Energy Expenditure in Hospitalized Patients: Implications for Nutritional Support
2006; Elsevier BV; Volume: 81; Issue: 6 Linguagem: Inglês
10.4065/81.6.809
ISSN1942-5546
Autores Tópico(s)Child Nutrition and Water Access
ResumoAn understanding of energy expenditure in hospitalized patients is necessary to determine optimal energy supply in the care of individuals who require nutritional support. A review was conducted of 19 studies in which resting energy expenditure (REE) had been measured using indirect calorimetry and compared with estimated basal energy expenditure (BEE) from the Harris-Benedict equation. Studies of patients with burns, head injuries, and fever were excluded because REE is known to be increased in these conditions. The studies reported data on 1256 patients with the following diagnoses: postoperative (28%), trauma or sepsis (26%), cancer (18%), pulmonary disease (9%), cardiovascular disease (2%), miscellaneous (9%), and unspecified (6%). The average REE in the 19 studies was 113% of the BEE. The mean ± SD REE/BEE ratio was higher in 11 studies in which the REE was measured during feeding than in 5 studies in which the measurement was made during fasting (117%±3% vs 105%±4%; P=.047). In those 11 studies, overfeeding may have contributed to higher REE values than otherwise would have been observed. Some evidence indicated that the REE/BEE ratio is higher in more severe illness, but results were inconsistent. Unfortunately, little information is available concerning total energy expenditure, which includes the contribution of physical activity. It appears that most patients can be fed adequately with energy equal to 100% to 120% of estimated BEE. Hypoenergetic feeding may be appropriate in some overweight and obese individuals. Additional research in hospitalized patients on total energy expenditure and on the relationship between severity of illness and energy expenditure is needed. An understanding of energy expenditure in hospitalized patients is necessary to determine optimal energy supply in the care of individuals who require nutritional support. A review was conducted of 19 studies in which resting energy expenditure (REE) had been measured using indirect calorimetry and compared with estimated basal energy expenditure (BEE) from the Harris-Benedict equation. Studies of patients with burns, head injuries, and fever were excluded because REE is known to be increased in these conditions. The studies reported data on 1256 patients with the following diagnoses: postoperative (28%), trauma or sepsis (26%), cancer (18%), pulmonary disease (9%), cardiovascular disease (2%), miscellaneous (9%), and unspecified (6%). The average REE in the 19 studies was 113% of the BEE. The mean ± SD REE/BEE ratio was higher in 11 studies in which the REE was measured during feeding than in 5 studies in which the measurement was made during fasting (117%±3% vs 105%±4%; P=.047). In those 11 studies, overfeeding may have contributed to higher REE values than otherwise would have been observed. Some evidence indicated that the REE/BEE ratio is higher in more severe illness, but results were inconsistent. Unfortunately, little information is available concerning total energy expenditure, which includes the contribution of physical activity. It appears that most patients can be fed adequately with energy equal to 100% to 120% of estimated BEE. Hypoenergetic feeding may be appropriate in some overweight and obese individuals. Additional research in hospitalized patients on total energy expenditure and on the relationship between severity of illness and energy expenditure is needed. Nutritional support is often given to hospitalized patients when illness interferes with normal food intake. However, uncertainty