Measured and Predicted Resting Energy Expenditure in Malnourished Older Hospitalized Patients: A Cross-Sectional and Longitudinal Comparison.

A number of equations have been proposed to predict resting energy expenditure (REE). The role of nutritional status in the accuracy and validity of the REE predicted in older patients has been paid less attention. We aimed to compare REE measured by indirect calorimetry (IC) and REE predicted by the Harris-Benedict formula in malnourished older hospitalized patients. Twenty-three malnourished older patients (age range 67-93 years, 65% women) participated in this prospective longitudinal observational study. Malnutrition was defined as Mini Nutritional Assessment Long Form (MNA-SF) score of less than 17. REE was measured (REEmeasured) and predicted (REEpredicted) on admission and at discharge. REEpredicted within ±10% of the REEmeasured was considered as accuracy. Nutritional support was provided to all malnourished patients during hospitalization. All patients were malnourished with a median MNA-LF score of 14. REEmeasured and REEpredicted increased significantly during 2-week nutritional therapy (+212.6 kcal and +19.5 kcal, respectively). Mean REEpredicted (1190.4 kcal) was significantly higher than REEmeasured (967.5 kcal) on admission (p < 0.001). This difference disappeared at discharge (p = 0.713). The average REEpredicted exceeded the REEmeasured on admission and at discharge by 29% and 11%, respectively. The magnitude of difference between REEmeasured and REEpredicted increased along with the degree of malnutrition (r = 0.42, p = 0.042) as deviations ranged from -582 to +310 kcal/day in severe to mildly malnourished patients, respectively. REEpredicted by the Harris-Benedict formula is not accurate in malnourished older hospitalized patients. REE measured by IC is considered precise, but it may not represent the true energy requirements to recover from malnutrition. Therefore, the effect of malnutrition on measured REE must be taken into account when estimating energy needs in these patients.

Changing laws of rest energy expenditure in critically ill patients and the intervention effect for nutritional support: a prospective study / 中华危重病急救医学

Objective To investigate the changing laws of rest energy expenditure (REE) in intensive care unit (ICU) patients and the intervention effect for nutritional support. Methods A prospective randomized control trial was conducted. Fifty-eight critically ill patients who were expected to be able to receive sustained enteral and (or) parenteral nutrition for more than 7 days admitted to ICU of the First Affiliated Hospital of Bengbu Medical College from December 2016 to June 2017 were enrolled. The patients were divided into REE group (n = 29) and HBREE group (n = 29) according to the random number table. On the 1st to 7th day after ICU admission, the indirect calorimetry and the Harris-Benedict (HB) formula were used to obtain the REE and HBREE values, and nutritional support was given according to REE and HBREE values respectively. The data of hemoglobin (Hb), albumin (Alb), prealbumin (PA), C-reactive protein (CRP), oxygenation index (OI) on 1st, 3rd, 5th, 7th and discharged day, and insulin dosage, vasopressor time, mechanical ventilation time, the length of ICU stay, and 28-day mortality were collected. Results ① At the beginning, the REE level was high, and then decreased gradually with the extension of hospitalization, and the decline was obvious on the 2nd to 3rd day (kJ/d: 7088.38±559.41, 6751.34±558.72 vs. 7553.44±645.55, both P < 0.05), and was stable from the 5th day, the changing laws showed high at first, then the low, the first rapid decline, then the slow decline, and then reached the steady, there was a 2-day plateau in the middle. During the first 2 days, the REE value was significantly higher than the HBREE value (kJ/d: 7553.44±645.55 vs. 6759.21±668.14, 7088.38± 559.41 vs. 6759.21±668.14, both P < 0.01); on the 3rd, 4th day, the REE value was almost the same as the HBREE value (kJ/d: 6751.34±558.72 vs. 6759.21±668.14, 6568.03±760.19 vs. 6759.21±668.14, both P > 0.05). After that, the REE value was significantly lower than the HBREE value (kJ/d: 6089.55±560.70 vs. 6759.21±668.14, 5992.55±501.82 vs. 6759.21±668.14, 5860.84±577.59 vs. 6759.21±668.14, all P < 0.01). ② After the initiation of nutritional support, Hb in the REE group (the first 3 days) and HBREE group (the first 7 days) all increased slowly in the early stage. It increased obviously on the 5th day in the REE group. Compared with the REE group, Hb increased more slowly in the HBREE group, however, there was no difference between the two groups at the time of discharge (g/L: 113.75±17.28 vs. 110.86±15.35, P > 0.05). PA and OI all enhanced significantly on the 3rd day since the nutritional support was initiated, but the daily increase of the REE group was significantly higher than that of the HBREE group [3rd day, PA (mg/L): 110.38±27.65 vs. 96.28±18.06, OI (mmHg, 1 mmHg = 0.133 kPa): 259.29±49.36 vs. 231.74±28.02, both P < 0.05]. The Alb and CRP in the REE group began to improve on the 3rd day, while the index in the HBREE group was delayed on the 5th day, overall, at the time of discharge, the PA, CRP and OI were lower in the HBREE group than in the REE group [PA (mg/L): 252.28±56.94 vs. 295.86±57.26, CRP (mg/L): 73.14±17.63 vs. 56.52±14.91, OI (mmHg): 353.59±70.36 vs. 417.52±71.58, all P < 0.01]. ③ The vasopressor was used in both groups for less than 3 days, but the REE group was shorter (days: 2.26±0.82 vs. 2.95±1.22, P < 0.05), the insulin dosage in the HBREE group was much more than that in the REE group (U: 101.97±21.05 vs. 84.59±22.21, P <0.01); compared with the REE group, the time of mechanical ventilation and the length of ICU stay in the HBREE group were longer (hours: 113.07±25.96 vs. 93.41±27.25, days: 10.41±3.11 vs. 8.45±2.44, both P < 0.01). There was no significant difference in the 28-day mortality between the REE group and HBREE group (17.24％ vs. 24.14％, P >0.05). Conclusions Indirect calorimetry can more accurately grasp the changing laws of REE in critically ill patients. Nutritional support with REE value can make relevant nutritional indicators as good as possible, and reduce insulin dosage, shorten vasopressor use time, the length of ICU stay and mechanical ventilation time, but does not change the 28-day mortality.

