EE: Gas Collection Devices in Healthy and Non-Critically Ill 2014
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.
EE: Gas Collection Devices in Healthy Adults and Children
The registered dietitian nutritionist (RDN) may select any gas collection device (ventilated hood and canopy, mouthpiece and nose clip or face mask) for a resting metabolic rate (RMR) measurement in a healthy adult or child. Studies comparing the use of different devices are conflicting. The individual's comfort or preference should be considered when selecting a device, if possible.
Risks/Harms of Implementing This Recommendation
There are no potential risks or harms associated with the application of this recommendation.
Conditions of Application
- For children, if the choice is mouthpiece and noseclip vs. face mask, it has been reported that children (7 to 12 years) prefer the facemask (Mellecker and McManis, 2009)
- Clinical judgment should be used in applying this recommendation to non-critically ill adults and children because there is no evidence in these populations
- When applying the recommendation to children, the child's age should be considered, due to variability in physical and developmental attributes
- For research, the same type of device should be used throughout the study.
Potential Costs Associated with Application
Some face masks and mouthpiece/noseclips are disposable, so additional costs will be incurred.
A total of four studies were included in the evidence analysis for this recommendation:
- Three neutral-quality diagnostic, validity or reliability studies (Forse, 1993; McAnena et al, 1986; Segal, 1987)
- One neutral-quality non-randomized crossover study (Mellecker and McManus, 2009).
- Four studies provide conflicting evidence regarding RMR measurements made comparing a ventilated hood with either mouthpiece and noseclip or face mask; this may be due to differences in patient comfort. One study in healthy children reported no significant differences between RMR measurements comparing mouthpiece and noseclip vs. face mask. Additional research comparing gas collection devices is needed.
- Evidence is based on the following four studies: Forse, 1993; Mellecker and McManus, 2009; McAnena et al, 1986; and Segal, 1987.
Recommendation Strength Rationale
Conclusion statement supporting this recommendation is Grade III.
- Risks/Harms of Implementing This Recommendation
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).
Is there a difference in RMR measurements related to different types of gas collection devices (such as face mask, mouthpieces with noseclips, or ventilated hood/canopy) in healthy and non-critically ill individuals?
Forse RA. Comparison of gas exchange measurements with a mouthpiece, face mask, and ventilated canopy. Journal of Parenteral and Enteral Nutrition 1993;17:388-391.
McAnena OJ, Harvey LP, Katzeff HL, Daly JM. Indirect calorimetry: Comparison of hood and mask systems for measuring resting energy expenditure in healthy volunteers. J Parenter Enteral Nutri. 1986; 10: 555-557.
Mellecker RR, McManus AM. Measurement of resting energy expenditure in healthy children. JPEN J Parenter Enteral Nutr. 2009 Nov-Dec; 33(6): 640-645.
Segal KR. Comparison of indirect calorimetric measurements of resting energy expenditure with a ventilated hood, face mask, and mouthpiece. Am J Clin Nutr 1987;45:1420-1423. (Not used in Conclusion Statement Grade)
References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process
Brandi LS, Bertolini R, Calafa M. Indirect calorimetry in critically ill patients: Clinical applications and practical advice. Nutrition, 1997 13, 349-358.
Matarese LE. Indirect calorimetry: Technical aspects. J Am Diet Assoc. 1997 Oct; 97(10 Suppl 2): S154-S160. Review.