CI: Individual Equations (2010)

CI: Individual Equations (2010)

For more information on all predictive equations used in critically ill adults, see Predictive Equation Formulas.

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

  • Conclusion

    In two studies, the Faisy equation was unbiased but inaccurate, as it predicted RMR ±10% in 53% of subjects.

  • 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 adult critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Faisey equation?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Frankenfield DC, Coleman A, Alam S, Cooney R. Analysis of estimation methods for resting metabolic rate in critically ill adults. J Parenter Enteral Nutr. 2009; 33: 27.
      • Savard JF. Faisy C. Lerolle N. Guerot E. Diehl JL. Fagon JY. Validation of a predictive method for an accurate assessment of resting energy expenditure in medical mechanically ventilated patients. Critical Care Medicine. 2008; 36(4): 1,175-1,183.
  • Search Plan and Results: CI: Determination of RMR 2009
     
  In adult critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Fick equation?

  • Conclusion

    Five studies (four positive quality and one neutral quality) studied the thermodilution technique for measuring cardiac output and calculating RMR using the Fick equation. These studies generally report a correlation between the methods, but the equation tends to be biased and imprecise, demonstrating little agreement. Accuracy of the predictive equation was not reported.

  • 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 adult 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
      • 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. 
  • Search Plan and Results: CI: Determination of RMR 2009
     
  In adult 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

     

    Seventeen studies (13 positive and four neutral research quality) compared RMR and the Harris-Benedict equation (HBE) using stress and activity factors ranging from 1.1 to 1.6. The HBE may be biased or imprecise by as much as ±900kcals, depending on the factors used. Percent accuracy ranged from 15% to 51%.

  • 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 adult 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.
      • Anderegg BA, Worrall C, Barbour E, Simpson KN, Delegge M. Comparison of resting energy expenditure prediction methods with measured resting energy expenditure in obese, hospitalized adults. J Parenter Enteral Nutr. 2009 Mar-Apr; 33(2): 168-175.
      • Boullata J, Williams J, Cottrell F, Hudson L, Compher C. Accurate determination of energy needs in hospitalized patients. J Am Diet Assoc. 2007; 107: 393-401.
      • 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.
      • 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. 
      • Frankenfield DC, Coleman A, Alam S, Cooney R. Analysis of estimation methods for resting metabolic rate in critically ill adults. J Parenter Enteral Nutr. 2009; 33: 27.
      • Savard JF. Faisy C. Lerolle N. Guerot E. Diehl JL. Fagon JY. Validation of a predictive method for an accurate assessment of resting energy expenditure in medical mechanically ventilated patients. Critical Care Medicine. 2008; 36(4): 1,175-1,183.
      • Stucky CC, Moncure M, Hise M, Gossage CM, Northrop D. How accurate are resting energy expenditure prediction equations in obese trauma and burn patients? J Parenter Enteral Nutr. 2008 Jul-Aug; 32(4): 420-426.
  • Search Plan and Results: CI: Determination of RMR 2009
     
  In adult 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 (eleven positive-quality and two neutral-quality) compared measurements of energy expenditure with the Harris-Benedict equation (HBE), with no adjustments for stress or injury. The HBE (without adjustments) generally underestimates RMR. The underestimation may be as much as 1,000kcal. Percent accuracy ranged from 26% to 35%.

     

  • 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 adult 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
      • 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.
      • 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.
      • 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. 
      • Frankenfield DC, Coleman A, Alam S, Cooney R. Analysis of estimation methods for resting metabolic rate in critically ill adults. J Parenter Enteral Nutr. 2009; 33: 27.
      • Savard JF. Faisy C. Lerolle N. Guerot E. Diehl JL. Fagon JY. Validation of a predictive method for an accurate assessment of resting energy expenditure in medical mechanically ventilated patients. Critical Care Medicine. 2008; 36(4): 1,175-1,183.
      • Stucky CC, Moncure M, Hise M, Gossage CM, Northrop D. How accurate are resting energy expenditure prediction equations in obese trauma and burn patients? J Parenter Enteral Nutr. 2008 Jul-Aug; 32(4): 420-426.
  • Search Plan and Results: CI: Determination of RMR 2009
     
  In adult critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by Harris-Benedict Equation with adjustments for weight?

  • Conclusion

    Five studies compared measurements of energy expenditure with the value predicted by Harris-Benedict equation (HBE), with adjustments. The HBE with adjustment for weight generally underestimates RMR. The HBE with stress factors can under- or over-estimate, depending on the factor used. Mean accuracy was 55% with a range of 34% maximum under-prediction to 62% maximum over-prediction.