Application value of resting energy monitoring in nutritional support therapy for mechanical ventilation patients / 中华危重病急救医学

Objective To investigate the value of resting energy expenditure (REE) monitoring in nutritional support therapy of critical patients on mechanical ventilation.Methods A prospective randomized controlled trial was conducted.Sixty critical patients [acute physiology and chronic health evaluation Ⅱ score (APACHE Ⅱ) ＞ 15] on ventilation admitted to intensive care unit (ICU) of Dalian Friendship Hospital from September 2016 to October 2018 were enrolled.The enrolled patients were randomly divided into Harris-Benedict formula (HB formula) group and indirect energy measurement (metabolic vehicle) group with 30 patients in each group.The HB formula group was used traditional HB formula to determine the energy supply and ratio of nutritional support therapy,and the metabolic vehicle group was regularly measured the energy supply and proportion of nutritional support therapy.Serum albumin (ALB),total protein (TP),lymphocyte ratio,blood glucose,blood gas analysis parameters and REE value were determined at 3,5,7,9,and 11 days of nutritional support therapy.Results The value of REE at 3 days of nutritional support therapy in metabolic vehicle group was significantly higher than that in HB formula group (kJ/d:7 850.4±947.3 vs.6 915.3±875.7,P ＜ 0.05).With the time of nutritional support treatment prolonged,the REE value of metabolic vehicle group was decreased gradually,and after 7 days,the patient's condition was stable and improved,and the REE value tended to be stable gradually,it was significantly lower than that of HB formula group at 11 days (kJ/d:5 046.3 ± 493.3 vs.6 915.3 ± 875.7,P ＜ 0.05).There was no significant difference in blood gas analysis or plasma protein before nutritional support therapy between the two groups.After 5 days of nutritional support therapy,the respiratory function of critical patients in both groups was improved,and the lymphocyte ratio and plasma protein parameters were alleviated.After 11 days of nutrition support therapy,the respiratory function of critical patients in both groups was further improved,the ventilator model was adjusted to continuous positive airway pressure (CPAP) mode,the lymphocyte ratio and plasma protein parameters were improved,and the skin color and elasticity were improved,the granulation of the wound was fresh and healed well,and the plasma protein level was increased obviously,ALB level in metabolic vehicle group was significantly higher than that in HB formula group (g/L:31.8 ± 2.5 vs.26.7 ± 2.3,P ＜ 0.05).In the metabolic vehicle group,REE value was decreased from the maximum level on the 3rd day (k J/d:7 850.4 ± 947.3) to a stable level after 11 days (k J/d:5 046.3 ± 493.3),and its energy ratio changed significantly,from carbohydrate:fat of 77％ ∶ 21％ with protein consumption gradually transition in the early (3 days) to carbohydrates:fat of 56％ ∶ 44％ without protein consumption in the later stage (11 days),which showed the tendency of energy consumption was reasonable.Conclusion The energy metabolism rule of critical patients on ventilation could be determined by using the accurate metabolic vehicle and dynamic monitoring of REE value,which could be used for the implementation of nutritional support therapy.

