Prediction of resting metabolic rate in critically ill adult patients: results of a systematic review of the evidence.

Metabolic rate is generally assessed by use of equations in critically ill patients, but evidence pertaining to the validity of these equations in this population has not been systematically evaluated. This paper represents the first such systematic analysis in adult patients. A work group created by the American Dietetic Association identified pertinent peer-reviewed articles. The work group systematically evaluated these articles and formulated conclusion statements and grades based on the available evidence. Seven equations plus the Fick method were found to have validation work that met criteria for inclusion in this analysis. The Harris-Benedict equation with and without modifiers had the most validation work behind it (n=13), followed by Ireton-Jones (1992 and 1997) (n=9), Penn State (1998, 2003) (n=2), and Swinamer (n=1). Five studies pertaining to the Fick method met acceptance criteria. Based on these validation studies, the Harris-Benedict, Ireton-Jones 1997, and Fick methods can be confidently eliminated from use in assessment of energy expenditure in critically ill patients. The Penn State 2003, Swinamer, and Ireton-Jones 1992 equations may be useful in critically ill nonobese patients, whereas the Ireton-Jones 1992 and Penn State 1998 equations seem to be useful in obese patients. The strength of these conclusions is moderated because of limited and sometimes inconsistent data. More validation work is needed to confirm and increase the strength of these conclusions.

[1]  Charlene Compher,et al.  Comparison of predictive equations for resting metabolic rate in healthy nonobese and obese adults: a systematic review. , 2005, Journal of the American Dietetic Association.

[2]  L. Hildebrandt,et al.  Comparison of formulaic equations to determine energy expenditure in the critically ill patient. , 2003, Nutrition.

[3]  M. Gottschlich,et al.  Contemporary Nutrition Support Practice: A Clinical Guide , 1998 .

[4]  R. Dickerson,et al.  Hypocaloric enteral tube feeding in critically ill obese patients. , 2002, Nutrition.

[5]  N. Cheung,et al.  Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition. , 2005, Diabetes care.

[6]  E. Rosato,et al.  Net protein anabolism with hypocaloric parenteral nutrition in obese stressed patients. , 1986, The American journal of clinical nutrition.

[7]  Jill Donaldson-Andersen,et al.  METABOLIC REQUIREMENTS OF THE CRITICALLY ILL, MECHANICALLY VENTILATED TRAUMA PATIENT : MEASURED VERSUS PREDICTED ENERGY EXPENDITURE , 1998 .

[8]  C. Ireton-Jones,et al.  Improved equations for predicting energy expenditure in patients: the Ireton-Jones Equations. , 2002, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[9]  C. Baxter,et al.  Equations for the estimation of energy expenditures in patients with burns with special reference to ventilatory status. , 1992, The Journal of burn care & rehabilitation.

[10]  B. Bistrian,et al.  An evaluation of resting energy expenditure in hospitalized, severely underweight patients. , 1999, Nutrition.

[11]  L. S. Brandi,et al.  Energy expenditure and severity of injury and illness indices in multiple trauma patients. , 1999, Critical care medicine.

[12]  S B Heymsfield,et al.  Human energy requirements: overestimation by widely used prediction equation. , 1985, The American journal of clinical nutrition.

[13]  C. Compher,et al.  Preliminary evidence for a medical nutrition therapy protocol: enteral feedings for critically ill patients. , 2006, Journal of the American Dietetic Association.

[14]  C. Compher,et al.  Best practice methods to apply to measurement of resting metabolic rate in adults: a systematic review. , 2006, Journal of the American Dietetic Association.

[15]  F. Ognibene,et al.  Retrospective Evaluation of Commonly Used Equations to Predict Energy Expenditure in Mechanically Ventilated, Critically Ill Patients , 2004, Pharmacotherapy.

[16]  Lewis B. Sheiner,et al.  Some suggestions for measuring predictive performance , 1981, Journal of Pharmacokinetics and Biopharmaceutics.

[17]  The quality of nutrition at an intensive care unit , 2002 .

[18]  E. Guérot,et al.  Assessment of resting energy expenditure in mechanically ventilated patients. , 2003, The American journal of clinical nutrition.

