Critical Illness

CI: Individual Predictive Equations (2006)

• Assessment
  In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Fick equation?

  • Conclusion
    Five studies comparing RMR and the Fick equation generally report little agreement between methods. 
  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Fick equation?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Brandi LS, Bertolini R, Santini L.  Calculated and measured oxygen consumption in mechanically ventilated surgical patients in the early post-operative period.  Eur J Anaesthesiol 1999;16(1):53-61. 
      • Epstein CD, Peerless JR, Martin JE, Malangoni MA. Comparison of methods of measurements of oxygen consumption in mechanically ventilated patients with multiple trauma: The Fick method vs. indirect calorimetry. Crit Care Med. 2000; 28(5): 1,363-1,369. 
      • Flancbaum L, Choban PS, Sambucco S, Verducci J, Burge JC.  Comparison of indirect calorimetry, the Fick method, and prediction equations in estimating the energy requirements of critically ill patients.  Am J Clin Nutr 1999; 69(3):461-6. 
      • Marson F, Martins MA, Coletto FA, Campos AD, Basile-Filho A.  Correlation between oxygen consumption calculated using Fick's method and measured with indirect calorimetry in critically ill patients.  Arq Bras Cardiol 2003;81:77-81. 
      • Ogawa AM, Shikora SA, Burke LM, Heetderks-Cox JE, Bergren CT, Muskat PC. The thermodilution technique for measuring resting energy expenditure does not agree with indirect calorimetry for the critically ill patient. JPEN 1998; 22: 347-351. 
  • Search Plan and Results: CI: Determination of RMR 2006
     
  In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Harris-Benedict equation (with stress and activity factors)?

  • Conclusion
    Thirteen studies comparing RMR and the Harris-Benedict equation, with stress and activity factors ranging from 1.1 to 1.6, may be biased and/or imprecise, by as much as 900 kcals or more, depending on the factors used.   
  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Harris-Benedict equation (with stress and activity factors)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Alexander E, Susla GM, Burstein AH, Brown DT, Ognibene FP. Retrospective evaluation of commonly used equations to predict energy expenditure in mechanically ventilated, critically ill patients. Pharmacotherapy. 2004; 24(12): 1,659-1,667.
      • Barak N, Wall-Alonso E, Sitrin MD.  Evaluation of stress factors and body weight adjustments currently used to estimate energy expenditure in hospitalized patients.  JPEN 2002; 26(4):231-8. 
      • Brandi LS, Santini L, Bertolini R, Malacarne P, Casagli S, Baraglia AM.  Energy expenditure and severity of injury and illness indices in multiple trauma patients.  Crit Care Med 1999;27(12):2684-9. 
      • Casati A, Colombo S, Leggieri C, Muttini S, Capocasa T, Gallioli G. Measured versus calculated energy expenditure in pressure support ventilated ICU patients. Minerva Anestesiol. 1996; 62 (5): 165-170.
      • Cheng CH, Chen CH, Wong Y, Lee BJ, Kan MN, Huang YC. Measured versus estimated energy expenditure in mechanically ventilated critically ill patients. Clin Nutr. 2002; 21 (2): 165-172.
      • Cutts ME, Dowdy RP, Ellersieck MR, Edes TE.  Predicting energy needs in ventilator-dependent critically ill patients:  effect of adjusting weight for edema or adiposity.  Am J Clin Nutr 1997;66:1250-6. 
      • Dickerson RN, Gervasio JM, Riley ML, Murrell JE, Hickerson WL, Kudsk KA, Brown RO.  Accuracy of predictive methods to estimate resting energy expenditure of thermally-injured patients.  JPEN 2002;26(1):17-29. 
      • Donaldson-Andersen J, Fitzsimmons L.  Metabolic requirements of the critically ill, mechanically ventilated trauma patient:  measured versus predicted energy expenditure.  Nutr Clin Pract 1998;13(1):25-31. 
      • Faisy C, Guerot E, Diehl JL, Labrousse J, Fagon JY.  Assessment of resting energy expenditure in mechanically ventilated patients. Am J Clin Nutr. 2003; 78: 241-249. 
      • Ireton-Jones C, Jones JD.  Improved equations for predicting energy expenditure in patients:  the Ireton-Jones equations.  Nutr Clin Pract 2002;17(1):29-31.
      • Jansen MMPM, Heymer F, Leusink JA, de Boer A.  The quality of nutrition at an intensive care unit.  Nutrition Research 2002;22(4):411-422. 
      • MacDonald A, Hildebrandt L.  Comparison of formulaic equations to determine energy expenditure in the critically ill patient.  Nutrition 2003;19(3):233-9. 
      • O'Leary-Kelley CM, Puntillo KA, Barr J, Stotts N, Douglas MK.  Nutritional adequacy in patients receiving mechanical ventilation who are fed enterally.  Am J Crit Care 2005; 14(3):222-31. 
  • Search Plan and Results: CI: Determination of RMR 2006
     
  In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Harris-Benedict equation (without adjustments)?