exists regarding when it should be used and how much should be given. Early work suggested that energy requirements are increased during illness to levels higher than those predicted for healthy individuals, in proportion to the severity of illness and degree of stress.1Long CL Schaffel N Geiger JW Schiller WR Blakemore WS Metabolic response to injury and illness: estimation of energy and protein needs from indirect calorimetry and nitrogen balance.JPEN J Parenter Enteral Nutr. 1979; 3: 452-456Crossref PubMed Google Scholar More conservative estimates of energy expenditure, and thus energy requirements, have subsequently been adopted.2Cerra FB Benitez MR Blackburn GL et al.Applied nutrition in ICU patients: a consensus statement of the American College of Chest Physicians.Chest. 1997; 111: 769-778Crossref PubMed Scopus (369) Google Scholar However, a comprehensive review of studies in which energy expenditure was measured in hospitalized patients has not been conducted. Furthermore, the magnitude of the effect of stress and severity of illness on energy expenditure remains unclear. In this article, the results of such a review are presented, together with a discussion of the implications of the findings for nutritional care. The overall goals of the review were to (1) determine a best estimate of energy expenditure in hospitalized patients, (2) to investigate the effect of nutritional support on energy expenditure, and (3) to determine whether energy expenditure is increased in individuals with critical illnesses such as sepsis compared with individuals who are less critically ill. In a MEDLINE search, all studies of hospitalized patients in which resting energy expenditure (REE) had been measured with indirect calorimetry were identified. Search terms included REE, hospital, and critical illness. The review was confined to studies published since 1980 with a minimum of 20 patients in which REE was compared with estimated basal energy expenditure (BEE) determined by the Harris-Benedict equation.3Harris JA Benedict FG A Biometric Study of Basal Metabolism in Man. Carnegie Institute of Washington, Washington, DC1919Google Scholar (The Harris-Benedict equations are BEE = 13.8W + 5H − 6.8A + 66.5 for males and BEE = 9.6W + 1.8H − 4.7A + 655 for females, where BEE is the BEE in kilocalories, W is the weight in kilograms, H is the height in centimeters, and A is the age in years.) Often, REE is considered to be synonymous with BEE, which represents the energy expenditure that occurs at complete rest after an overnight fast. For the purposes of this review, REE merely refers to a measurement of energy expenditure made in an inpatient; the measurement is sometimes made under fasting conditions and sometimes during feeding (see the “Results” section). In this review, studies of predominantly head injury or burn patients were excluded because these conditions are known to be accompanied by systematic increases in energy expenditure.4Miles JM Nutritional support in stroke: a balanced meal or a feast? [editorial].Neurocrit Care. 2004; 1: 283-286Crossref PubMed Scopus (2) Google Scholar When possible, febrile patients were excluded from analysis for the same reason. If the ratio of REE to BEE (hereafter referred to as REE/BEE and expressed in percentage) was not provided, it was calculated from available data. The coefficient of variation for REE/BEE was also calculated when possible. Information on whether the REE measurements were made during infusion of nutrients wasrecorded since feeding has a thermic effect, producing an increase in energy expenditure.5Segal KR Gutin B Thermic effects of food and exercise in lean and obese women.Metabolism. 