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Assessment of resting energy expenditure in mechanically ventilated patients

Medicine D, Beilinson Hospital
Rabin Medical Center
Petah-Tikva 49100
Israel
E-mail: nirbarak{at}post.tau.ac.il

Dear Sir:

A recent study by Faisy et al (1) provided an equation for predicting energy expenditure (EE) in mechanically ventilated patients. Like Ireton-Jones and Jones (2), Swinamer et al (3), and Frankenfield et al (4), Faisy et al speculated that the addition of factors such as minutes of ventilation and body temperature to the traditional indexes (ie, sex, age, weight, and height) used for EE prediction (5) would result in a better correlation.

To assess the validity of this equation, I screened the indirect calorimetry database of the University of Chicago Hospitals (6) and found 77 patients with complete records. Weight for the Harris-Benedict equation was adjusted by 50% (6), and a stress factor of 1.3 was used (7). The correlation (r) was assessed by using Pearson's coefficient, bias was the difference between measured and calculated EEs, and agreement was assessed by using Bland-Altman analysis (8).

The data validate the equation of Faisy et al as a tool for EE prediction in mechanically ventilated patients. However, the Harris-Benedict equation (multiplied by 1.3) gave a better correlation and agreement with the measured EE and the smallest mean bias (Table 1). EE should be measured whenever possible. This analysis shows that, when the EE measurement is not available, the Harris-Benedict equation with a stress factor of 1.3 is the most accurate tool for EE prediction.

REFERENCES

1. Faisy C, Guerot E, Diehl JL, Labrousse J, Fagon JY. Assessment of resting energy expenditure in mechanically ventilated patients. Am J Clin Nutr 2003;78:241-9.[Abstract/Free Full Text]
2. Ireton-Jones C, Jones JD. Improved equations for predicting energy expenditure in patients: the Ireton-Jones equations. Nutr Clin Pract 2002;17:29-31.[Free Full Text]
3. Swinamer DL, Grace MG, Hamilton SM, Jones RL, Roberts P, King EG. Predictive equation for assessing energy expenditure in mechanically ventilated critically ill patients. Crit Care Med 1990;18:657-61.[Medline]
4. Frankenfield DC, Omert LA, Badellino MM, et al. Correlation between measured energy expenditure and clinically obtained variables in trauma and sepsis patients. JPEN J Parenter Enteral Nutr 1994;18:398-403.[Abstract/Free Full Text]
5. Harris JA, Benedict FG. Biometric studies of basal metabolism in men. Washington, DC: Carnegie Institution of Washington, 1919 (Publication 270.).
6. Barak N, Wall-Alonso E, Sitrin MD. Evaluation of stress factors and body weight adjustments currently used to estimate energy expenditure in hospitalized patients. JPEN J Parenter Enteral Nutr 2002;26:231-8.[Abstract/Free Full Text]
7. Malone AM. Methods of assessing energy expenditure in the intensive care unit. Nutr Clin Pract 2002;17:21-8.[Abstract/Free Full Text]
8. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986;8476:307-10.

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