Department of Surgery, Division of Trauma, Acute, and Critical Care Surgery, Duke University School of Medicine, Durham, North Carolina; Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina; Department of Anesthesiology, Division of Critical Care, Human Pharmacology and Physiology Laboratory (HPPL), Duke University School of Medicine, Durham, North Carolina.
Department of Surgery, Division of Trauma, Acute, and Critical Care Surgery, Duke University School of Medicine, Durham, North Carolina.
J Surg Res. 2024 Oct;302:525-532. doi: 10.1016/j.jss.2024.07.098. Epub 2024 Aug 22.
Suboptimal nutrition promotes unfavorable outcomes in trauma patients, particularly among those aged 60 and over. While many institutions employ predictive energy equations to determine patients' energy requirements, mounting evidence shows these equations inaccurately estimate caloric needs. In this pilot randomized controlled trial, we sought to quantify the discrepancy between predictive equations and indirect calorimetry (IC)-the gold standard for determining energy requirements-in the older adult trauma population.
This is a nested cohort study within a pilot randomized control trial in which 32 older adult trauma patients were randomized 3:1 to receive IC-guided nutrition delivery versus standard of care. IC requirements of patients in the intervention arm were compared to Mifflin St. Jeor (MSJ), Harris-Benedict (HB), and the American Society for Parenteral and Enteral Nutrition-Society of Critical Care Medicine (ASPEN-SCCM) predictive energy equations.
Twenty patients underwent IC to assess measured resting energy expenditure (mREE), yielding a mean (standard deviation) mREE of 23.1 ± 4.8 kcal/kg/d. MSJ and HB gave mean predictive resting energy expenditures of 17.5 ± 2.0 and 18.5 ± 2.0 kcal/kg/d in these patients, demonstrating that IC-derived values were 32.1% and 25.0% higher, respectively. When patients were stratified by body mass index (BMI), MSJ, and HB more severely underestimated caloric requirements in individuals with BMI <30 versus BMI 30-50. While the mean mREE fell within the mean predictive resting energy expenditure range prescribed by ASPEN-SCCM equations (21.4 ± 4.1 to 26.2 ± 4.3 kcal/kg/d), individuals' IC-derived values fell within their personal range in 8 of 20 cases.
The MSJ and HB predictive energy equations consistently and significantly underpredict metabolic demands of older adult trauma patients compared to IC and perform worse in lower BMI individuals. ASPEN-SCCM equations frequently overpredict or underpredict resting energy expenditure. While these findings should be confirmed in a larger randomized control trial, this study suggests that institutions should prioritize IC to accurately identify the metabolic demands of older trauma patients.
营养摄入不足会使创伤患者的预后恶化，尤其是 60 岁及以上的老年患者。尽管许多机构采用预测能量方程来确定患者的能量需求，但越来越多的证据表明这些方程并不能准确估计热量需求。在这项初步的随机对照试验中，我们旨在量化预测方程与间接测热法（确定能量需求的金标准）在老年创伤患者中的差异。
这是一项嵌套队列研究，纳入了一项初步的随机对照试验中的患者，32 名老年创伤患者按照 3:1 的比例随机分为接受间接测热法指导的营养输送组和常规护理组。干预组患者的间接测热法需求与米夫林-圣杰罗（Mifflin St. Jeor，MSJ）、哈里斯-本尼迪克特（Harris-Benedict，HB）和美国肠外与肠内营养学会-重症医学会（American Society for Parenteral and Enteral Nutrition-Society of Critical Care Medicine，ASPEN-SCCM）预测能量方程进行了比较。
20 名患者接受了间接测热法以评估测量的静息能量消耗（mREE），得出的平均（标准差）mREE 为 23.1±4.8 kcal/kg/d。在这些患者中，MSJ 和 HB 预测的静息能量消耗分别为 17.5±2.0 和 18.5±2.0 kcal/kg/d，表明 IC 衍生值分别高 32.1%和 25.0%。当根据体重指数（body mass index，BMI）对患者进行分层时，MSJ 和 HB 在 BMI<30 与 BMI 30-50 的个体中更严重地低估了热量需求。虽然平均 mREE 落在 ASPEN-SCCM 方程规定的预测静息能量消耗范围内（21.4±4.1 至 26.2±4.3 kcal/kg/d），但在 20 例患者中，有 8 例患者的 IC 衍生值落在其个人范围内。
与间接测热法相比，MSJ 和 HB 预测能量方程一致且显著低估了老年创伤患者的代谢需求，并且在 BMI 较低的个体中表现更差。ASPEN-SCCM 方程经常过高或过低预测静息能量消耗。尽管这些发现需要在更大的随机对照试验中得到证实，但本研究表明，各机构应优先采用间接测热法来准确识别老年创伤患者的代谢需求。