1983; 32: 581-589Abstract Full Text PDF PubMed Scopus (92) Google Scholar The amount of nutrition received was noted when it was available. In some cases, it was necessary to add the contribution of dietary protein to “nonprotein” calories to determine total energy supply. Information on diagnosis was recorded, and the studies were examined to determine whether there was evidence of a relationship between severity of illness and REE/BEE. Studies in which REE was measured during feeding were compared with those in which REE was measured in the fasting state to determine whether evidence existed for an effect of feeding on REE in hospitalized patients. Twenty studies of energy expenditure in hospitalized patients that met the study criteria were identified. Of these studies, 1 was excluded because its results were more than 3 SDs from the mean.6Hwang TL Huang SL Chen MF The use of indirect calorimetry in critically ill patients—the relationship of measured energy expenditure to Injury Severity Score, Septic Severity Score, and APACHE II Score.J Trauma. 1993; 34: 247-251Crossref PubMed Scopus (63) Google Scholar Diagnostic information on the patients studied from the remaining 19 studies7Askanazi J Carpentier YA Elwyn DH et al.Influence of total parenteral nutrition on fuel utilization in injury and sepsis.Ann Surg. 1980; 191: 40-46Crossref PubMed Scopus (328) Google Scholar, 8Quebbeman EJ Ausman RK Schneider TC A re-evaluation of energy expenditure during parenteral nutrition.Ann Surg. 1982; 195: 282-286Crossref PubMed Scopus (51) Google Scholar, 9Knox LS Crosby LO Feurer ID Buzby GP Miller CL Mullen JL Energy expenditure in malnourished cancer patients.Ann Surg. 1983; 197: 152-162Crossref PubMed Scopus (202) Google Scholar, 10Baker JP Detsky AS Stewart S Whitwell J Marliss EB Jeejeebhoy KN Randomized trial of total parenteral nutrition in critically ill patients: metabolic effects of varying glucose-lipid ratios as the energy source.Gastroenterology. 1984; 87: 53-59PubMed Scopus (99) Google Scholar, 11Mann S Westenskow DR Houtchens BA Measured and predicted caloric expenditure in the acutely ill.Crit Care Med. 1985; 13: 173-177Crossref PubMed Scopus (87) Google Scholar, 12Weissman C Kemper M Askanazi J Hyman AI Kinney JM Resting metabolic rate of the critically ill patient: measured versus predicted.Anesthesiology. 1986; 64: 673-679Crossref PubMed Scopus (107) Google Scholar, 13Foster GD Knox LS Dempsey DT Mullen JL Caloric requirements in total parenteral nutrition.J Am Coll Nutr. 1987; 6: 231-253PubMed Google Scholar, 14Hunter DC Jaksic T Lewis D Benotti PN Blackburn GL Bistrian BR Resting energy expenditure in the critically ill: estimations versus measurement.Br J Surg. 1988; 75: 875-878Crossref PubMed Scopus (99) Google Scholar, 15Green CJ McClelland P Gilbertson AA WIlkes RG Bone JM Campbell IT Energy balance in acute illness [abstract].Proc Nutr Soc. 1989; 48: 73AGoogle Scholar, 16Cortes V Nelson LD Errors in estimating energy expenditure in critically ill surgical patients.Arch Surg. 1989; 124: 287-290Crossref PubMed Scopus (29) Google Scholar, 17Liggett SB Renfro AD Energy expenditures of mechanically ventilated nonsurgical patients.Chest. 1990; 98: 682-686Crossref PubMed Scopus (50) Google Scholar, 18Fredrix EW Soeters PB von Meyenfeldt MF Saris WH Resting energy expenditure in cancer patients before and after gastrointestinal surgery.JPEN J Parenter Enteral Nutr. 1991; 15: 604-607Crossref PubMed Scopus (25) Google Scholar, 19McMahon MM Farnell MB Murray MJ Nutritional support of critically ill patients.Mayo Clin Proc. 1993; 68: 911-920Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar, 20Brown PE McClave SA Hoy NW Short AF Sexton LK Meyer KL The Acute Physiology and Chronic Health Evaluation II classification system is a valid marker for physiologic stress in the critically ill patient.Crit Care Med. 1993; 21: 363-367Crossref PubMed Scopus (23) Google Scholar, 21Guenst JM Nelson LD Predictors of total parenteral nutrition-induced lipogenesis.Chest. 