Prevalence of Underprescription or Overprescription of Energy Needs in Critically Ill Mechanically Ventilated Adults as Determined by Indirect Calorimetry

Tatucu-Babet, Oana A.; Ridley, Emma J.; Tierney, Audrey C.

doi:10.1177/0148607114567898

Cited by 99 publications

(87 citation statements)

References 51 publications

(60 reference statements)

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“…4 As a result, predictive equations (PEs) aiming to estimate the REE were developed in the past century and are frequently used in clinical practice in the place of IC. 7,8 Despite a large number of existing equations, the accuracy of PEs is still questioned, and they may not be suited for elderly patients as most were validated for the healthy, young, adult population. In addition, aging is associated with changes in body composition such as the reduction of fat-free mass, resulting in the progressive decrease of the REE at a rate of 1%-2% per year beginning at age 20 years.…”

Section: Introductionmentioning

confidence: 99%

Energy Expenditure in Critically Ill Elderly Patients: Indirect Calorimetry vs Predictive Equations

Segadilha¹,

Rocha²,

Tanaka³

et al. 2016

J Parenter Enteral Nutr

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Section: Introductionmentioning

confidence: 99%

Energy Expenditure in Critically Ill Elderly Patients: Indirect Calorimetry vs Predictive Equations

Segadilha¹,

Rocha²,

Tanaka³

et al. 2016

J Parenter Enteral Nutr

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“…One systematic review of 18 studies showed discrepancies between predictive equations and indirect calorimetry in predicting resting energy expenditure. Of the 160 variations of 13 predictive equations reviewed at a group level, 38% underestimated and 12% overestimated energy expenditure by >10%, and on an individual patient level, predictive equations underestimated and overestimated energy expenditure in 13%–90% and 0%–88% of patients, respectively …”

Section: Discussionmentioning

confidence: 99%

Permissive or Trophic Enteral Nutrition and Full Enteral Nutrition Had Similar Effects on Clinical Outcomes in Intensive Care: A Systematic Review of Randomized Clinical Trials

et al. 2018

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The aim of this study was to systematically review the effect of permissive underfeeding/trophic feeding on the clinical outcomes of critically ill patients. A systematic review of randomized clinical trials to evaluate the mortality, length of stay, and mechanical ventilation duration in patients randomized to either hypocaloric or full-energy enteral nutrition was performed. Data sources included PubMed and Scopus and the reference lists of the articles retrieved. Two independent reviewers participated in all phases of this systematic review as proposed by the Cochrane Handbook, and the review was reported according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A total of 7 randomized clinical trials that included a total of 1,717 patients were reviewed. Intensive care unit length of stay and mechanical ventilation duration were not statistically different between the intervention and control groups in all randomized clinical trials, and mortality rate was also not different between the groups. In conclusion, hypocaloric enteral nutrition had no significantly different effects on morbidity and mortality in critically ill patients when compared with full-energy nutrition. It is still necessary to determine the safety of this intervention in this group of patients, the optimal amount of energy provided, and the duration of this therapy.

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“…The absence of a gold standard method to quantify requirements is an important limitation of all the studies included, since the prevalence of underprescription or overprescription of energy needs in critically ill mechanically ventilated patients is high when predictive equations or weight-based fixed prescriptions are compared to estimates of indirect calorimetry values (38% and 12%, respectively) (41). Thus, the standard caloric requirements and the goals of caloric intake set by the strategies evaluated (full-feeding versus underfeeding) probably fail to match the actual energy needs.…”

Section: Discussionmentioning

confidence: 99%

Underfeeding versus full enteral feeding in critically ill patients with acute respiratory failure: a systematic review with meta-analysis of randomized controlled trials

Franzosi¹,

Frankenberg²,

Loss³

et al. 2017

Nutr Hosp

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Franzosi OS, Von Frankenberg AD, Loss SH, Nunes DSL, Vieira SR. Underfeeding versus full enteral feeding in critically ill patients with acute respiratory failure: a systematic review with meta-analysis of randomized controlled trials. Resumen Introducción: a pesar de las directrices que hacen hincapié en que la cantidad de la Nutrición Enteral (NE) administrada debe estar próxima a las necesidades del paciente, los estudios prospectivos cuestionan esta estrategia.Objetivo: comparar el efecto de dos estrategias de NE (subalimentación vs. alimentación completa) sobre la mortalidad en la UCI y general (mortalidad hospitalaria o la mortalidad en 60 días), el tiempo de internación en la UCI y en el hospital, duración de la ventilación mecánica (VM), complicaciones infecciosas y la tolerancia gastrointestinal en pacientes críticos.Métodos: metaanálisis de efectos aleatorios de ensayos clínicos aleatorizados (ECA). Nuestra búsqueda se basa en MEDLINE, EMBASE, SCOPUS y CENTRAL hasta mayo de 2015. La subalimentación fue asignada a dos grupos diferentes de acuerdo con el nivel de consumo de energía (alimentación moderada 46-72% y la alimentación trófi ca 16-25%) para el análisis de subgrupos.Resultados: se incluyeron cinco ECA entre los 904 estudios que se encontraron en la búsqueda (n = 2.432 pacientes). No se encontraron diferencias en la mortalidad general cuando se combinaron los cinco estudios. En el análisis de subgrupos, la alimentación moderada (tres estudios) mostró una mortalidad más baja en comparación con la alimentación completa (RR 0,82; IC 95% 0,68-0,98; I 2 0% p = 0,59 para la heterogeneidad). No se encontraron diferencias de mortalidad en la UCI ni en el tiempo de internación hospitalaria, la duración de la VM y las complicaciones infecciosas. La subalimentación mostró menor aparición de signos y síntomas gastrointestinales, excepto para aspiración y distensión abdominal (no se encontró ninguna diferencia).Conclusiones: este metaanálisis no encontró diferencias signifi cativas de mortalidad, duración de la estancia, duración de VM ni complicaciones infecciosas en la UCI o hospitalización total entre los grupos de subalimentación y alimentación completa. El análisis de subgrupos mostró menor mortalidad global entre los pacientes que recibieron la subalimentación moderada. Este resultado debe interpretarse con cautela debido a las limitaciones del pequeño número de estudios analizados y su metodología. Key words:Enteral nutrition. Critical care. Mortality. Artifi cial respiration. Digestive signs and symptoms. AbstractIntroduction: Although guidelines emphasize that the provision of enteral nutrition (EN) should be as close as the patient's needs, prospective studies question this strategy.

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Prevalence of Underprescription or Overprescription of Energy Needs in Critically Ill Mechanically Ventilated Adults as Determined by Indirect Calorimetry

Abstract: Large discrepancies exist between predictive equation estimates and indirect calorimetry measurements in individuals and groups. Further research is needed to determine the influence of indirect calorimetry and predictive equation limitations in contributing to these observed differences.

Cited by 99 publications

References 51 publications

Energy Expenditure in Critically Ill Elderly Patients: Indirect Calorimetry vs Predictive Equations

Energy Expenditure in Critically Ill Elderly Patients: Indirect Calorimetry vs Predictive Equations

Permissive or Trophic Enteral Nutrition and Full Enteral Nutrition Had Similar Effects on Clinical Outcomes in Intensive Care: A Systematic Review of Randomized Clinical Trials

Underfeeding versus full enteral feeding in critically ill patients with acute respiratory failure: a systematic review with meta-analysis of randomized controlled trials

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