  • Conclusion
    Thirteen studies comparing RMR and the Harris-Benedict equation (without adjustments) generally report an underestimation of energy needs in the critically ill population, by as much as 1000 kcals or more.  
  • Grade: I
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Harris-Benedict equation (without adjustments)?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Ahmad A, Duerksen DR, Munroe S, Bistrian BR.  An evaluation of resting energy expenditure in hospitalized, severely underweight patients.  Nutrition 1999;15(5):384-8. 
      • Alexander E, Susla GM, Burstein AH, Brown DT, Ognibene FP. Retrospective evaluation of commonly used equations to predict energy expenditure in mechanically ventilated, critically ill patients. Pharmacotherapy. 2004; 24(12): 1,659-1,667.
      • Brandi LS, Santini L, Bertolini R, Malacarne P, Casagli S, Baraglia AM.  Energy expenditure and severity of injury and illness indices in multiple trauma patients.  Crit Care Med 1999;27(12):2684-9. 
      • Campbell CG, Zander E, Thorland W.  Predicted vs measured energy expenditure in critically ill, underweight patients.  Nutr Clin Pract 2005;20(2):276-80. 
      • Cheng CH, Chen CH, Wong Y, Lee BJ, Kan MN, Huang YC. Measured versus estimated energy expenditure in mechanically ventilated critically ill patients. Clin Nutr. 2002; 21 (2): 165-172.
      • Compher C, Cato R, Bader J, Kinosian B.  Harris-Benedict equations do not adequately predict energy requirements in elderly hospitalized African Americans.  J National Med Assoc 2004;96(2):209-214. 
      • Dickerson RN, Gervasio JM, Riley ML, Murrell JE, Hickerson WL, Kudsk KA, Brown RO.  Accuracy of predictive methods to estimate resting energy expenditure of thermally-injured patients.  JPEN 2002;26(1):17-29. 
      • Donaldson-Andersen J, Fitzsimmons L.  Metabolic requirements of the critically ill, mechanically ventilated trauma patient:  measured versus predicted energy expenditure.  Nutr Clin Pract 1998;13(1):25-31. 
      • Faisy C, Guerot E, Diehl JL, Labrousse J, Fagon JY.  Assessment of resting energy expenditure in mechanically ventilated patients. Am J Clin Nutr. 2003; 78: 241-249. 
      • Flancbaum L, Choban PS, Sambucco S, Verducci J, Burge JC.  Comparison of indirect calorimetry, the Fick method, and prediction equations in estimating the energy requirements of critically ill patients.  Am J Clin Nutr 1999; 69(3):461-6. 
      • Frankenfield D, Smith JS, Cooney RN.  Validation of 2 approaches to predicting resting metabolic rate in critically ill patients.  JPEN 2004;28(4):259-64. 
      • Ireton-Jones C.  Comparison of the metabolic response to burn injury in obese and nonobese patients.  J Burn Care Rehabil 1997;18(1 Pt 1):82-5. 
      • MacDonald A, Hildebrandt L.  Comparison of formulaic equations to determine energy expenditure in the critically ill patient.  Nutrition 2003;19(3):233-9. 
  • Search Plan and Results: CI: Determination of RMR 2006
     
  In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Ireton-Jones 1992 equations?

  • Conclusion
    Seven studies comparing RMR and the Ireton-Jones, 1992 equations report similar mean values, however, for an individual, energy predictions may be different by as much as 500 kcals (52% of non-obese subjects predicted within 10% of RMR).  Further research regarding the accuracy of the Ireton-Jones, 1992 equation is warranted.