1994; 105: 553-559Crossref PubMed Scopus (58) Google Scholar, 22Boulanger BR Nayman R McLean RF Phillips E Rizoli SB What are the clinical determinants of early energy expenditure in critically injured adults?.J Trauma. 1994; 37: 969-974Crossref PubMed Scopus (34) Google Scholar, 23Frankenfield DC Smith Jr, JS Cooney RN Blosser SA Sarson GY Relative association of fever and injury with hypermetabolism in critically ill patients.Injury. 1997; 28: 617-621Abstract Full Text PDF PubMed Scopus (54) Google Scholar, 24Flancbaum L Choban PS Sambucco S Verducci J Burge JC Comparison of indirect calorimetry, the Fick method, and prediction equations in estimating the energy requirements of critically ill patients.Am J Clin Nutr. 1999; 69: 461-466PubMed Google Scholar, 25Alexander E Susla GM Burstein AH Brown DT Ognibene FP Retrospective evaluation of commonly used equations to predict energy expenditure in mechanically ventilated, critically ill patients.Pharmacotherapy. 2004; 24: 1659-1667Crossref PubMed Scopus (39) Google Scholar is provided in Table 1. Among the 1256 patients described, 355 (28%) were postoperative patients with a variety of surgical diagnoses. Another 329 (26%) had either trauma or sepsis. A total of 226 (18%) had a diagnosis of cancer, whereas 118 patients (9%) had pneumonia or respiratory failure. Nonsurgical cardiovascular conditions accounted for 31 patients (2%). Miscellaneous diagnoses, each less than 2% of the total, included bowel obstruction, pancreatitis, inflammatory bowel disease, enterocutaneous fistula, burns, renal failure, and bowel infarction. A diagnosis was not specified in 79 patients.TABLE 1Distribution of Diagnoses in 19 Studies of the Relationship Between Resting Energy Expenditure and Basal Energy Expenditure in Hospitalized PatientsReferencePost-operative surgical diagnosesTraumaSepsisRespiratory failureCardio-vascular diseaseCancerPneumoniaMiscellaneousNot eportedTotalAskanazi et al7Askanazi J Carpentier YA Elwyn DH et al.Influence of total parenteral nutrition on fuel utilization in injury and sepsis.Ann Surg. 1980; 191: 40-46Crossref PubMed Scopus (328) Google Scholar0311000018032Quebbeman et al8Quebbeman EJ Ausman RK Schneider TC A re-evaluation of energy expenditure during parenteral nutrition.Ann Surg. 1982; 195: 282-286Crossref PubMed Scopus (51) Google Scholar1056002219044Knox et al9Knox LS Crosby LO Feurer ID Buzby GP Miller CL Mullen JL Energy expenditure in malnourished cancer patients.Ann Surg. 1983; 197: 152-162Crossref PubMed Scopus (202) Google Scholar00000200000200Baker et al10Baker JP Detsky AS Stewart S Whitwell J Marliss EB Jeejeebhoy KN Randomized trial of total parenteral nutrition in critically ill patients: metabolic effects of varying glucose-lipid ratios as the energy source.Gastroenterology. 1984; 87: 53-59PubMed Scopus (99) Google Scholar24801050020Mann et al11Mann S Westenskow DR Houtchens BA Measured and predicted caloric expenditure in the acutely ill.Crit Care Med. 1985; 13: 173-177Crossref PubMed Scopus (87) Google Scholar0000614027451Weissman et al12Weissman C Kemper M Askanazi J Hyman AI Kinney JM Resting metabolic rate of the critically ill patient: measured versus predicted.Anesthesiology. 