Department of Internal Medicine, Division of Dietetics, Erasmus Medical Centre, Rotterdam, the Netherlands.
Department of Intensive Care Medicine, Erasmus Medical Centre, Rotterdam, the Netherlands.
Clin Nutr. 2024 Oct;43(10):2267-2272. doi: 10.1016/j.clnu.2024.07.048. Epub 2024 Aug 7.
BACKGROUND & AIMS: The use of indirect calorimetry to determine energy requirements is highly recommended in critically ill patients. To facilitate this a new and easy to use calorimeter (Q-NRG+, Cosmed) was developed. The primary aim of our study was to describe the usefulness of this calorimeter and, secondarily, to investigate the agreement between measured and predicted energy needs in a large cohort of critically ill adult patients.
A prospective observational study was conducted among adult mechanically ventilated patients with COVID-19. Indirect calorimetry (Q-NRG+) to measure resting energy expenditure (mREE) was performed in the first week after admission and, wherever possible, repeated weekly. Reasons for not performing indirect calorimetry were reported. Parameters of indirect calorimetry and patient's conditions during the measurements were collected. Measurements were defined as valid if less than 10% overall variation in VO and VCO and respiratory quotient ranges between 0.67 and 1.1 were observed. mREE was compared with predictive REE (pREE) using standard formulas to explore hypo (<90%)-and hypermetabolism. (>110%). Bland-Altman method and two-way mixed intraclass correlation coefficients (ICC) (single measures) were used to assess the agreement between mREE and pREE.
Indirect calorimetric measurements were performed in 180 of the 432 admitted patients (42%). Of the 276 performed measurements 85% were valid, and of these 90% were used to tailor nutritional therapy. Most patients were male (71%), median age was 62 years [IQR 52; 70]. Logistical issues (absence of measuring staff, no device, no stock of disposables, MRSA isolation) and clinical issues (e.g Fio>70%, detubated but still in ICU) were the main reasons for not performing indirect calorimetry. The majority of the REE-measurements indicated either hypo- or hypermetabolism (57% week 1 and 56% week 2). The correlation between mREE and pREE was very moderate (ICC = 0.527).
Although indirect calorimetry was performed in less than half of the patients, it proved to be of value to guide nutritional therapy. We conclude that the technique is easily applicable and expect that its impact can be significantly increased with the resolution of logistical and organizational issues.
在危重症患者中，推荐使用间接热量测定法来确定能量需求。为此，开发了一种新型易用的热量计（Q-NRG+，Cosmed）。本研究的主要目的是描述该热量计的实用性，并在大型成人危重症患者队列中研究测量的能量需求与预测的能量需求之间的一致性。
对患有 COVID-19 的机械通气成人患者进行前瞻性观察性研究。在入院后第一周内进行间接热量测定（Q-NRG+）以测量静息能量消耗（mREE），并尽可能每周重复一次。报告无法进行间接热量测定的原因。收集间接热量测定参数和患者在测量期间的情况。如果观察到 VO 和 VCO 总变化率<10%，呼吸商范围在 0.67 至 1.1 之间，则认为测量值有效。使用标准公式将 mREE 与预测 REE（pREE）进行比较，以探讨低（<90%）和高代谢（>110%）。采用 Bland-Altman 法和双向混合组内相关系数（ICC）（单次测量）评估 mREE 与 pREE 之间的一致性。
在 432 名入院患者中，有 180 名患者（42%）进行了间接热量测定。在进行的 276 次测量中，85%是有效的，其中 90%用于调整营养治疗。大多数患者为男性（71%），中位年龄为 62 岁[IQR 52；70]。无法进行间接热量测定的主要原因是存在后勤问题（缺乏测量人员、无设备、无一次性用品库存、耐甲氧西林金黄色葡萄球菌隔离）和临床问题（例如 Fio>70%，脱管但仍在 ICU 中）。大多数 REE 测量结果表明存在低代谢或高代谢（第 1 周 57%，第 2 周 56%）。mREE 与 pREE 之间的相关性为中度（ICC=0.527）。
尽管只有不到一半的患者进行了间接热量测定，但它证明对指导营养治疗有价值。我们得出的结论是，该技术易于应用，并期望随着后勤和组织问题的解决，其影响会显著增加。
