Department of Intensive Care, S L Raheja Hospital-A Fortis Associate, Mumbai, Maharashtra, India.
Department of Clinical Nutrition and Dietetics, AIG Hospitals, Hyderabad, Telangana, India.
JPEN J Parenter Enteral Nutr. 2022 Nov;46(8):1875-1882. doi: 10.1002/jpen.2393. Epub 2022 May 28.
Indirect calorimetry (IC) is the gold standard for measuring resting energy expenditure. Energy expenditure (EE) estimated by ventilator-derived carbon dioxide consumption (EEVCO ) has also been proposed. In the absence of IC, predictive weight-based equations have been recommended to estimate daily energy requirements. This study aims to compare simple predictive weight-based equations with those estimated by EEVCO and IC in mechanically ventilated patients of COVID-19.
Retrospective study of a cohort of critically ill adult patients with COVID-19 requiring mechanical ventilation and artificial nutrition to compare energy estimations by three methods through the calculation of bias and precision agreement, reliability, and accuracy rates.
In 58 mechanically ventilated patients, a total of 117 paired measurements were obtained. The mean estimated energy derived from weight-based calculations was 2576 ± 469 kcal/24 h, as compared with 1507 ± 499 kcal/24 h when EE was estimated by IC, resulting in a significant bias of 1069 kcal/day (95% CI [-2158 to 18.7 kcal]; P < 0.001). Similarly, estimated mean EEVCO was 1388 ± 467 kcal/24 h when compared with estimation of EE from IC. A significant bias of only 118 kcal/day (95% CI [-187 to 422 kcal]; P < 0.001), compared by the Bland-Altman plot, was noted.
The energy estimated with EEVCO correlated better with IC values than energy derived from weight-based calculations. Our data suggest that the use of simple predictive equations may potentially lead to overfeeding in mechanically ventilated patients with COVID-19.
间接热量测定法（IC）是测量静息能量消耗的金标准。通过呼吸机衍生的二氧化碳消耗（EEVCO）来估计能量消耗（EE）也已被提出。在没有 IC 的情况下，推荐使用预测体重的方程式来估计每日能量需求。本研究旨在比较机械通气的 COVID-19 患者中简单的预测体重方程式与 EEVCO 和 IC 估计值。
回顾性研究了一组需要机械通气和人工营养的重症 COVID-19 成年患者，通过计算偏差和精度一致性、可靠性和准确率来比较三种方法的能量估计。
在 58 例机械通气的患者中，共获得了 117 对测量值。基于体重计算得出的估计能量平均值为 2576 ± 469 kcal/24 h，而通过 IC 估计 EE 时则为 1507 ± 499 kcal/24 h，每天有显著的 1069 kcal 偏差（95%CI [-2158 至 18.7 kcal]；P < 0.001）。同样，与 IC 估计 EE 相比，估计的 EEVCO 平均值为 1388 ± 467 kcal/24 h。Bland-Altman 图显示，只有 118 kcal/天的显著偏差（95%CI [-187 至 422 kcal]；P < 0.001）。
与基于体重计算的能量相比，EEVCO 估计的能量与 IC 值相关性更好。我们的数据表明，在机械通气的 COVID-19 患者中，使用简单的预测方程可能会导致过度喂养。
