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  • 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.
    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.
    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.
    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.
    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.
    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.
    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.
    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.