Indirect Calorimetry: Is it Required to Maximize Patient Outcome from Nutrition Therapy?

Landes, Sarah; McClave, Stephen A.; Frazier, Thomas H.; Lowen, Cynthia C.; Hurt, Ryan T.

doi:10.1007/s13668-016-0171-9

Cited by 11 publications

(25 citation statements)

References 18 publications

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“…The literature search identified 4060 articles following the removal of duplicates (Figure 1), with 203 articles retrieved for full-text screening and 5 RCTs included. [17][18][19][20][21] One study was excluded following initial inclusion, as it did not meet the review definition of being conducted in a critically ill population, 17 leaving 4 studies that analyzed 396 participants. [18][19][20][21] No nonrandomized studies met the eligibility criteria.…”

Section: Study Selectionmentioning

confidence: 99%

Is Energy Delivery Guided by Indirect Calorimetry Associated With Improved Clinical Outcomes in Critically Ill Patients? A Systematic Review and Meta-analysis

Tatucu-Babet

Fetterplace

Lambell

et al. 2020

Nutr Metab Insights

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Background: Indirect calorimetry (IC) is recommended to guide energy delivery over predictive equations in critical illness due to its precision. However, the impact of using IC to measure energy expenditure on clinical outcomes is uncertain. Objective: To evaluate whether using IC to measure energy expenditure to inform energy delivery reduced hospital mortality and improved other important outcomes compared to using predictive equations in critically ill adults. Methods: A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Medline, Embase, CINAHL, and the Cochrane Library were searched for studies using IC to guide energy delivery compared to a predictive equation in adult critically ill patients with the primary outcome (hospital mortality) or any of the secondary outcomes reported (including but not limited to hospital and intensive care unit (ICU) length of stay (LOS) and duration mechanical ventilation (MV). Risk of bias within studies was assessed using the Cochrane “Risk of Bias” 1 tool. Random-effect meta-analyses were used when heterogeneity between studies existed (I2 > 50%). Data are reported as median (interquartile range [IQR]), binomial outcomes as odds ratio (OR), 95% confidence interval (CI), and continuous outcomes as mean difference (MD). Results: Of 4060 articles, 4 randomized controlled trials were identified with 396 patients included in analysis. Three studies were considered low risk of bias and 1 as high risk. Two studies reported hospital mortality (n = 130 and 40 participants, respectively). When combined, no association between IC-guided energy delivery and hospital mortality was found (OR = 0.81, 95% CI = [0.25, 2.67], P = 0.73, I2 = 52). No differences were reported with ICU mortality and hospital LOS between groups, but ICU LOS and duration of MV varied across all studies. According to the meta-analysis, no differences were observed in ICU LOS (MD = 1.39, 95% CI = [–5.01, 7.79], P = 0.67, I2 = 81%), although the duration of MV was increased when energy delivery was guided by IC (MD = 2.01, 95% CI = [0.45, 3.57], P = 0.01, I2 = 26%). In all 4 studies, prescribed energy targets were more closely met when energy delivery was informed by IC compared to a predictive equation. Three studies reported the percentage delivered versus the prescribed energy target, with the median (IQR) delta between the IC and predictive equation arms 19% (10%-32%). Conclusion: Limited data exist to assess the impact of using IC to inform energy delivery in comparison to predictive equations on hospital mortality. The association of IC use with other important outcomes, including duration of MV, needs to be further explored before definitive conclusions can be made.

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Section: Study Selectionmentioning

confidence: 99%

Is Energy Delivery Guided by Indirect Calorimetry Associated With Improved Clinical Outcomes in Critically Ill Patients? A Systematic Review and Meta-analysis

Tatucu-Babet

Fetterplace

Lambell

et al. 2020

Nutr Metab Insights

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“…They reported an IC-guided energy delivery regimen showed no between-groups difference regarding mortality (both hospital and ICU mortality) and ICU LOS but a longer duration of MV. However, the authors reviewed only four trials with a total of 398 patients [7,[20][21][22]. By contrast, our meta-analysis had a larger sample size than the previous meta-analysis as it added four other trials published recently [12][13][14][15]23], with more power to assess this effect.…”

