Research
Review
Prediction of Resting Metabolic Rate in Critically Ill Adult Patients: Results of a Systematic Review of the Evidence

https://doi.org/10.1016/j.jada.2007.06.010Get rights and content

Abstract

Metabolic rate is generally assessed by use of equations in critically ill patients, but evidence pertaining to the validity of these equations in this population has not been systematically evaluated. This paper represents the first such systematic analysis in adult patients. A work group created by the American Dietetic Association identified pertinent peer-reviewed articles. The work group systematically evaluated these articles and formulated conclusion statements and grades based on the available evidence. Seven equations plus the Fick method were found to have validation work that met criteria for inclusion in this analysis. The Harris-Benedict equation with and without modifiers had the most validation work behind it (n=13), followed by Ireton-Jones (1992 and 1997) (n=9), Penn State (1998, 2003) (n=2), and Swinamer (n=1). Five studies pertaining to the Fick method met acceptance criteria. Based on these validation studies, the Harris-Benedict, Ireton-Jones 1997, and Fick methods can be confidently eliminated from use in assessment of energy expenditure in critically ill patients. The Penn State 2003, Swinamer, and Ireton-Jones 1992 equations may be useful in critically ill nonobese patients, whereas the Ireton-Jones 1992 and Penn State 1998 equations seem to be useful in obese patients. The strength of these conclusions is moderated because of limited and sometimes inconsistent data. More validation work is needed to confirm and increase the strength of these conclusions.

Section snippets

Methods

A group of evidence analysts and clinical and research experts was convened by the American Dietetic Association (ADA) to determine, among other critical care questions, which methods of determining metabolic rate are the most accurate. The general process has been described elsewhere (18, 19, 20). Briefly, a set of questions is posed by the work group to address a topic. A trained evidence analyst performs electronic literature searches, evaluates the quality of the resulting papers against

Results

Of the existing equations and methods for calculating resting metabolic rate in the intensive care unit, eight had at least one validation study pertaining to its accuracy. Those methods were the Fick method, the Harris-Benedict equation with stress factors and without stress factors, the Swinamer equation, the Ireton-Jones equation (1992 and 1997 versions), and the Penn State equation (1998 and 2003 versions).

Discussion

Much has been written about the metabolic rate of the critically ill patient, and many attempts have been made to develop prediction models to determine by calculation the metabolic rate of an individual critically ill patient. The rejoinder to such efforts is often that there is no substitute for measurement of the metabolic rate. Although this is undoubtedly true, it is also often irrelevant because many clinicians do not have the equipment to perform the measurements. Therefore, a systematic

Conclusions

There is plentiful, strong evidence on which to recommend that the Harris-Benedict equation (unmodified or modified with stress factors) should not be used to predict resting metabolic rate in critically ill patients. Likewise, there is strong evidence against the use of Fick-derived oxygen consumption calculations to assess metabolic rate. In contrast, there are no data on which to base conclusions on the Mifflin-St Jeor, Faisy, or Brandi equations. The Ireton-Jones equation (1997 version) has

D. Frankenfield is chief clinical dietitian and a nutrition support dietitian, Department of Clinical Nutrition, Milton S. Hershey Medical Center, Hershey, PA.

References (46)

  • A. Ahmad et al.

    An evaluation of resting energy expenditure in hospitalized, severely underweight patients

    Nutrition

    (1999)
  • C.H. Cheng et al.

    Measured versus estimated energy expenditure in mechanically ventilated critically ill patients

    Clin Nutr.

    (2002)
  • A. MacDonald et al.

    Comparison of formulaic equations to determine energy expenditure in the critically ill patient

    Nutr.

    (2003)
  • M.E. Cutts et al.

    Predicting energy needs in ventilator-dependent critically ill patients: Effect of adjusting weight for edema or adiposity

    Am J Clin Nutr.

    (1997)
  • M.M.P.M. Jansen et al.

    The quality of nutrition at an intensive care unit

    Nutrition Research

    (2002)
  • D.C. Frankenfield et al.

    Relative association of fever and injury with hypermetabolism in critically ill patients

    Injury

    (1997)
  • F.D. Battistella et al.

    A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition

    J Trauma

    (1997)
  • N.W. Cheung et al.

    Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition

    Diabetes Care

    (2005)
  • J.C. Burge et al.

    Efficacy of hypocaloric total parenteral nutrition in hospitalized obese patients: A prospective, double-blind randomized trial

    J Parenter Enteral Nutr.

    (1994)
  • D.C. Frankenfield et al.

    Accelerated nitrogen loss after traumatic injury is not attenuated by achievement of nitrogen balance

    J Parenter Enteral Nutr.

    (1997)
  • J.A. Harris et al.

    A Biometric Study of Basal Metabolism in Man

    (1919)
  • C.L. Long et al.

    Metabolic response to injury and illness: Estimation of energy and protein needs from indirect calorimetry and nitrogen balance

    J Parenter Enteral Nutr.

    (1979)
  • D.L. Swinamer et al.

    Predictive equation for assessing energy expenditure in mechanically ventilated critically ill patients

    Crit Care Med.

    (1990)
  • Cited by (89)

    • Calorie and protein intake in traumatic brain injury patients

      2023, Diet and Nutrition in Neurological Disorders
    • Animal models of ingestive behaviors

      2021, Encyclopedia of Behavioral Neuroscience: Second Edition
    • A Comparison of the Indirect Calorimetry and Different Energy Equations for the Determination of Resting Energy Expenditure of Patients With Renal Transplantation

      2021, Journal of Renal Nutrition
      Citation Excerpt :

      Indirect calorimetry, which is used to determine the resting energy expenditure (REE) in clinical settings, is considered the gold standard.9 However, the use of indirect calorimetry in the field is limited because of the high cost and the need for trained technical staff.10 As an alternative to indirect calorimetry in the field, there are many energy equations for the calculation of the energy expenditure, including age, sex, body weight, height, body fat mass, and fat-free mass (FFM).11,12

    View all citing articles on Scopus

    D. Frankenfield is chief clinical dietitian and a nutrition support dietitian, Department of Clinical Nutrition, Milton S. Hershey Medical Center, Hershey, PA.

    M. Hise is an assistant professor, University of Kansas Medical Center, Kansas City.

    A. Malone is with the nutrition support team, Department of Pharmacy, Mt Carmel West Hospital, Columbus, OH.

    M. Russell is interim director, Nutrition Services, University of Chicago Hospitals, Chicago, IL.

    E. Gradwell is lead evidence analyst, independent contractor, American Dietetic Association, Arvada, CO.

    C. Compher is an assistant professor of nutrition science, Penn Nursing and Hospital of University of Pennsylvania Clinical Nutrition Support Service, Philadelphia.

    View full text