How Accurate Are Resting Energy Expenditure Prediction Equations in Obese Trauma and Burn Patients?

Stucky, Chee-Chee; Moncure, Michael; Hise, Mary; Gossage, C. M.; Northrop, David

doi:10.1177/0148607108319799

Cited by 23 publications

(25 citation statements)

References 19 publications

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“…This result is even more relevant given the recent recommendations (33) that suggest the adoption of a hypocaloric (11 to 14 kcal/ kg per day of current weight) and a high protein diet for obese patients who have no contraindications. Stucky et al (34) even recommend the use of hypocaloric diets for all patients who are admitted to the ICU.…”

Section: Discussionmentioning

confidence: 99%

Necessidades nutricionais do doente crítico

Costa¹,

Marinho²,

Cançado³

2012

Rev. bras. ter. intensiva

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Objective: Given the inaccessibility of indirect calorimetry, intensive care units generally use predictive equations or recommendations that are established by international societies to determine energy expenditure. The aim of the present study was to compare the energy expenditure of critically ill patients, as determined using indirect calorimetry, to the values obtained using the Harris-Benedict equation.Methods: A retrospective observational study was conducted at the Intensive Care Unit 1 of the Centro Hospitalar do Porto. The energy requirements of hospitalized critically ill patients as determined using indirect calorimetry were assessed between January 2003 and April 2012. The accuracy (± 10% difference between the measured and estimated values), the mean differences and the limits of agreement were determined for the studied equations.Results: Eighty-five patients were assessed using 288 indirect calorimetry measurements. The following energy requirement values were obtained for the different methods: 1,753.98±391.13 kcal/ day (24.48 ± 5.95 kcal/kg/day) for indirect calorimetry and 1,504.11 ± 266.99 kcal/day (20.72±2.43 kcal/kg/day) for the HarrisBenedict equation. The equation had a precision of 31.76% with a mean difference of -259.86 kcal/day and limits of agreement between -858.84 and 339.12 kcal/day. Sex (p=0.023), temperature (p=0.009) and body mass index (p<0.001) were found to significantly affect energy expenditure.Conclusion: The Harris-Benedict equation is inaccurate and tends to underestimate energy expenditure. In addition, the Harris-Benedict equation is associated with significant differences between the predicted and true energy expenditure at an individual level.

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Section: Discussionmentioning

confidence: 99%

Necessidades nutricionais do doente crítico

Costa¹,

Marinho²,

Cançado³

2012

Rev. bras. ter. intensiva

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“…Enerji metabolizmasının çalış-masıyla ilgili olarak, indirekt kalorimetre enerji harcamasını ölçmek için altın standart olarak kabul edilmektedir. 5,26,27 İndirekt kalorimetre O 2 tüketimi ve CO 2 üretimini belirleyerek REE ölçümü yapmaktadır. 5,26 Bu yöntemle tahmin derecesi minimize edilmekte ve düzenli ölçümlerin kullanılması klinik durum değişikliği ile uyum içinde kalmak için yeterli enerji verilmesini sağlamaktadır.…”

Section: Yanikta Metaboli̇k Yanitunclassified

“…5,26,27 İndirekt kalorimetre O 2 tüketimi ve CO 2 üretimini belirleyerek REE ölçümü yapmaktadır. 5,26 Bu yöntemle tahmin derecesi minimize edilmekte ve düzenli ölçümlerin kullanılması klinik durum değişikliği ile uyum içinde kalmak için yeterli enerji verilmesini sağlamaktadır. 22 İndirekt kalorimetrenin düzenli kullanımı, yanık hastasına yeterli besin desteği sağladığından yetersiz-aşırı beslenmenin erken teşhisinde yararlıdır.…”

Section: Yanikta Metaboli̇k Yanitunclassified

“…5 İndirekt kalorimetrenin yanık hastalarında rutin kullanımı deneyimli personel ve cihaz gerektirdiğinden pratik değildir ve pahalı bir yöntemdir. 4,5,26,27 Bu nedenle beslenme değerlendirmesi için indirekt kalorimetre kullanımı araştırmalar için esas oluştursa da çok az uzman buna erişebilmektedir. 2 Ek olarak, sık metabolik ölçümler hastayı rahatsız ederek, klinik iş yükünü artırmaktadır, baş ve yüz yanıkları olan hastalar için uyumu kötüdür.…”

