20, 25, or 30 kcal/kg/d to estimate daily caloric requirements in critically ill surgical patients is inaccurate compared to REE measured by IC. In SICU patients with nutrition requirements essential to recovery, IC measurement should be performed to guide clinicians in determining goal caloric requirements.

Authors+Show Affiliations

1 Division of Acute Care Surgery (Trauma, Burns, Critical Care, Emergency Surgery), Department of Surgery, University of Michigan, Ann Arbor, MI, USA.2 Respiratory Care, University of Michigan Health System, Ann Arbor, MI, USA.1 Division of Acute Care Surgery (Trauma, Burns, Critical Care, Emergency Surgery), Department of Surgery, University of Michigan, Ann Arbor, MI, USA.3 Department of Pharmacy Services, University of Michigan Health System, Ann Arbor, MI, USA.4 Division of General Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA.5 Nutrition Services, University of Michigan Health System, Ann Arbor, MI, USA.1 Division of Acute Care Surgery (Trauma, Burns, Critical Care, Emergency Surgery), Department of Surgery, University of Michigan, Ann Arbor, MI, USA.1 Division of Acute Care Surgery (Trauma, Burns, Critical Care, Emergency Surgery), Department of Surgery, University of Michigan, Ann Arbor, MI, USA.

Pub Type(s)

Comparative Study
Journal Article

Language

eng

PubMed ID

28382850

Citation

Tignanelli, Christopher J., et al. "Are Predictive Energy Expenditure Equations in Ventilated Surgery Patients Accurate?" Journal of Intensive Care Medicine, vol. 34, no. 5, 2019, pp. 426-431.
Tignanelli CJ, Andrews AG, Sieloff KM, et al. Are Predictive Energy Expenditure Equations in Ventilated Surgery Patients Accurate? J Intensive Care Med. 2019;34(5):426-431.
Tignanelli, C. J., Andrews, A. G., Sieloff, K. M., Pleva, M. R., Reichert, H. A., Wooley, J. A., Napolitano, L. M., & Cherry-Bukowiec, J. R. (2019). Are Predictive Energy Expenditure Equations in Ventilated Surgery Patients Accurate? Journal of Intensive Care Medicine, 34(5), 426-431. https://doi.org/10.1177/0885066617702077
Tignanelli CJ, et al. Are Predictive Energy Expenditure Equations in Ventilated Surgery Patients Accurate. J Intensive Care Med. 2019;34(5):426-431. PubMed PMID: 28382850.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Are Predictive Energy Expenditure Equations in Ventilated Surgery Patients Accurate? AU - Tignanelli,Christopher J, AU - Andrews,Allan G, AU - Sieloff,Kurt M, AU - Pleva,Melissa R, AU - Reichert,Heidi A, AU - Wooley,Jennifer A, AU - Napolitano,Lena M, AU - Cherry-Bukowiec,Jill R, Y1 - 2017/04/06/ PY - 2017/4/7/pubmed PY - 2019/8/14/medline PY - 2017/4/7/entrez KW - Harris-Benedict equations KW - indirect calorimetry KW - metabolic cart KW - resting energy expenditure KW - surgical critical care SP - 426 EP - 431 JF - Journal of intensive care medicine JO - J Intensive Care Med VL - 34 IS - 5 N2 - BACKGROUND:: While indirect calorimetry (IC) is the gold standard used to calculate specific calorie needs in the critically ill, predictive equations are frequently utilized at many institutions for various reasons. Prior studies suggest these equations frequently misjudge actual resting energy expenditure (REE) in medical and mixed intensive care unit (ICU) patients; however, their utility for surgical ICU (SICU) patients has not been fully evaluated. Therefore, the objective of this study was to compare the REE measured by IC with REE calculated using specific calorie goals or predictive equations for nutritional support in ventilated adult SICU patients. MATERIALS AND METHODS:: A retrospective review of prospectively collected data was performed on all adults (n = 419, 18-91 years) mechanically ventilated for >24 hours, with an Fio2 ≤ 60%, who met IC screening criteria. Caloric needs were estimated using Harris-Benedict equations (HBEs), and 20, 25, and 30 kcal/kg/d with actual (ABW), adjusted (ADJ), and ideal body (IBW) weights. The REE was measured using IC. RESULTS:: The estimated REE was considered accurate when within ±10% of the measured REE by IC. The HBE, 20, 25, and 30 kcal/kg/d estimates of REE were found to be inaccurate regardless of age, gender, or weight. The HBE and 20 kcal/kg/d underestimated REE, while 25 and 30 kcal/kg/d overestimated REE. Of the methods studied, those found to most often accurately estimate REE were the HBE using ABW, which was accurate 35% of the time, and 25 kcal/kg/d ADJ, which was accurate 34% of the time. This difference was not statistically significant. CONCLUSION:: Using HBE, 20, 25, or 30 kcal/kg/d to estimate daily caloric requirements in critically ill surgical patients is inaccurate compared to REE measured by IC. In SICU patients with nutrition requirements essential to recovery, IC measurement should be performed to guide clinicians in determining goal caloric requirements. SN - 1525-1489 UR - https://www.unboundmedicine.com/medline/citation/28382850/Are_Predictive_Energy_Expenditure_Equations_in_Ventilated_Surgery_Patients_Accurate L2 - http://journals.sagepub.com/doi/full/10.1177/0885066617702077?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -