Amir Kamel, PharmD, BCNSP
Clinical Pharmacy Specialist, Nutrition Support / Critical Care
n/a
Gainesville, Florida
Disclosure information not submitted.
Jessica Truong, PharmD
Clinical Pharmacist
University of Florida Health, Florida, United States
Disclosure information not submitted.
Laura Robayo, PharmD
Clinical Pharmacist
University of Florida, Florida, United States
Disclosure information not submitted.
Martin Rosenthal, MD
Department of Surgery, Assitant Professor of Trauma and Acute Care Surgery
University of Florida
Gainesville, Florida
Disclosure information not submitted.
Philip Efron, MD, FACS, FCCM
Professor
University of Florida
Gainesville, Florida, United States
Disclosure information not submitted.
Gabriela Ghita, PhD
Statist Ian
University of Florida, Florida, United States
Disclosure information not submitted.
Babette Brumback, PhD
Professor and Division Chair
Department of Biostatistics, University of Florida Health Hospital, College of Public Health & Health Professions College of Medicine, Gainesville, FL, United States, Florida, United States
Disclosure information not submitted.
Alicia Mohr, MD, FACS, FCCM
Division Chief Acute Care Surgery
University of Florida College of Medicine
Gainesville, Florida, United States
Disclosure information not submitted.
Chasen Croft, MD, FACS
Associate Professor of Surgery; Associate Trauma Medical Director
University of Florida College of Medicine, Florida, United States
Disclosure information not submitted.
Frederick Moore, MD, MCCM
Professor, Division of Acute Care Surgery and Center for Sepsis and Critical Illness Research
University of Florida, Florida, United States
Disclosure information not submitted.
Scott Brakenridge, MD, MSCS, FACS
assistant professor of surgery
University of Florida, Florida, United States
Disclosure information not submitted.
Title: Measured vs Estimated Energy Expenditure in Critically Ill Ventilated Surgical-Trauma Patients
Introduction:
Indirect calorimetry (IC) is the gold standard to measure resting energy expenditure (REE). Predictive equations (PEs) are also used to estimate REE, but there is limited evidence for their use in ICU patients. The aim of this study is to evaluate the degree of agreement and accuracy between IC measured REE and sixteen different PEs (4 of which are ICU specific equations) in mechanically ventilated surgical and trauma critically ill patients (MVSTCIPs) who had received enteral nutrition.
Methods:
IC- REE of MVSTCIPs was compared to PE-REE by 16 PEs: Harris and Benedict (HB), modified HB (HB for non-obese and HB x 1.2 for obese patients); weight based 25 kcal/kg and 30 kcal/kg; Mifflin–St Jeor; Bernstein, Livingston; Schofield; Cunningham; Katch-McArdle, Penn state (98, 03, 10), Ireon-Jones (92, 97), Swinamer, Faisey and Owen equations and to dietitian determined calculation. Degree of agreement between REE-PE and REE-IC was analyzed by the Bland-Altman test (BAt) and the Concordance correlation coefficient (CCC). The accuracy was calculated by the percentage of male and/or female patients whose REE-PE values differ by up to ±10% in relation to REE-IC as well as by Body mass index (BMI). Actual calories administered was compared to PEs and IC calories.
Results:
103 patients analyzed and the closest estimate to IC-REE was the modified HB equation with BAt limit of agreement average of - 28.3 calories (- 601.5, 544.8) overall, -43.7 (-647.6, 560.3) for males, -2.1 (-522, 517.8) for females, 8.6 (-555.1, 572.3) for BMI < 25 and -44.2 (-622.5, 534) for BMI > 25. The overall CCC between the IC- REE and modified HB was 0.744 (95% CI (0.647, 0.817); 0.639 (0.586, 0.817) for males; 0.726 (0.192, 0.603) for females; 0.569 (0.415, 0.691) for BMI < 25; and 0.649 (0.598, 0.818) for BMI > 25. The most accurate equation was mHB with overall accuracy of 47.6% and 19.4% and 33% under and overestimation respectively. Mean difference between calories given and IC measure or calculated using mHB, 25kcal/kg or Katch-McArdle equations were not statistically significant ((55.7, p= 0.147), (-54.9, p=0.105), (-4.6, p=.0.885) respectively).
Conclusions:
Effectiveness of estimating REE using PEs including ICU specific equations in MVSTCIPs is limited, however, of all examined equations, mHB is the closest to IC measured REE.