Changing laws of rest energy expenditure in critically ill patients and the intervention effect for nutritional support: a prospective study / 中华危重病急救医学

Objective@#To investigate the changing laws of rest energy expenditure (REE) in intensive care unit (ICU) patients and the intervention effect for nutritional support.@*Methods@#A prospective randomized control trial was conducted. Fifty-eight critically ill patients who were expected to be able to receive sustained enteral and (or) parenteral nutrition for more than 7 days admitted to ICU of the First Affiliated Hospital of Bengbu Medical College from December 2016 to June 2017 were enrolled. The patients were divided into REE group (n = 29) and HBREE group (n = 29) according to the random number table. On the 1st to 7th day after ICU admission, the indirect calorimetry and the Harris-Benedict (HB) formula were used to obtain the REE and HBREE values, and nutritional support was given according to REE and HBREE values respectively. The data of hemoglobin (Hb), albumin (Alb), prealbumin (PA), C-reactive protein (CRP), oxygenation index (OI) on 1st, 3rd, 5th, 7th and discharged day, and insulin dosage, vasopressor time, mechanical ventilation time, the length of ICU stay, and 28-day mortality were collected.@*Results@#① At the beginning, the REE level was high, and then decreased gradually with the extension of hospitalization, and the decline was obvious on the 2nd to 3rd day (kJ/d: 7 088.38±559.41, 6 751.34±558.72 vs. 7 553.44±645.55, both P < 0.05), and was stable from the 5th day, the changing laws showed high at first, then the low, the first rapid decline, then the slow decline, and then reached the steady, there was a 2-day plateau in the middle. During the first 2 days, the REE value was significantly higher than the HBREE value (kJ/d: 7 553.44±645.55 vs. 6759.21±668.14, 7 088.38±559.41 vs. 6 759.21±668.14, both P < 0.01); on the 3rd, 4th day, the REE value was almost the same as the HBREE value (kJ/d: 6 751.34±558.72 vs. 6 759.21±668.14, 6 568.03±760.19 vs. 6 759.21±668.14, both P > 0.05). After that, the REE value was significantly lower than the HBREE value (kJ/d: 6 089.55±560.70 vs. 6 759.21±668.14, 5 992.55±501.82 vs. 6 759.21±668.14, 5 860.84±577.59 vs. 6 759.21±668.14, all P < 0.01). ② After the initiation of nutritional support, Hb in the REE group (the first 3 days) and HBREE group (the first 7 days) all increased slowly in the early stage. It increased obviously on the 5th day in the REE group. Compared with the REE group, Hb increased more slowly in the HBREE group, however, there was no difference between the two groups at the time of discharge (g/L: 113.75±17.28 vs. 110.86±15.35, P > 0.05). PA and OI all enhanced significantly on the 3rd day since the nutritional support was initiated, but the daily increase of the REE group was significantly higher than that of the HBREE group [3rd day, PA (mg/L): 110.38±27.65 vs. 96.28±18.06, OI (mmHg, 1 mmHg = 0.133 kPa): 259.29±49.36 vs. 231.74±28.02, both P < 0.05]. The Alb and CRP in the REE group began to improve on the 3rd day, while the index in the HBREE group was delayed on the 5th day, overall, at the time of discharge, the PA, CRP and OI were lower in the HBREE group than in the REE group [PA (mg/L): 252.28±56.94 vs. 295.86±57.26, CRP (mg/L): 73.14±17.63 vs. 56.52±14.91, OI (mmHg): 353.59±70.36 vs. 417.52±71.58, all P < 0.01]. ③ The vasopressor was used in both groups for less than 3 days, but the REE group was shorter (days: 2.26±0.82 vs. 2.95±1.22, P < 0.05), the insulin dosage in the HBREE group was much more than that in the REE group (U: 101.97±21.05 vs. 84.59±22.21, P < 0.01); compared with the REE group, the time of mechanical ventilation and the length of ICU stay in the HBREE group were longer (hours: 113.07±25.96 vs. 93.41±27.25, days: 10.41±3.11 vs. 8.45±2.44, both P < 0.01). There was no significant difference in the 28-day mortality between the REE group and HBREE group (17.24% vs. 24.14%, P > 0.05).@*Conclusions@#Indirect calorimetry can more accurately grasp the changing laws of REE in critically ill patients. Nutritional support with REE value can make relevant nutritional indicators as good as possible, and reduce insulin dosage, shorten vasopressor use time, the length of ICU stay and mechanical ventilation time, but does not change the 28-day mortality.

