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Recommendations Summary

EE: Duration of Measurement (Steady State) 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: Duration of Measurement Related to Steady State in Critically Ill

    When measuring energy expenditure in a critically ill patient,  the registered dietitian nutritionist (RDN) should discard the data for the first five minutes to exclude artifact and then achieve either a five-minute measure with up to 5% or a 25-minute measurement with up to 10% coefficient of variation (CV) in VO2 and VCO2. Research indicates that these protocols are equivalent.

    Rating: Strong
    Imperative

    EE: Measurement Duration If Unable to Achieve Steady State in Critically Ill

    If unable to achieve steady state in critically ill patients, the RDN should take a single indirect calorimetry measurement extended for up to two hours or average two non-consecutive indirect calorimetry measurements within a 24-hour period. Research suggests that this protocol likely reflects 24-hour total energy expenditure (TEE) with acceptable error.

    Rating: Fair
    Conditional

    • Risks/Harms of Implementing This Recommendation

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

    • Conditions of Application

      • The recommendation EE: Measurement Duration If Unable to Achieve Steady State is only necessary for critically ill patients in whom steady state cannot be achieved
      • Coordination with other healthcare professionals (e.g., nurse, respiratory therapy) is suggested to schedule the measurement(s)
      • Early morning measurements may be most practical, when the patient is least likely to be disturbed.

       

    • Potential Costs Associated with Application

      The recommendation EE: Measurement Duration If Unable to Achieve Steady State in Critically Ill may be associated with increased time cost.

    • Recommendation Narrative

      A total of seven studies were included in the evidence analysis for this recommendation: 

      • One positive-quality retrospective cohort study (Frankenfield et al, 1996)
      • One positive-quality prospective cohort study (Petros and Engelmann, 2001) 
      • One neutral-quality retrospective cohort study (Cunningham et al, 1994)
      • One neutral-quality time series study (McClave et al, 2003)
      • One neutral-quality cross-sectional study (van Lanschot et al, 1988)
      • One neutral-quality prospective cohort study (van Lanschot et al, 1986)
      • One neutral-quality validity study (Zijlstra et al, 2007).

      EE: Duration of Measurement Related to Steady State in Critically Ill

      • Three studies provide evidence that in critically ill patients, after discarding the data for the first five minutes to exclude artifact, achieving five additional minutes of measurement with up to a 5% coefficient of variation (CV) in VO2 and VCO2 was comparable to 25 additional minutes of measurement with up to 10% CV
      • Evidence is based on three studies: Cunningham et al, 1994; Frankenfield et al, 1996; Petros and Engelmann, 2001. 

      EE: Duration of Measurement If Unable to Achieve Steady State in Critically Ill 

      • Six studies provide evidence that in individuals unable to achieve steady state, a single indirect calorimetry measurement extended for up to two hours may reflect 24-hour TEE with acceptable error. In addition, averaging two non-consecutive indirect calorimetry measurements provides sufficient accuracy for estimation of TEE.
      • Evidence is based on six studies: Cunningham et al, 1994; McClave et al, 2003; Petros and Engelmann, 2001; van Lanschot et al, 1988; van Lanschot et al, 1986; and Zijlstra et al, 2007.

    • Recommendation Strength Rationale

      • Conclusion statement supporting EE: Duration of Measurement Related to Steady State in Critically Ill is Grade I
      • Conclusion statement supporting EE: Duration of Measurement If Unable to Achieve Steady State in Critically Ill  is Grade II.

    • Minority Opinions

      None.