1986; 64: 673-679Crossref PubMed Scopus (107) Google Scholar400000000040Foster et al13Foster GD Knox LS Dempsey DT Mullen JL Caloric requirements in total parenteral nutrition.J Am Coll Nutr. 1987; 6: 231-253PubMed Google Scholar2204400101203100Hunter et al14Hunter DC Jaksic T Lewis D Benotti PN Blackburn GL Bistrian BR Resting energy expenditure in the critically ill: estimations versus measurement.Br J Surg. 1988; 75: 875-878Crossref PubMed Scopus (99) Google Scholar150000032020Green et al15Green CJ McClelland P Gilbertson AA WIlkes RG Bone JM Campbell IT Energy balance in acute illness [abstract].Proc Nutr Soc. 1989; 48: 73AGoogle Scholar07770000021Cortes & Nelson16Cortes V Nelson LD Errors in estimating energy expenditure in critically ill surgical patients.Arch Surg. 1989; 124: 287-290Crossref PubMed Scopus (29) Google Scholar256000000031Liggett & Renfro17Liggett SB Renfro AD Energy expenditures of mechanically ventilated nonsurgical patients.Chest. 1990; 98: 682-686Crossref PubMed Scopus (50) Google Scholar001892001101573Fredrix et al18Fredrix EW Soeters PB von Meyenfeldt MF Saris WH Resting energy expenditure in cancer patients before and after gastrointestinal surgery.JPEN J Parenter Enteral Nutr. 1991; 15: 604-607Crossref PubMed Scopus (25) Google Scholar650000000065McMahon et al19McMahon MM Farnell MB Murray MJ Nutritional support of critically ill patients.Mayo Clin Proc. 1993; 68: 911-920Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar550000000055Brown et al20Brown PE McClave SA Hoy NW Short AF Sexton LK Meyer KL The Acute Physiology and Chronic Health Evaluation II classification system is a valid marker for physiologic stress in the critically ill patient.Crit Care Med. 1993; 21: 363-367Crossref PubMed Scopus (23) Google Scholar00170000114270Guenst & Nelson21Guenst JM Nelson LD Predictors of total parenteral nutrition-induced lipogenesis.Chest. 1994; 105: 553-559Crossref PubMed Scopus (58) Google Scholar840202310408140Boulanger et al22Boulanger BR Nayman R McLean RF Phillips E Rizoli SB What are the clinical determinants of early energy expenditure in critically injured adults?.J Trauma. 1994; 37: 969-974Crossref PubMed Scopus (34) Google Scholar01150000000115Frankenfield et al23Frankenfield DC Smith Jr, JS Cooney RN Blosser SA Sarson GY Relative association of fever and injury with hypermetabolism in critically ill patients.Injury. 1997; 28: 617-621Abstract Full Text PDF PubMed Scopus (54) Google Scholar22238113000067Flancbaum et al24Flancbaum L Choban PS Sambucco S Verducci J Burge JC Comparison of indirect calorimetry, the Fick method, and prediction equations in estimating the energy requirements of critically ill patients.Am J Clin Nutr. 1999; 69: 461-466PubMed Google Scholar1347000012036Alexander et al25Alexander E Susla GM Burstein AH Brown DT Ognibene FP Retrospective evaluation of commonly used equations to predict energy expenditure in mechanically ventilated, critically ill patients.Pharmacotherapy. 2004; 24: 1659-1667Crossref PubMed Scopus (39) Google Scholar2016420009776Total (%)355 (28)167 (13)162 (13)92 (7)31 (2)226 (18)26 (2)118 (9)79 (6)1256 (100) Open table in a new tab A summary of feeding and energy expenditure data is given in Table 2. The REE data on individual patients was provided in only 2 studies.14Hunter DC Jaksic T Lewis D Benotti PN Blackburn GL Bistrian BR Resting energy expenditure in the critically ill: estimations versus measurement.Br J Surg. 1988; 75: 875-878Crossref PubMed Scopus (99) Google Scholar, 16Cortes V Nelson LD Errors in estimating energy expenditure in critically ill surgical patients.Arch Surg. 1989; 124: 287-290Crossref PubMed Scopus (29) Google Scholar The mean REE/BEE in the 19 studies ranged from 94% to 130% and averaged 113%. Substantial intersubject variation occurred in REE/BEE in several of the reports.TABLE 2Measured vs Predicted Energy Expenditure in Hospitalized Patients*BEE is the estimated basal energy expenditure calculated using the Harris-Benedict equation. REE is the resting energy expenditure measured by indirect