1 Division of Acute Care Surgery (Trauma, Burns, Critical Care, Emergency Surgery), Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
2 Respiratory Care, University of Michigan Health System, Ann Arbor, MI, USA.
J Intensive Care Med. 2019 May;34(5):426-431. doi: 10.1177/0885066617702077. Epub 2017 Apr 6.
: While indirect calorimetry (IC) is the gold standard used to calculate specific calorie needs in the critically ill, predictive equations are frequently utilized at many institutions for various reasons. Prior studies suggest these equations frequently misjudge actual resting energy expenditure (REE) in medical and mixed intensive care unit (ICU) patients; however, their utility for surgical ICU (SICU) patients has not been fully evaluated. Therefore, the objective of this study was to compare the REE measured by IC with REE calculated using specific calorie goals or predictive equations for nutritional support in ventilated adult SICU patients.
: A retrospective review of prospectively collected data was performed on all adults (n = 419, 18-91 years) mechanically ventilated for >24 hours, with an Fio ≤ 60%, who met IC screening criteria. Caloric needs were estimated using Harris-Benedict equations (HBEs), and 20, 25, and 30 kcal/kg/d with actual (ABW), adjusted (ADJ), and ideal body (IBW) weights. The REE was measured using IC.
: The estimated REE was considered accurate when within ±10% of the measured REE by IC. The HBE, 20, 25, and 30 kcal/kg/d estimates of REE were found to be inaccurate regardless of age, gender, or weight. The HBE and 20 kcal/kg/d underestimated REE, while 25 and 30 kcal/kg/d overestimated REE. Of the methods studied, those found to most often accurately estimate REE were the HBE using ABW, which was accurate 35% of the time, and 25 kcal/kg/d ADJ, which was accurate 34% of the time. This difference was not statistically significant.
: Using HBE, 20, 25, or 30 kcal/kg/d to estimate daily caloric requirements in critically ill surgical patients is inaccurate compared to REE measured by IC. In SICU patients with nutrition requirements essential to recovery, IC measurement should be performed to guide clinicians in determining goal caloric requirements.
虽然间接量热法（IC）是用于计算危重症患者特定热量需求的金标准，但由于各种原因，预测方程在许多机构中经常被使用。先前的研究表明，这些方程经常错误判断医学和混合重症监护病房（ICU）患者的实际静息能量消耗（REE）；然而，它们在外科重症监护病房（SICU）患者中的应用尚未得到充分评估。因此，本研究的目的是比较通过 IC 测量的 REE 与通过特定热量目标或预测方程计算的用于通气成人 SICU 患者营养支持的 REE。
对所有机械通气超过 24 小时、FiO2≤60%、符合 IC 筛选标准的成年人（n=419，18-91 岁）进行前瞻性收集数据的回顾性分析。使用 Harris-Benedict 方程（HBE）、实际体重（ABW）、调整体重（ADJ）和理想体重（IBW）的 20、25 和 30 kcal/kg/d 来估计热量需求。使用 IC 测量 REE。
当估计 REE 与 IC 测量的 REE 相差±10%时，认为估计 REE 是准确的。无论年龄、性别或体重如何，HBE、20、25 和 30 kcal/kg/d 的 REE 估计值均不准确。HBE 和 20 kcal/kg/d 低估了 REE，而 25 和 30 kcal/kg/d 则高估了 REE。在所研究的方法中，发现最能准确估计 REE 的是使用 ABW 的 HBE，其准确率为 35%，其次是 ADJ 的 25 kcal/kg/d，准确率为 34%。这一差异无统计学意义。
与 IC 测量的 REE 相比，使用 HBE、20、25 或 30 kcal/kg/d 来估计危重症外科患者的每日热量需求是不准确的。在对恢复至关重要的营养需求的 SICU 患者中，应进行 IC 测量，以指导临床医生确定目标热量需求。