[19]  S. Muttini,et al.  Measured versus calculated energy expenditure in pressure support ventilated ICU patients. , 1996, Minerva anestesiologica.

[20]  M. Malangoni,et al.  Comparison of methods of measurements of oxygen consumption in mechanically ventilated patients with multiple trauma: The Fick method versus indirect calorimetry , 2000, Critical care medicine.

[21]  Richard L. Jones,et al.  Predictive equation for assessing energy expenditure in mechanically ventilated critically ill patients. , 1990, Critical care medicine.

[22]  B. Kinosian,et al.  Harris-Benedict equations do not adequately predict energy requirements in elderly hospitalized African Americans. , 2004, Journal of the National Medical Association.

[23]  C. Ireton-Jones,et al.  Why Use Predictive Equations for Energy Expenditure Assessment , 1997 .

[24]  P. Choban,et al.  Efficacy of hypocaloric total parenteral nutrition in hospitalized obese patients: a prospective, double-blind randomized trial. , 1994, JPEN. Journal of parenteral and enteral nutrition.

[25]  A. Basile-Filho,et al.  Correlation between oxygen consumption calculated using Fick's method and measured with indirect calorimetry in critically ill patients. , 2004, Arquivos brasileiros de cardiologia.

[26]  M. Ellersieck,et al.  Predicting energy needs in ventilator-dependent critically ill patients: effect of adjusting weight for edema or adiposity. , 1997, The American journal of clinical nutrition.

[27]  L. S. Brandi,et al.  Calculated and measured oxygen consumption in mechanically ventilated surgical patients in the early post-operative period. , 1999, European journal of anaesthesiology.

[28]  D. Frankenfield,et al.  Relative association of fever and injury with hypermetabolism in critically ill patients. , 1997, Injury.

[29]  M. Davidson,et al.  Diabetes mellitus, diagnosis and treatment , 1981 .

[30]  M. Mifflin,et al.  A new predictive equation for resting energy expenditure in healthy individuals. , 1990, The American journal of clinical nutrition.

[31]  D. Frankenfield,et al.  Accelerated nitrogen loss after traumatic injury is not attenuated by achievement of energy balance. , 1997, JPEN. Journal of parenteral and enteral nutrition.

[32]  J. Barr,et al.  Nutritional adequacy in patients receiving mechanical ventilation who are fed enterally. , 2005, American journal of critical care : an official publication, American Association of Critical-Care Nurses.

[33]  L M Burke,et al.  The thermodilution technique for measuring resting energy expenditure does not agree with indirect calorimetry for the critically ill patient. , 1998, JPEN. Journal of parenteral and enteral nutrition.

[34]  J. Verducci,et al.  Comparison of indirect calorimetry, the Fick method, and prediction equations in estimating the energy requirements of critically ill patients. , 1999, The American journal of clinical nutrition.

[35]  Y. Wong,et al.  Measured versus estimated energy expenditure in mechanically ventilated critically ill patients. , 2002, Clinical nutrition.

[36]  M. Sitrin,et al.  Evaluation of stress factors and body weight adjustments currently used to estimate energy expenditure in hospitalized patients. , 2002, JPEN. Journal of parenteral and enteral nutrition.

[37]  C. Ireton-Jones.  Comparison of the metabolic response to burn injury in obese and nonobese patients. , 1997, The Journal of burn care & rehabilitation.

[38]  J. Gervasio,et al.  Accuracy of predictive methods to estimate resting energy expenditure of thermally-injured patients. , 2002, JPEN. Journal of parenteral and enteral nutrition.

[39]  J. Siepler,et al.  A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition. , 1997, The Journal of trauma.

[40]  C. Campbell,et al.  Predicted vs measured energy expenditure in critically ill, underweight patients. , 2005, Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition.

[41]  N. Greer,et al.  A practical approach to evidence grading. , 2000, The Joint Commission journal on quality improvement.

[42]  D. Frankenfield,et al.  Validation of 2 approaches to predicting resting metabolic rate in critically ill patients. , 2004, JPEN. Journal of parenteral and enteral nutrition.

[43]  W S Blakemore,et al.  Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance. , 1979, JPEN. Journal of parenteral and enteral nutrition.