     
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Ireton-Jones 1992 equations?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Campbell CG, Zander E, Thorland W.  Predicted vs measured energy expenditure in critically ill, underweight patients.  Nutr Clin Pract 2005;20(2):276-80. 
      • Cheng CH, Chen CH, Wong Y, Lee BJ, Kan MN, Huang YC. Measured versus estimated energy expenditure in mechanically ventilated critically ill patients. Clin Nutr. 2002; 21 (2): 165-172.
      • Dickerson RN, Gervasio JM, Riley ML, Murrell JE, Hickerson WL, Kudsk KA, Brown RO.  Accuracy of predictive methods to estimate resting energy expenditure of thermally-injured patients.  JPEN 2002;26(1):17-29. 
      • Flancbaum L, Choban PS, Sambucco S, Verducci J, Burge JC.  Comparison of indirect calorimetry, the Fick method, and prediction equations in estimating the energy requirements of critically ill patients.  Am J Clin Nutr 1999; 69(3):461-6. 
      • Frankenfield D, Smith JS, Cooney RN.  Validation of 2 approaches to predicting resting metabolic rate in critically ill patients.  JPEN 2004;28(4):259-64. 
      • Ireton-Jones C.  Comparison of the metabolic response to burn injury in obese and nonobese patients.  J Burn Care Rehabil 1997;18(1 Pt 1):82-5. 
      • MacDonald A, Hildebrandt L.  Comparison of formulaic equations to determine energy expenditure in the critically ill patient.  Nutrition 2003;19(3):233-9. 
  • Search Plan and Results: CI: Determination of RMR 2006
     
  In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Ireton-Jones 1997 equations?

  • Conclusion
    Three studies comparing RMR and the updated Ireton-Jones, 1997 equations report similar mean values, however, only 36% of subjects were predicted within 10% of RMR.  Further research in the critically ill population is needed regarding the Ireton-Jones, 1997 equations. 
  • Grade: II
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Ireton-Jones 1997 equations?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Alexander E, Susla GM, Burstein AH, Brown DT, Ognibene FP. Retrospective evaluation of commonly used equations to predict energy expenditure in mechanically ventilated, critically ill patients. Pharmacotherapy. 2004; 24(12): 1,659-1,667.
      • Frankenfield D, Smith JS, Cooney RN.  Validation of 2 approaches to predicting resting metabolic rate in critically ill patients.  JPEN 2004;28(4):259-64. 
      • Ireton-Jones C, Jones JD.  Improved equations for predicting energy expenditure in patients:  the Ireton-Jones equations.  Nutr Clin Pract 2002;17(1):29-31.
  • Search Plan and Results: CI: Determination of RMR 2006
     
  In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Mifflin-St. Jeor equation?

  • Conclusion
    At the current time, the Mifflin-St. Jeor equation has not been adequately researched in the critically ill population.  Further research in the critically ill population is needed regarding the Mifflin-St. Jeor equation.
  • Grade: V
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Mifflin-St. Jeor equation?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Frankenfield D, Smith JS, Cooney RN.  Validation of 2 approaches to predicting resting metabolic rate in critically ill patients.  JPEN 2004;28(4):259-64. 
  • Search Plan and Results: CI: Determination of RMR 2006
     
  In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Penn State equation?

  • Conclusion
    Two studies comparing RMR and the Penn State equation report adequate precision (79% of non-obese subjects predicted within 10% of RMR).  Further research in the critically ill population is needed regarding the Penn State equation.
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Penn State equation?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Frankenfield D, Smith JS, Cooney RN.  Validation of 2 approaches to predicting resting metabolic rate in critically ill patients.  JPEN 2004;28(4):259-64. 
      • MacDonald A, Hildebrandt L.  Comparison of formulaic equations to determine energy expenditure in the critically ill patient.  Nutrition 2003;19(3):233-9. 
  • Search Plan and Results: CI: Determination of RMR 2006
     
  In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Swinamer equation?

  • Conclusion
    One study comparing RMR and the Swinamer equation have reported that 55% of non-obese subjects were predicted within 10% of RMR.  Further research in the critically ill population is needed regarding the Swinamer equation.
  • Grade: III
    • Grade I means there is Good/Strong evidence supporting the statement;
    • Grade II is Fair;
    • Grade III is Limited/Weak;
    • Grade IV is Expert Opinion Only;
    • Grade V is Not Assignable.
    • High (A) means we are very confident that the true effect lies close to that of the estimate of the effect;
    • Moderate (B) means we are moderately confident in the effect estimate;
    • Low (C) means our confidence in the effect estimate is limited;
    • Very Low (D) means we have very little confidence in the effect estimate.
    • Ungraded means a grade is not assignable.
  • Evidence Summary: In critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Swinamer equation?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • MacDonald A, Hildebrandt L.  Comparison of formulaic equations to determine energy expenditure in the critically ill patient.  Nutrition 2003;19(3):233-9. 
  • Search Plan and Results: CI: Determination of RMR 2006