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Determining energy requirements in the ICU
Anne Berit Guttormsen1, Claude Pichard
1aIntensive Care Unit, Haukeland University Hospital and University of Bergen, Bergen, Norway bClinical Nutrition, Geneva University Hospital, Switzerland.
Current Opinion in Clinical Nutrition and Metabolic Care
|February 7, 2014
Summary
Determining optimal energy targets for critically ill patients remains challenging. Indirect calorimetry is the gold standard for measuring energy needs, but accessible devices are currently unavailable.
Area of Science:
- Critical care medicine
- Nutritional support
- Metabolic monitoring
Background:
- Resting energy expenditure in critically ill patients is highly variable.
- Optimal energy targets in the intensive care unit (ICU) are uncertain.
- Nutritional provision significantly impacts patient outcomes.
Purpose of the Study:
- To address the uncertainty in optimal energy targets for ICU patients.
- To evaluate if measured energy expenditure equals energy requirements.
- To discuss current feeding strategies in critical care.
Main Methods:
- Indirect calorimetry is the gold standard for measuring energy expenditure.
- Predictive formulas based on patient characteristics are insufficient.
- Current limitations include the lack of affordable and accurate indirect calorimeters.
Main Results:
- Indirect calorimetry is essential for accurate energy requirement assessment.
- Assumptions based on patient demographics or ventilation are unreliable.
- Outcome is dependent on nutritional provision, components, and route.
Conclusions:
- Collaboration is needed to develop cost-effective, accurate indirect calorimeters for clinical use.
- Accessible indirect calorimetry devices are not currently available.
- Clinicians rely on best practices and predictive formulas in the absence of ideal tools.
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