calorimetry. NR = not reported.ReferenceNo. of patientsFed(REE/BEE) × 100 (%)Coefficient of variation (%)Askanazi et al7Askanazi J Carpentier YA Elwyn DH et al.Influence of total parenteral nutrition on fuel utilization in injury and sepsis.Ann Surg. 1980; 191: 40-46Crossref PubMed Scopus (328) Google Scholar32No94NRQuebbeman et al8Quebbeman EJ Ausman RK Schneider TC A re-evaluation of energy expenditure during parenteral nutrition.Ann Surg. 1982; 195: 282-286Crossref PubMed Scopus (51) Google Scholar44Yes10612Knox et al9Knox LS Crosby LO Feurer ID Buzby GP Miller CL Mullen JL Energy expenditure in malnourished cancer patients.Ann Surg. 1983; 197: 152-162Crossref PubMed Scopus (202) Google Scholar200NR9919Baker at al10Baker JP Detsky AS Stewart S Whitwell J Marliss EB Jeejeebhoy KN Randomized trial of total parenteral nutrition in critically ill patients: metabolic effects of varying glucose-lipid ratios as the energy source.Gastroenterology. 1984; 87: 53-59PubMed Scopus (99) Google Scholar20No10229Mann et al11Mann S Westenskow DR Houtchens BA Measured and predicted caloric expenditure in the acutely ill.Crit Care Med. 1985; 13: 173-177Crossref PubMed Scopus (87) Google Scholar51Yes115NRWeissman et al12Weissman C Kemper M Askanazi J Hyman AI Kinney JM Resting metabolic rate of the critically ill patient: measured versus predicted.Anesthesiology. 1986; 64: 673-679Crossref PubMed Scopus (107) Google Scholar40NR10421Foster et al13Foster GD Knox LS Dempsey DT Mullen JL Caloric requirements in total parenteral nutrition.J Am Coll Nutr. 1987; 6: 231-253PubMed Google Scholar100Yes10514Hunter et al14Hunter DC Jaksic T Lewis D Benotti PN Blackburn GL Bistrian BR Resting energy expenditure in the critically ill: estimations versus measurement.Br J Surg. 1988; 75: 875-878Crossref PubMed Scopus (99) Google Scholar20Yes10439Green et al15Green CJ McClelland P Gilbertson AA WIlkes RG Bone JM Campbell IT Energy balance in acute illness [abstract].Proc Nutr Soc. 1989; 48: 73AGoogle Scholar21Yes1215Cortes & Nelson16Cortes V Nelson LD Errors in estimating energy expenditure in critically ill surgical patients.Arch Surg. 1989; 124: 287-290Crossref PubMed Scopus (29) Google Scholar31Yes12819Liggett & Renfro17Liggett SB Renfro AD Energy expenditures of mechanically ventilated nonsurgical patients.Chest. 1990; 98: 682-686Crossref PubMed Scopus (50) Google Scholar73No11710Fredrix et al18Fredrix EW Soeters PB von Meyenfeldt MF Saris WH Resting energy expenditure in cancer patients before and after gastrointestinal surgery.JPEN J Parenter Enteral Nutr. 1991; 15: 604-607Crossref PubMed Scopus (25) Google Scholar65No1108McMahon et al19McMahon MM Farnell MB Murray MJ Nutritional support of critically ill patients.Mayo Clin Proc. 1993; 68: 911-920Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar55No10226Brown et al20Brown PE McClave SA Hoy NW Short AF Sexton LK Meyer KL The Acute Physiology and Chronic Health Evaluation II classification system is a valid marker for physiologic stress in the critically ill patient.Crit Care Med. 1993; 21: 363-367Crossref PubMed Scopus (23) Google Scholar70Yes115NRGuenst & Nelson21Guenst JM Nelson LD Predictors of total parenteral nutrition-induced lipogenesis.Chest. 1994; 105: 553-559Crossref PubMed Scopus (58) Google Scholar140Yes12017Boulanger et al22Boulanger BR Nayman R McLean RF Phillips E Rizoli SB What are the clinical determinants of early energy expenditure in critically injured adults?.J Trauma. 1994; 37: 969-974Crossref PubMed Scopus (34) Google Scholar115NR12426Frankenfield et al23Frankenfield DC Smith Jr, JS Cooney RN Blosser SA Sarson GY Relative association of fever and injury with hypermetabolism in critically ill patients.Injury. 