01.12.2016  Research  Ausgabe 1/2016 Open Access
Energy expenditure in critically ill patients estimated by populationbased equations, indirect calorimetry and CO_{2}based indirect calorimetry
 Zeitschrift:
 Annals of Intensive Care > Ausgabe 1/2016
Background
Methods
Patients
Equations for estimation of EE
Method  Equation  

a  ACCP  
EE(ACCP) = 25 kcal/kg/day · BM  
b  Harris–Benedict  The Harris–Benedict equation from 1919 [11] multiplied by a SF 
Men: EE(HB) = (66.5 + 13.75 kg^{−1} · BM + 5.003 cm^{−1} · height − 6.775 year^{−1} · age) kcal/day · SF Women: EE(HB) = (655.1 + 9.563 kg^{−1} · BM + 1.85 cm^{−1} · height − 4.676 year^{−1} · age) kcal/day · SF  
c  Harris–Benedict IBM  The Harris–Benedict equation with ideal body mass (IBM) multiplied by a SF 
Men: EE(HBI) = (66.5 + 13.75 kg^{−1} · IBM + 5.003 cm^{−1} · height − 6.775 year^{−1} · age) kcal/day · SF Women: EE(HBI) = (655.1 + 9.563 kg^{−1} · IBM + 1.85 cm^{−1} · height − 4.676 year^{−1} · age) kcal/day · SF  
d  Mifflin St Jeor  The Mifflin St Jeor equation [12] multiplied by a SF 
Men: EE(MSJ) = (9.99 kg^{−1} · BM + 6.25 cm^{−1} · height − 4.92 year^{−1} · age + 166) kcal/day · SF Women: EE(MSJ) = (9.99 kg^{−1} · BM + 6.25 cm^{−1} · height − 4.92 year^{−1} · age − 161) kcal/day · SF  
e  Penn State 1  The original Penn State equation from 1998 [13] 
EE(PS1) = 1.1 · HB + (32 min l^{−1} · MV + 140 °C^{−1} · T
_{Max} − 5340) kcal/day  
f  Penn State 2  Version 2 of the Penn State equation from 2003 [14] 
EE(PS2) = 0.85 · HB + (33 min l^{−1} · MV + 175 °C^{−1} · T
_{Max} − 6433) kcal/day  
g  Penn State 3  Version 3 of the Penn State equation from 2003 [14] 
EE(PS3) = 0.96 · MSJ + (31 min l^{−1} · MV + 167 °C^{−1} · T
_{Max} − 6212) kcal/day 
Sensitivity analysis of RQ
Statistical analysis
Over/underestimation
Quality
Accuracy
Qualitative analysis of dynamic errors
Quantitative analysis of dynamic errors
Method for assessing constancy of EE in individual patients
Results
Comparing estimates of energy expenditure
Pt. no.  Age (years)  Height (cm)  Gender  BM (kg)  Meas. (h)  VO_{2} (ml/min)  VCO_{2} (ml/min)  RQ  MV (l/min) 
T
_{Max} (°C)  Vent. mode  Diagnosis  Apache2 score  Sedation 

1  54  165  F  65  54  230  209  0.90  12.0  36.5  PS  S  18  No 
2  55  165  M  60  44  189  159  0.85  7.4  34.1  VC  S  12  No 
3  76  165  M  70  26  365  298  0.82  13.3  38.0  VC  T, ES  22  No 
4  52  180  M  75  13  373  282  0.76  10.5  37.0  PS  S  17  Se 
5  22  180  M  75  20  450  349  0.77  16.1  37.3  VC  S  14  An 
6  60  179  M  73  1  294  228  0.77  6.9  35.1  VC  ES  6  Se 
7  62  179  M  94  2  416  313  0.76  9.7  36.0  VC  SS  5  An 
8  67  172  M  64  1  359  206  0.73  8.0  35.9  PS  SS  20  An 
9  73  158  F  69  1  246  193  0.79  7.1  35.4  VC  SS  20  An 
10  79  175  M  75  18  407  330  0.81  9.0  37.8  VC  ES  28  Se 
11  56  173  M  105  1  416  371  0.89  12.0  35.5  VC  SS  16  An 
12  81  155  F  84  1  248  223  0.90  6.4  36.5  VC  SS  12  An 
13  82  180  M  100  19  389  310  0.80  12.4  37.1  PS  ES  17  Se 
14  74  160  F  70  120  281  217  0.77  7.3  38.0  VC  ES  18  An 
15  72  160  M  72  2  347  266  0.77  8.3  36.5  VC  SS  5  An 
16  35  176  M  54  18  401  274  0.69  11.6  37.1  VC  ES  16  Se 
17  55  170  M  75  72  351  335  0.96  12.0  37.8  VC  ES  29  Se 
18  38  165  F  80  96  417  344  0.83  11.3  38.0  PS  T  11  An 
Mean  61  170  –  76  28  343  273  0.81  10.1  36.6  –  –  15.9  – 
SD  17  8.4  –  13  36  77  63  0.07  2.7  1.1  –  –  6.8  – 
Equation  Mean EE (bias) (kcal/day)  SF  Range of estimation differences  RMSE of EE difference  # Of patients with accurate EE estimates (%) 

