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Recommendations Summary

EE: Rest Period Duration in Critically Ill 2013

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)

  EE: Rest Period Duration in Critically Ill

  The registered dietitian nutritionist (RDN) should ensure a 30-minute rest period prior to resting metabolic rate (RMR) measurement in critically ill patients. One study indicates that energy expenditure is elevated for up to 30 minutes after routine intensive care unit (ICU) care in non-sedated patients. The potential for sedation to shorten the rest period has not been studied. 

  Rating: Fair
  Imperative

  • Risks/Harms of Implementing This Recommendation

    There are no potential risks or harms associated with the application of this recommendation.

  • Conditions of Application

    • Sedation might reduce the time it takes to return to rest after routine ICU care, but the effect is not known
    • For the purposes of this recommendation, routine ICU care includes suctioning, vent adjustments, turning, bathing and dressing changes, as well as any other invasive procedures
    • Further studies are needed to identify the optimal wait time after procedures, such as surgery and hemodialysis
    • Coordination with other healthcare professionals (e.g., nurse, respiratory therapy) is needed to ensure a sufficient wait time.

  • Potential Costs Associated with Application

    If the 30-minute wait time cannot be achieved, then the measurement should be rescheduled or a measurement of total energy expenditure (TEE) may be attempted. Additional costs may occur due to increased time.

  • Recommendation Narrative

    Only one study was included in the evidence analysis for this recommendation.

    • One neutral-quality study (Swinamer et al, 1987) provides evidence that rest periods greater than 30 minutes are not necessary. Additional research is needed to confirm this and determine the minimum time to recover to rest in critically ill patients, taking into account their sedation level.
    • No new studies were identified in the update of this question.

  • Recommendation Strength Rationale

    Conclusion statement is Grade III.

  • Minority Opinions

    None.

• Supporting Evidence

  The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

  How long of a rest period is needed prior to the measurement of resting metabolic rate (RMR) to ensure accuracy in the critically ill population?

  • References

    Swinamer DL, Phang PT, Jones RL, Grace M, Garner King E. Twenty-four hour energy expenditure in critically ill patients. Crit Care Med. 1987;15(7):637-643.

  • References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

    None.