1997; 28: 617-621Abstract Full Text PDF PubMed Scopus (54) Google Scholar67Yes12414Flancbaum et al24Flancbaum L Choban PS Sambucco S Verducci J Burge JC Comparison of indirect calorimetry, the Fick method, and prediction equations in estimating the energy requirements of critically ill patients.Am J Clin Nutr. 1999; 69: 461-466PubMed Google Scholar36Yes130NRAlexander et al25Alexander E Susla GM Burstein AH Brown DT Ognibene FP Retrospective evaluation of commonly used equations to predict energy expenditure in mechanically ventilated, critically ill patients.Pharmacotherapy. 2004; 24: 1659-1667Crossref PubMed Scopus (39) Google Scholar76Yes12627Mean (SD)113.0 (10.9)* BEE is the estimated basal energy expenditure calculated using the Harris-Benedict equation. REE is the resting energy expenditure measured by indirect calorimetry. NR = not reported. Open table in a new tab Patients were receiving nutrition at the time the REE was determined in 11 of the studies; in 8 of the studies, nutritional support provided energy equal to an average of 137% (range, 118%-165%) of the BEE8Quebbeman EJ Ausman RK Schneider TC A re-evaluation of energy expenditure during parenteral nutrition.Ann Surg. 1982; 195: 282-286Crossref PubMed Scopus (51) Google Scholar, 11Mann S Westenskow DR Houtchens BA Measured and predicted caloric expenditure in the acutely ill.Crit Care Med. 1985; 13: 173-177Crossref PubMed Scopus (87) Google Scholar, 13Foster GD Knox LS Dempsey DT Mullen JL Caloric requirements in total parenteral nutrition.J Am Coll Nutr. 1987; 6: 231-253PubMed Google Scholar, 15Green CJ McClelland P Gilbertson AA WIlkes RG Bone JM Campbell IT Energy balance in acute illness [abstract].Proc Nutr Soc. 1989; 48: 73AGoogle Scholar, 16Cortes V Nelson LD Errors in estimating energy expenditure in critically ill surgical patients.Arch Surg. 1989; 124: 287-290Crossref PubMed Scopus (29) Google Scholar, 21Guenst JM Nelson LD Predictors of total parenteral nutrition-induced lipogenesis.Chest. 1994; 105: 553-559Crossref PubMed Scopus (58) Google Scholar, 25Alexander E Susla GM Burstein AH Brown DT Ognibene FP Retrospective evaluation of commonly used equations to predict energy expenditure in mechanically ventilated, critically ill patients.Pharmacotherapy. 2004; 24: 1659-1667Crossref PubMed Scopus (39) Google Scholar (J.M.M. and D. Frankenfield, MS, RD, written communication, April 2005), whereas in 3 studies the amount of nutrition was not stated.14Hunter DC Jaksic T Lewis D Benotti PN Blackburn GL Bistrian BR Resting energy expenditure in the critically ill: estimations versus measurement.Br J Surg. 1988; 75: 875-878Crossref PubMed Scopus (99) Google Scholar, 20Brown PE McClave SA Hoy NW Short AF Sexton LK Meyer KL The Acute Physiology and Chronic Health Evaluation II classification system is a valid marker for physiologic stress in the critically ill patient.Crit Care Med. 1993; 21: 363-367Crossref PubMed Scopus (23) Google Scholar, 24Flancbaum L Choban PS Sambucco S Verducci J Burge JC Comparison of indirect calorimetry, the Fick method, and prediction equations in estimating the energy requirements of critically ill patients.Am J Clin Nutr. 1999; 69: 461-466PubMed Google Scholar In 5 studies, patients were not receiving any nutrition at the time of the REE measurement, and in 1 study no information on nutritional status was available.22Boulanger BR Nayman R McLean RF Phillips E Rizoli SB What are the clinical determinants of early energy expenditure in critically injured adults?.J Trauma. 