Section: Yanikta Metaboli̇k Yanitunclassified

“…Bu değişiklikleri düzeltmenin bir yolu REE'ye yaralanma ölçütüne bağlı bir stres faktörü çarpanı eklenmesidir. 26 Ancak, Harris ve Benedict denklemini modüle etmek için kullanılan stres faktörlerinin ya çok hatalı ya da tamamen yanlış olduğu gösterilmiştir. 3 Yanık sonrası metabolizma artışını göz önünde tutarak, enerji harcamasını belirlemek için birçok tahmin eşitliği geliştirilmiştir (Tablo 1).…”

Section: Yanikta Enerji̇ Harcamasinin Saptanmasinda Kullanilan Denklemlerunclassified

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Energy Metabolism in Burn Injury and Current Approaches to Determine the Energy Requirements

Sabuncular¹,

Tek²

2017

Turkiye Klinikleri J Health Sci

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Resting Energy Expenditure Measured by Indirect Calorimetry in Obese Patients: Variation Within Different BMI Ranges

Alves

Rocha

Gonzalez

et al. 2019

J Parenter Enteral Nutr

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Background: The adequate provision of energy for obese patients by estimation without indirect calorimetry (IC) is challenging. The goal was to establish values of kilocalories per kilogram (kcal/kg) for patients in different ranges of body mass index (BMI [kg/m 2 ]) comparable to resting energy expenditure (REE [kcal/kg/d]) measurements by IC. Methods: In 63 overweight (OW) hospitalized patients with BMIs (25.0-29.9) or obesity (OB; ࣙ30), the REE was measured in fasting and fed states. IC was performed with Deltatrac II on patients with enteral or parenteral nutrition, classified by their BMI, in 3 groups: OW (25-29.9), OB (30-39.9), and morbidly obese (ࣙ40). The actual body weight was measured with a microprocessed bed scale or a precision anthropometric scale, and REE was transformed to kcal/kg. Results: Ninety-seven IC measurements were obtained from 63 patients: in 54 on a ventilator, and of 9 with a canopy; 58 in the fasting state; and 39 after reaching measured caloric requirements. The patients' BMIs ranged from 27.3 to 53.4, average of 33.9 ± 6.2. There were no differences in measured REE (mREE) between the fasting and fed states (P > 0.05) within each BMI group; however, differences were observed when comparing the mREE between the groups in the fed state. Conclusion: These results, in kcal/kg/d, suggest using 22.0 for OW, 18.4 for OB, and 16.9 for individuals with BMIs >40. However, we recommend the use of IC to determine REE for the latter subset of patients, since 16.9 kcal/kg/d might be an underestimation. (JPEN J Parenter Enteral Nutr. 2020;44:129-137) Keywords body mass index; indirect calorimetry; kcal per kg; obese patients; predictive equations; resting energy expenditure Clinical Relevancy StatementThe primary aim of this study was to establish a precise predictive method for estimating the energy needs of obese critically ill patients using body mass index (BMI) and actual body weight, based on the results of indirect calorimetry (IC) measurements. Following the stratification of the patients into groups according to their BMI, the resting energy expenditure (REE) of the patients was measured, and the resulting values were expressed as kcal/kg/d for each BMI group. Thus, a new modality of REE estimation was developed for obese patients, which might help clinicians when IC is not promptly available for day-to-day clinical nutrition practice.From the

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How Accurate Are Resting Energy Expenditure Prediction Equations in Obese Trauma and Burn Patients?

Abstract: The measured average REE is significantly less than current guidelines. This finding suggests that a hypocaloric regimen is worth considering for ICU patients. Also, if an injury factor of 1.2 is incorporated in certain equations, patients may be given too many calories.

Cited by 23 publications

References 19 publications

Necessidades nutricionais do doente crítico

Necessidades nutricionais do doente crítico

Energy Metabolism in Burn Injury and Current Approaches to Determine the Energy Requirements

Resting Energy Expenditure Measured by Indirect Calorimetry in Obese Patients: Variation Within Different BMI Ranges

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