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DOI: 10.1055/s-0040-1710251
Validating the predicted energy expenditure according to standard care hospital protocol of the University clinic St. Pölten with indirect calorimetry, Quark RMR, and EEVCO2 measurements in critically ill patients a pilot study
Background Evaluating energy needs is demanding, as no defined gold standard method exists. Indirect calorimetry (IC) is said to be the most accurate. The ‘standard of care’ in the University clinic of St. Pölten is an estimation method. The aim of this pilot study is the validation of the ‘standard of care’ protocol with predictive equations and IC.
Methods The patients were recruited at the University clinic of St. Pölten in the period from January to March 2019. All patients admitted to the intermediate care unit with traumatic brain injury, but with stabile vital parameters, were accepted to the study. The first measurement of indirect calorimetry was done in the first 24 hours of hospital admittance and the following 2 days. Also, the
estimation method and the predictive equations were applied so. In total 4 measurements on 3 consecutive days were done.
Results 6 men and 2 women with the mean age of 49 years and a mean BMI of 28,6 kg/m2 participated in the study. Clear differences between the methods could be observed. The ‘standard of care’ protocol had the greatest difference in EE to the IC method (kcal_PL -475 kcal, kcal_weir 37 kcal, kcal_weir 0,85 - 244, p = 0,1). Over time the differences in EE became more equal (Day 1: kcal_PL 777,8, kcal_weir
1750,4, kcal_weir_0,85 1371,6 and kcal_quark 1660,5. Day 2: kcal_PL 1450,0, kcal_weir 1862,2, kcal_weir_0,85 1631,1 and kcal_quark 1859,4; Day 3: kcal_PL 1828,1, kcal_weir 1978,4, kcal_weir_0,85 1748,1 and kcal_quark 1961,5)
Conclusion IC is yet the most accurate method to estimate EE. The ‘standard of care protocol’ had the greatest difference compared to the other predictive equations. Influences of changes in medication, mechanical ventilation, fasting periods, continuous nutritional therapy and body temperature such as room temperature influence the EE drastically. If indirect calorimetry is not possible then formulas including body temperature and mechanically ventilation parameters should be preferred.
Publication History
Article published online:
16 June 2020
© Georg Thieme Verlag KG
Stuttgart · New York