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Recommendations Summary

CI: Effects of Different Length Rest Periods on RMR in Critically Ill Patients 2006

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.


  • Recommendation(s)

    CI: Rest periods and RMR

    Allow a rest of 30 minutes prior to RMR measurement in critically ill patients.

    Rating: Consensus
    Imperative

    CI: Rest Period and Accuracy of RMR

    If the critically ill patient has undergone a nursing activity or medical procedure (e.g., suctioning, wound care, central venous access or ventilator setting change), then employ a 30-minute rest after procedures to achieve a resting state during RMR measurement. Measuring RMR before the 30-minute period may be inaccurate due to patient instability or ventilator gas re-equilibration.

    Rating: Consensus
    Conditional

    • Risks/Harms of Implementing This Recommendation

      The time needed for rest extends the time invested in obtaining the measures.

    • Conditions of Application

      • Further studies are needed to identify the optimal wait time after procedures
        • Current evidence is based only on narrative reviews.
      • After surgical procedures and intermittent hemodialysis, longer times may be necessary to return to resting and steady state. However,  evidence analysis of these issues has not been performed
      • Resting metabolic rate may be easier to assess when patient is sedated
      • Resting metabolic rate should be repeated when level of sedation or clinical state changes significantly
      • Potential barriers: Scheduling of measurements within these parameters may be difficult for individual patients.

    • Potential Costs Associated with Application

      If the operator must wait with no other tasks to perform, a time cost is incurred.

    • Recommendation Narrative

      • Resting metabolic rate may be erroneously increased, due to physical activity engaged in prior to the RMR measurement, but the physical activity of critical care patients is limited to passive range-of-motion exercises and thus has limited impact on RMR
      • According to one positive quality repeat measures crosssover study, low levels of physical activity related to activities of daily living have minimal impact on RMR, provided that a suitable rest period follows the activity prior to measurement (Turley et al,  1993) 
      • In hospitalized patients, two neutral quality reviews (Feurer and Mullen, 1986; McClave and Snider,  1992) suggest a 30-minute rest prior to RMR measurement, although primary studies supporting this suggestion were not found
      • One neutral quality observational study (Swinamer et al,  1987) found that in ventilated patients, changes in ventilator settings require a period of time to permit re-equilibration of gases prior to accurate measurement of RMR
      • Further studies are needed to determine the minimum number of minutes of rest required after undergoing nursing activities or medical procedures to avoid impact on RMR.

    • Recommendation Strength Rationale

      • Since the evidence found was largely based on reviews with no evidence basis and since only two studies were found in critical care patients, the evidence was viewed as limited
      • Conclusion statement is Grade IV.