Porter C, Cohen N H
Department of Nutrition and Dietetics, University of California, San Francisco 94143-0212, USA.
J Am Diet Assoc. 1996 Jan;96(1):49-57. doi: 10.1016/S0002-8223(96)00014-4.
Evaluation and interpretation of energy needs of critically ill patients require the expertise of clinical dietitians: Dietitians must be knowledgeable about the methods available to quantify energy needs and able to communicate effectively with physicians and nurses regarding nutritional requirements. Several prediction equations are available for calculating energy needs of critically ill patients. Indirect calorimetry is also used frequently to measure energy requirements in this patient population. This article defines when energy expenditure measured by indirect calorimetry may provide clinically useful information. Data obtained by indirect calorimetry must be interpreted carefully. Indirect calorimetry is based on the equations for oxidation of carbohydrate, protein, and fat. Errors in interpretation can be made when metabolic pathways other than oxidation dominate or when clinical conditions exist that affect carbon dioxide excretion from the lungs. Before incorporating data obtained from indirect calorimetry into a nutrition care plan, the clinical dietitian should carefully evaluate the following factors for a patient: clinical conditions when the measurement was made, desired weight loss or gain, tolerance to food or nutrition support, relationship between protein intake and energy need, and need for anabolism or growth. This article provides clinical examples illustrating how measured values compare with calculated values and recommendations for how to incorporate measured values into nutrition care plans.
营养师必须了解可用于量化能量需求的方法，并且能够就营养需求与医生和护士进行有效沟通。有几种预测方程可用于计算重症患者的能量需求。间接测热法也经常用于测量该患者群体的能量需求。本文定义了通过间接测热法测量的能量消耗何时可能提供临床有用信息。通过间接测热法获得的数据必须仔细解读。间接测热法基于碳水化合物、蛋白质和脂肪氧化的方程。当氧化以外的代谢途径占主导或存在影响二氧化碳从肺部排出的临床情况时，可能会出现解读错误。在将间接测热法获得的数据纳入营养护理计划之前，临床营养师应仔细评估患者的以下因素：测量时的临床情况、期望的体重减轻或增加、对食物或营养支持的耐受性、蛋白质摄入量与能量需求之间的关系以及合成代谢或生长的需求。本文提供了临床实例，说明测量值与计算值的比较情况，以及如何将测量值纳入营养护理计划的建议。
