Validation Study of Energy Requirements in Critically Ill, Obese Cancer Patients

Abstract

Critically ill, obese cancer patients require more calories than the current guidelines recommend, likely due to malignancy-associated metabolic variations. Our results demonstrate the need for IC studies to determine the energy requirements in these patients and for reassessment of the current recommendations.

Systematic review of factors associated with energy expenditure in the critically ill

“…The relationship with EE can be explained by the change in oxygen consumption noted with infusions or intrinsic increases of inotropes or vasopressors [123e126]. Clinical scores were evaluated frequently in this review, two of those were in the indeterminate category for their relationship with EE, APACHE [39,41,46,49,95,105,117,127] and SAPS [88,90,113,117,127]. Both of these scores summarize the extent of organ failure based on multiple criteria that may be better treated as separate factors in future studies.…”

Comparison of Resting Energy Expenditure Assessment in Pediatric Oncology Patients

“…Studies have shown that chronically ill cancer patients are either underfed or overfed based on predictive equations when compared with traditional indirect calorimetry . This is especially important in pediatric oncology patients because being underweight or overweight may have a direct impact on clinical outcomes and further complicate the late effects of therapy.…”

“…40 The variations in design and use between the ReeVue and the Medgem may explain the conflicting results that were found by Woo et al 43 Studies have shown that chronically ill cancer patients are either underfed or overfed based on predictive equations when compared with traditional indirect calorimetry. 50,51 This is especially important in pediatric oncology patients because being underweight or overweight may have a direct impact on clinical outcomes and further complicate the late effects of therapy. Underfeeding may result in poor growth and development, decreased wound healing, increased infection rates, increased resource utilization, decreased therapeutic response, duration of mechanical ventilation, and increased length of stay.…”

Clinical Guide for the Use of Metabolic Carts

“…recommends using indirect calorimetry to better assess their energy requirements 23 . A recent retrospective study compared the measured energy expenditure of 33 obese ICU patients with cancer and found a measured energy expenditure of 28.7 ± 5.2 kcal/kg ideal body weight (IBW)/d, significantly higher than the 25 kcal/kg IBW/d recommended by A.S.P.E.N 34 . Based on small prospective studies available, a hypocaloric high‐protein diet is currently recommended for obese patients.…”