The effect of resting energy expenditure on the prognosis of patients with severe coma determined by the indirect energy metabolism measurement and Harris-Benedict budget formula / 中国中西医结合急救杂志

Objective Under 2 methods of guidance: indirect energy metabolism measurement and classical Harris-Benedict (HB) formula to carry out enteral nutritional support program to observe the difference in influence on nutritional status and prognosis of the patients. Methods Sixty patients with critical coma admitted to the Department of Critical Care Medicine of the 903rd Hospital of PLA from November 2015 to April 2017 were enrolled, and they were divided into a metabolic vehicle group (30 cases) and a formula group (30 cases) according to the random number digital table. All the patients were treated with stage nutritional therapy according to the daily energy consumption, which was measured by indirect energy metabolism measurement or HB formula. The change of serum albulmin (Alb), blood hemoglobin (Hb) and peripheral blood total lymphocyte count (TLC) before treatment and after 1 week and 2 weeks of nutritional support and the incidence of complications and prognosis after 2 weeks of nutritional support were observed; the difference of mid-upper arm circumference (MAC) was compared between before nutritional support. Results After the nutrritional therapy, serum Alb, Hb, and TLC in two groups were obviously higher than those before treatment, the degrees of elevation in metabolic group were more significant than those in the formula group [Alb (g/L): 36.34±4.09 vs. 35.26±3.82; Hb (g/L): 131.6±13.8 vs. 128.8±12.6; TLC (×109/L): 1.63±0.51 vs. 1.50±0.48, all P < 0.05]. The incidence of complications and mortality of the patients in metabolic vehicle group were lower than those of the formula group [40.0% (12/30) vs. 56.7% (17/30), 13.3% (4/30) vs. 16.7% (5/30) respectively, both P < 0.05]. After 2 weeks of nutrition support, the MAC of both groups increased compared with that before treatment, but there was no statistical significant difference in MAC in two groups (all P > 0.05). Conclusion Compared with the HB formula, the metabolic vehicle method can guide the daily energy intake of patients with severe coma more accurately. It is worthy to promote nutrition support program clinically guided by the metabolic vehicle one.

