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A predictive equation for determination of resting energy expenditure in mechanically ventilated patients
1Department of Medicine, Hahnemann University Hospital, Philadelphia.
Study Objective:
To evaluate an equation that estimates resting energy expenditure from two easily obtained measurements--expired carbon dioxide and minute ventilation, and compare the results of this equation with standard methods of estimating and measuring caloric expenditure in mechanically ventilated patients.
Design:
Prospective evaluation in a consecutive, unselected cohort.
Setting:
Medical, surgical, and coronary intensive care units in a university hospital.
Patients:
Twenty-five patients (16 to 79 years of age) receiving mechanical ventilation.
Intervention:
Indirect calorimetry (IC), minute ventilation (VE), and partial pressure of expired carbon dioxide (PECO2) were obtained on all patients. Harris-Benedict equations were calculated and corrected for known stress factors (HBc). Calculated energy expenditure (CEE) was determined using the following equation: CEE = 9.27 x VE x PECO2 CEE was then compared with IC and HBc.
Measurements And Results:
The IC was interpretable in 22 of 25 patients, and CEE was significantly better at estimating caloric requirements than HBc. The mean absolute difference between CEE and IC was significantly less than between HBc and IC (118 +/- 96 vs 302 +/- 269, p < .003). CEE estimated caloric requirements to within 200 kcal of IC in 16 of 22 (72 percent); HBc estimated within 200 kcal of IC in 9 of 22 (41 percent).
Conclusions:
Minute ventilation and expired carbon dioxide measurements are easily and inexpensively obtainable. Energy expenditures calculated from these measurements (CEE) compare favorably with values obtained from a metabolic cart and are significantly more accurate than HBc.