Section: Discussionmentioning

confidence: 99%

“…Our literature search yielded 964 potentially eligible articles through database searching. Further screening of 14 full texts identi ed 8 RCTs with 911 patients that ful lled our inclusion criteria and were included in the nal analysis [7,[13][14][15][20][21][22][23]. Figure 1 shows the owchart of the search strategy and the reasons for exclusion.…”

Section: Trial Identi Cation and Characteristicsmentioning

confidence: 99%

“…The IC measurements and types of IC devices used were described in all trials. As to the predictive equations used in the control group, a simplistic weight-based 25 kcal/kg per day and Harris-Benedict formula were used in 4 [7,14,20,21] and 3 [13,15,23] RCTs, respectively, while both were used in another trial [22]. The quality of the included RCTs was moderate, with the high-performance bias related to the lack of blinding of participants and personnel among most studies (Appendix 3).…”

Section: Trial Identi Cation and Characteristicsmentioning

confidence: 99%

“…2). Six trials reported duration of MV as an outcome, and showed no differences using IC compared to the control (n = 871; MD = 0.61 days; 95% CI, -1.08 to 2.29; I 2 = 72%; P = 0.48) [7,14,15,[20][21][22] (Fig. 3A).…”

Section: Clinical Outcomesmentioning

confidence: 99%

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Energy Delivery Guided by Indirect Calorimetry in Critically Ill Patients: a Systematic Review and Meta-analysis

Duan

Zheng

Zhou

et al. 2020

Preprint

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Background: The use of indirect calorimetry (IC) is increasing due to its precision in resting energy expenditure (REE) measurement in critically ill patients. Thus, we aimed to evaluate the clinical outcomes of an IC-guided nutrition therapy compared to predictive equations strategy in such a patient population.Methods: We searched PubMed, EMBASE, and Cochrane library databases up to Oct 25, 2020. Randomized controlled trials (RCTs) were included if they focused on energy delivery guided by either IC or predictive equations in critically ill adults. We used the Cochrane risk-of-bias tool to assess the quality of the included studies. Short-term mortality was the primary outcome. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity. Results: Eight RCTs with 991 adults met the inclusion criteria. The overall quality of the included studies was moderate. Significantly higher mean energy delivered per day was observed in the IC group, as well as percent delivered energy over REE targets, than the control group. IC-guided energy delivery significantly reduced short-term mortality compared with the control group (risk ratio=0.77; 95% CI, 0.60 to 0.98; I2=3%, P=0.03). IC-guided strategy did not significantly prolong the duration of mechanical ventilation (mean difference [MD]=0.61 days; 95% CI, -1.08 to 2.29; P=0.48), length of stay in ICU (MD=0.32 days; 95% CI, -2.51 to 3.16; P=0.82) and hospital (MD=0.30 days; 95% CI, -3.23 to 3.83; P=0.87). Additionally, adverse events were similar between the two groups. Conclusions: This meta-analysis indicates that IC-guided energy delivery significantly reduces short-term mortality in critically ill patients. This finding encourages the use of IC-guided energy delivery during critical nutrition support. But more high-quality studies are still needed to confirm these findings.

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Nutritional interventions for preventing and treating pressure ulcers

Langer,

Wan,

Fink

et al. 2024

Cochrane Database of Systematic Reviews

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Indirect Calorimetry: Is it Required to Maximize Patient Outcome from Nutrition Therapy?

Cited by 11 publications

References 18 publications

Is Energy Delivery Guided by Indirect Calorimetry Associated With Improved Clinical Outcomes in Critically Ill Patients? A Systematic Review and Meta-analysis

Is Energy Delivery Guided by Indirect Calorimetry Associated With Improved Clinical Outcomes in Critically Ill Patients? A Systematic Review and Meta-analysis

Energy Delivery Guided by Indirect Calorimetry in Critically Ill Patients: a Systematic Review and Meta-analysis

Nutritional interventions for preventing and treating pressure ulcers

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