Consistency study of indirect calorimetry and HB equation for measuring energy expenditure of patients with multiple injury receiving mechanical ventilation / 中华危重病急救医学

Objective To evaluate the difference and correlation of 24-hour energy expenditure in patients with multiple trauma receiving mechanical ventilation predicted by indirect calorimetry (IC) and HB formula. Methods 140 patients with multiple trauma receiving mechanical ventilation admitted to intensive care unit (ICU) of the General Hospital of Ningxia Medical University from December 1st, 2016 to August 31st, 2017 were enrolled. The 24-hour energy expenditure of patients was repeatedly measured at 1, 3, 5, and 7 days after ICU admission by IC method, and the 24-hour energy expenditure measured by IC method was used as the "gold standard" to calculate the 24-hour kilogram body weight energy expenditure. The 24-hour energy expenditure value measured by IC method was compared with the 24-hour energy expenditure predicted value calculated by HB formula method, the consistency of the two measurement methods was detected by Bland-Altman method, and the correlation between the two measurement methods was analyzed by Pearson method and the linear equation was fitted. Results The 24-hour energy expenditure of patients at 1, 3, 5 and 7 days after ICU was repeatedly measured by IC method for 501 times, and there was no significant difference in 24-hour energy expenditure (kJ/d: 8 163.1±1 599.4, 8 221.1±1 694.7, 8 445.8±1 756.4, 8 707.0±1 820.7, respectively, F = 2.451, P = 0.063) and 24-hour kilogram body weight energy expenditure (kJ·kg-1·d-1: 120.5±18.9, 121.4±19.7, 122.7±19.3, 121.4±19.3, respectively, F = 0.252, P = 0.860) at each time point, indicating that the first week of multi-injury patients had no significant changes in energy metabolism. The consistency between the 24-hour energy expenditure measured by IC method on the first day [(8 163.1±1 599.4) kJ/d] and that predicted by HB formula method [(6 568.8±782.0) kJ/d] was analyzed. The results showed that there was significant bias between the two methods, with an average bias of -(1 591.8±121.4) kJ/d, but the correlation analysis showed that there was a linear correlation between them (r = 0.439, P = 0.000), using one-way regression, the fitted linear equation was Y = 2 270.5+0.897X (X was 24-hour energy expenditure predicted by the HB formula). Conclusions The energy metabolism of patients with multiple trauma receiving mechanical ventilation is not obvious within 1 week. The HB formula method underestimates the 24-hour energy expenditure of patients. The prediction formula can be used to correct the HB formula and further to improve the accuracy of predicting the 24-hour energy consumption of patients.

Measurements of resting energy expenditure in surgical critically ill patients with mechanical ventilator / 国际外科学杂志

Objective To compare the differences between measured resting energy expenditure calculated by the indirect calorimetry with the resting energy expenditure calculated by the Harris-Benedict formula and weight formula in the mechanically ventilated surgical critically ill patients in SICU.Methods Patients mechanically ventilated in SICU of Xuanwu Hospital,from April 2014 to April 2015 were measured resting energy expenditure by the indirect calorimetry with the resting energy expenditure calculated by the Harris-Benedict formula and weight formula in the 1st,the 3rd and the 5th day.There were twenty-nine patients enrolled,thirteen males and sixteen females,measured the resting energy expenditure 188 times.The distribution of metabolism level was studied,and the resting energy expenditure measured by three methods were calculated and evaluated by paired sample t test.Results There were 177 times(62.24％)of low metabolism level,59 times(31.38％)of normal metabolism level,and 12 times(6.38％)of high metabolism level.Eighteen patients used these three methods to calculate the energy expenditure on 1st,3rd and 5th day:indirect calorimetry (1 627.11 ± 323.63) kcal,(1 614.67± 308.93) kcal,(1 576.11 ± 263.96) kcal;Weight formula (1 479.44 ± 200.24) kcal,(1 488.40 ± 227.72) kcal,(1434.14 ± 216.56) kcal;Harris-Benedict formula (1 777.43 ± 253.00) kcal,(1 730.08 ± 265.18) kcal,(1 689.33 ± 236.69) kcal.The results calculated from Harris-Benedict formula and the weight formula were significantly different fiom calculated from indirect calorimetry (P ＜ 0.05).Resting energy expenditure by Harris-Benedict formula was significantly higher than calculated from indirect calorimetry (All P ＜ 0.05).Resting energy expenditure by weight formula was significantly lower than calculated from indirect calorimetry(All P ＜ 0.05).Conclusions Although Harris-Benedict formula and weight formula is convenient in clinical use,while the results calculated by them is significant different from the results calculated by indirect calorimetry.So clinical nutrition support should rely on indirect calorimetry as far as possible.