ResearchReviewPrediction of Resting Metabolic Rate in Critically Ill Adult Patients: Results of a Systematic Review of the Evidence
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)
- et al.
Net protein anabolism with hypocaloric parenteral nutrition in obese stressed patients
Am J Clin Nutr.
(1986) - et al.
Hypocaloric enteral tube feeding in critically ill obese patients
Nutrition
(2002) - et al.
Human energy requirements: Overestimation by widely used prediction equations
Am J Clin Nutr.
(1985) - et al.
Best practice methods to apply to measurement of resting metabolic rate in adults: A systematic review
J Am Diet Assoc.
(2006) - et al.
A new predictive equation for resting energy expenditure in healthy individuals
Am J Clin Nutr.
(1990) - et al.
Assessment of resting energy expenditure in mechanically ventilated patients
Am J Clin Nutr.
(2003) - et al.
Comparison of predictive equation for resting metabolic rate in healthy nononbese and obese adults: A systematic review
J Am Diet Assoc.
(2005) - et al.
Preliminary evidence for a medical nutrition therapy protocol: Enteral feedings for critically ill patients
J Am Diet Assoc.
(2006) - et al.
A practical approach to evidence grading
Jt Comm J Qual Improv.
(2000) - et al.
Comparison of indirect calorimetry, the Fick method, and prediction equations in estimating the energy requirements of critically ill patients
Am J Clin Nutr.
(1999)
An evaluation of resting energy expenditure in hospitalized, severely underweight patients
Nutrition
Measured versus estimated energy expenditure in mechanically ventilated critically ill patients
Clin Nutr.
Comparison of formulaic equations to determine energy expenditure in the critically ill patient
Nutr.
Predicting energy needs in ventilator-dependent critically ill patients: Effect of adjusting weight for edema or adiposity
Am J Clin Nutr.
The quality of nutrition at an intensive care unit
Nutrition Research
Relative association of fever and injury with hypermetabolism in critically ill patients
Injury
A prospective, randomized trial of intravenous fat emulsion administration in trauma victims requiring total parenteral nutrition
J Trauma
Hyperglycemia is associated with adverse outcomes in patients receiving total parenteral nutrition
Diabetes Care
Efficacy of hypocaloric total parenteral nutrition in hospitalized obese patients: A prospective, double-blind randomized trial
J Parenter Enteral Nutr.
Accelerated nitrogen loss after traumatic injury is not attenuated by achievement of nitrogen balance
J Parenter Enteral Nutr.
A Biometric Study of Basal Metabolism in Man
Metabolic response to injury and illness: Estimation of energy and protein needs from indirect calorimetry and nitrogen balance
J Parenter Enteral Nutr.
Predictive equation for assessing energy expenditure in mechanically ventilated critically ill patients
Crit Care Med.
Cited by (89)
Calorie and protein intake in traumatic brain injury patients
2023, Diet and Nutrition in Neurological DisordersAnimal models of ingestive behaviors
2021, Encyclopedia of Behavioral Neuroscience: Second EditionA 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 NutritionCitation 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
A novel prediction equation of resting energy expenditure for Japanese septic patients
2020, Journal of Critical CareNutritional treatment in the critically-ill complicated patient
2020, Nutrition and Bariatric Surgery
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.