ACCP  1889 (−20 %)*  NA  [−49 %; 22 %]  28 %^{†}
 6 (33 %)^{‡}

Harris–Benedict  2347 (0 %)  1.55  [−20 %; 61 %]  16 %^{†}
 9 (50 %)^{‡}

Harris–Benedict, IBM  2347 (0 %)  1.67  [−23 %; 76 %]  18 %^{†}
 8 (35 %)^{‡}

Mifflin St Jeor  2347 (0 %)  1.59  [−18 %; 68 %]  15 %^{†}
 9 (50 %)^{‡}

Penn State 1  1782 (−24 %)*  NA  [−41 %; 0 %]  27 %^{†}
 1 (6 %)^{‡}

Penn State 2  1572 (−33 %)*  NA  [−49 %; −10 %]  35 %^{†}
 1 (6 %)^{‡}

Penn State 3  1637 (−30 %)*  NA  [−43 %; −9 %]  32 %^{†}
 1 (6 %)^{‡}

EE(VCO_{2}) RQ = 0.81  2332 (−1 %)  NA  [−13 %; 14 %]  7 %  16 (89 %) 
EE(IC)  2347 (0 %)  NA  –  –  – 
Sensitivity analysis of RQ  
EE(VCO_{2}) RQ = 0.70  2626 (12 %)*  NA  [−2 %; 30 %]  12 %  9 (50 %)^{‡}

EE(VCO_{2}) RQ = 0.76  2455 (5 %)*  NA  [−8 %; 20 %]  8 %  14 (78 %) 
EE(VCO_{2}) RQ = 0.85  2244 (−4 %)  NA  [−16 %; 10 %]  6 %  16 (89 %) 
EE(VCO_{2}) RQ = 0.89  2163 (−8 %)*  NA  [−19 %; 6 %]  10 %  10 (56 %) 
EE(VCO_{2}) RQ = 1.00  1976 (−16 %)*  NA  [−26 %; −3 %]  17 %  4 (22 %)^{‡}

Sensitivity analysis of RQ
Analysis of dynamic errors in EE(IC) and EE(VCO_{2})
Checking for constant EE
Dynamic errors in patients with variable EE
Dynamic errors in patients with constant EE
Quantitative analysis of dynamic errors
Max EE(IC) versus EE(IC) (%)  Max EE(IC) versus 5min EE(IC) (%)  Max EE(VCO_{2}) versus EE(VCO_{2}) (%)  Max EE(VCO_{2}) versus 5min EE(VCO_{2}) (%)  

1  −7  −2  −11  −3 
2  22  −12  −20  −13 
3  12  −6  14  −5 
4  −20  4  −21  8 
5  −4  1  −5  1 
6  −4  −3  −2  −1 
7  15  5  −7  4 
8  42  11  −38  11 
9  11  9  8  −6 
10  31  18  −24  14 
11  −3  −1  2  1 
12  −6  −3  −3  2 
13  20  4  5  2 
14  −7  −2  −6  −3 
15  −9  13  −9  11 
16  −28  9  46  12 
17  11  4  17  7 
Mean (±SD)  4.4 (±18.3)  2.8 (±7.5)  −3.2 (±18.9)  2.5 (±7.3) 
RMS  18  8  19  8 