Ratzlaff Robert, Nowak Diane, Gordillo Desiree, Cresci Gail A, Faulhaber Kevin, Mascha Edward J, Hata J Steven
Department of Cardiothoracic Anesthesiology & Department of General Anesthesiology, Anesthesiology Institute, Cleveland Clinic, Licensure, Ohio, USA
Digestive Disease Institute, Cleveland Clinic, Licensure, Ohio, USA.
JPEN J Parenter Enteral Nutr. 2016 Sep;40(7):959-65. doi: 10.1177/0148607115581837. Epub 2015 Apr 10.
Nutrition equations have been validated with indirect calorimetry for determining energy needs in intensive care unit (ICU) populations. This study tested the hypothesis that mechanically ventilated cardiothoracic surgical patients would have significantly different energy requirements when determined by indirect calorimetry vs the Penn State equations.
This single-center, retrospective cohort analysis of consecutive cardiothoracic surgical patients adhered to a prospectively designed protocol for indirect calorimetry energy measurements. Energy needs were estimated by Penn State equations 2010 and 2003b and then indirect calorimetry.
Analyzed patients (n = 71) had a mean ± SD difference of 556 ± 543 calories/d between indirect calorimetry and Penn State formulae, as well as a mean ± SD percentage caloric difference of 32% ± 31% (95% confidence interval [CI], -20 to 87) with a range of 1311 calories (minimum difference, -379; maximum difference, 933). There was a 10% or greater difference in resting metabolic rate between indirect calorimetry and the Penn State equations in 89% of patients (95% CI, 79%-95%). Based on Lin's concordance correlation of 0.20 (95% CI, 0.09-0.32), the strength of agreement between the resting metabolic rates determined by indirect calorimetry compared with the Penn State equations was poor within this patient sample. Indirect calorimetry performance showed a 10% increase in caloric need in 77% of patients and was associated with a nutrition prescription change in 66%.
Mechanically ventilated cardiothoracic surgical ICU patients appear to have higher energy requirements by indirect calorimetry than those determined by Penn State equations. Future studies targeting indirect calorimetry in relation to clinical outcomes are needed.
营养方程已通过间接测热法进行验证，用于确定重症监护病房（ICU）患者的能量需求。本研究检验了以下假设：对于接受机械通气的心胸外科手术患者，通过间接测热法与宾夕法尼亚州立大学方程确定的能量需求会有显著差异。
这项对连续心胸外科手术患者的单中心回顾性队列分析遵循了一项前瞻性设计的间接测热法能量测量方案。能量需求通过2010年和2003b版宾夕法尼亚州立大学方程进行估算，然后采用间接测热法。
分析的患者（n = 71）间接测热法与宾夕法尼亚州立大学公式之间的平均±标准差差异为556 ± 543卡路里/天，热量差异的平均±标准差百分比为32% ± 31%（95%置信区间[CI]，-20至87），范围为1311卡路里（最小差异，-379；最大差异，933）。89%的患者间接测热法与宾夕法尼亚州立大学方程之间的静息代谢率差异为10%或更大（95% CI，79%-95%）。基于林氏一致性相关系数0.20（95% CI，0.09 - 0.32），在该患者样本中，间接测热法确定的静息代谢率与宾夕法尼亚州立大学方程之间的一致性强度较差。间接测热法结果显示，77%的患者热量需求增加了10%，且66%的患者营养处方发生了变化。
接受机械通气的心胸外科ICU患者通过间接测热法得出的能量需求似乎高于通过宾夕法尼亚州立大学方程确定的能量需求。未来需要针对间接测热法与临床结局关系的研究。