1994; 37: 969-974Crossref PubMed Scopus (34) Google Scholar Two studies were excluded from this aspect of the analysis because some of the patients were receiving nutritional support and some were not; REE data in the 2 groups were not provided separately.9Knox LS Crosby LO Feurer ID Buzby GP Miller CL Mullen JL Energy expenditure in malnourished cancer patients.Ann Surg. 1983; 197: 152-162Crossref PubMed Scopus (202) Google Scholar, 12Weissman C Kemper M Askanazi J Hyman AI Kinney JM Resting metabolic rate of the critically ill patient: measured versus predicted.Anesthesiology. 1986; 64: 673-679Crossref PubMed Scopus (107) Google Scholar REE/BEE was higher in the 11 studies in which the measurement was made during nutrient infusion than in the 5 studies in which the measurement was made under fasting conditions (117%±3% vs 105%±4%; P=.047). A relationship between severity of illness and REE/BEE was not consistently observed, although the unavailability of individual REE/BEE data in most studies made it more difficult to examine this question. The mean ± SD REE/BEE was 105%±5% in 4 studies in which an average of 36% of patients had sepsis and the measurement was made under fasting conditions,7Askanazi J Carpentier YA Elwyn DH et al.Influence of total parenteral nutrition on fuel utilization in injury and sepsis.Ann Surg. 1980; 191: 40-46Crossref PubMed Scopus (328) Google Scholar, 8Quebbeman EJ Ausman RK Schneider TC A re-evaluation of energy expenditure during parenteral nutrition.Ann Surg. 1982; 195: 282-286Crossref PubMed Scopus (51) Google Scholar, 10Baker JP Detsky AS Stewart S Whitwell J Marliss EB Jeejeebhoy KN Randomized trial of total parenteral nutrition in critically ill patients: metabolic effects of varying glucose-lipid ratios as the energy source.Gastroenterology. 1984; 87: 53-59PubMed Scopus (99) Google Scholar, 13Foster GD Knox LS Dempsey DT Mullen JL Caloric requirements in total parenteral nutrition.J Am Coll Nutr. 1987; 6: 231-253PubMed Google Scholar, 17Liggett SB Renfro AD Energy expenditures of mechanically ventilated nonsurgical patients.Chest. 1990; 98: 682-686Crossref PubMed Scopus (50) Google Scholar 120%±6% in 4 studies in which an average of 25% of patients had sepsis but the measurements were made under fed conditions,15Green CJ McClelland P Gilbertson AA WIlkes RG Bone JM Campbell IT Energy balance in acute illness [abstract].Proc Nutr Soc. 1989; 48: 73AGoogle Scholar, 20Brown PE McClave SA Hoy NW Short AF Sexton LK Meyer KL The Acute Physiology and Chronic Health Evaluation II classification system is a valid marker for physiologic stress in the critically ill patient.Crit Care Med. 1993; 21: 363-367Crossref PubMed Scopus (23) Google Scholar, 24Flancbaum L Choban PS Sambucco S Verducci J Burge JC Comparison of indirect calorimetry, the Fick method, and prediction equations in estimating the energy requirements of critically ill patients.Am J Clin Nutr. 1999; 69: 461-466PubMed Google Scholar, 25Alexander E Susla GM Burstein AH Brown DT Ognibene FP Retrospective evaluation of commonly used equations to predict energy expenditure in mechanically ventilated, critically ill patients.Pharmacotherapy. 2004; 24: 1659-1667Crossref PubMed Scopus (39) Google Scholar and 116%±7% in 3 studies in which none of the patients had sepsis but the measurements were made under fed conditions.11Mann S Westenskow DR Houtchens BA Measured and predicted caloric expenditure in the acutely ill.Crit Care Med. 1985; 13: 173-177Crossref PubMed Scopus (87) Google Scholar, 14Hunter DC Jaksic T Lewis D Benotti PN Blackburn GL Bistrian BR Resting energy expenditure in the critically ill: estimations versus measurement.Br J Surg. 1988; 75: 875-878Crossref PubMed Scopus (99) Google Scholar, 16Cortes V Nelson LD Errors in estimating energy expenditure in critically ill surgical patients.Arch Surg. 1989; 124: 287-290Crossref PubMed Scopus (29) Google Scholar The differences in REE/BEE among these 3 groups of studi
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