  • 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 adult critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by Harris-Benedict Equation with adjustments for weight?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Anderegg BA, Worrall C, Barbour E, Simpson KN, Delegge M. Comparison of resting energy expenditure prediction methods with measured resting energy expenditure in obese, hospitalized adults. J Parenter Enteral Nutr. 2009 Mar-Apr; 33(2): 168-175.
      • Boullata J, Williams J, Cottrell F, Hudson L, Compher C. Accurate determination of energy needs in hospitalized patients. J Am Diet Assoc. 2007; 107: 393-401.
      • Frankenfield DC, Coleman A, Alam S, Cooney R. Analysis of estimation methods for resting metabolic rate in critically ill adults. J Parenter Enteral Nutr. 2009; 33: 27.
  • Search Plan and Results: CI: Determination of RMR 2009
     
  In adult critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Ireton-Jones, 1992 equations?

  • Conclusion

    Eight studies (six positive quality, two neutral quality) compared measurements of energy expenditure with REE predicted by the original equation (Ireton-Jones, 1992 equation). Overall accuracy rate ranged from 28% to 60% for ventilator-dependent patients.

     

  • 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 adult 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
      • 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.
      • Frankenfield DC, Coleman A, Alam S, Cooney R. Analysis of estimation methods for resting metabolic rate in critically ill adults. J Parenter Enteral Nutr. 2009; 33: 27.
      • Savard JF. Faisy C. Lerolle N. Guerot E. Diehl JL. Fagon JY. Validation of a predictive method for an accurate assessment of resting energy expenditure in medical mechanically ventilated patients. Critical Care Medicine. 2008; 36(4): 1,175-1,183.
  • Search Plan and Results: CI: Determination of RMR 2009
     
  In adult critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Ireton-Jones, 1997 equations?

  • Conclusion
    Four studies (three positive quality and one neutral quality) compared measured energy expenditure with energy expenditure predicted by the Ireton-Jones, 1997 equations, for ventilator-dependent individuals. Accuracy range was 15% to 48%.
  • 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 adult 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.
      • Anderegg BA, Worrall C, Barbour E, Simpson KN, Delegge M. Comparison of resting energy expenditure prediction methods with measured resting energy expenditure in obese, hospitalized adults. J Parenter Enteral Nutr. 2009 Mar-Apr; 33(2): 168-175.
  • Search Plan and Results: CI: Determination of RMR 2009
     
  In adult critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Mifflin-St. Jeor equation?

  • Conclusion

    Three positive quality research studies were reviewed. The MSJE was biased unless multiplied by a factor of 1.25, which also increased accuracy from 10% to almost 50% overall.

  • 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 adult 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
      • Anderegg BA, Worrall C, Barbour E, Simpson KN, Delegge M. Comparison of resting energy expenditure prediction methods with measured resting energy expenditure in obese, hospitalized adults. J Parenter Enteral Nutr. 2009 Mar-Apr; 33(2): 168-175.
      • Frankenfield DC, Coleman A, Alam S, Cooney R. Analysis of estimation methods for resting metabolic rate in critically ill adults. J Parenter Enteral Nutr. 2009; 33: 27.
  • Search Plan and Results: CI: Determination of RMR 2009
     
  In adult critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Penn State equations?

  • Conclusion

    Five positive quality studies compared measured resting metabolic rate (RMR) with RMR predicted by one of the Penn State equations. The versions from 1998 and 2003 (PSU(1998), PSU(2003a)] were unbiased and precise, but some of them had accuracy rates as low as 40% and as high as 70%. In large validation studies from 2009 and 2010 the PSU(2003b) and PSU(2010) forms of the equation were accurate 70 and 74% of the time.

     

     

  • 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 adult critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Penn State equations?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Boullata J, Williams J, Cottrell F, Hudson L, Compher C. Accurate determination of energy needs in hospitalized patients. J Am Diet Assoc. 2007; 107: 393-401.
      • Frankenfield David. Validation of an equation for resting metabolic rate in older obese critically ill patients. JPEN. 2010 (in press).
      • Frankenfield DC, Coleman A, Alam S, Cooney R. Analysis of estimation methods for resting metabolic rate in critically ill adults. J Parenter Enteral Nutr. 2009; 33: 27.
  • Search Plan and Results: CI: Determination of RMR 2009
     
  In adult critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Swinamer equation?

  • Conclusion

    Four studies compared RMR and the Swinamer equation. Accuracy rates ranged from 45% to 61%; however, the equation was biased toward overprediction.

     

  • 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 adult 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
      • Boullata J, Williams J, Cottrell F, Hudson L, Compher C. Accurate determination of energy needs in hospitalized patients. J Am Diet Assoc. 2007; 107: 393-401.
      • Frankenfield DC, Coleman A, Alam S, Cooney R. Analysis of estimation methods for resting metabolic rate in critically ill adults. J Parenter Enteral Nutr. 2009; 33: 27.
      • Savard JF. Faisy C. Lerolle N. Guerot E. Diehl JL. Fagon JY. Validation of a predictive method for an accurate assessment of resting energy expenditure in medical mechanically ventilated patients. Critical Care Medicine. 2008; 36(4): 1,175-1,183.
  • Search Plan and Results: CI: Determination of RMR 2009
     
  In adult critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Brandi equation?

  • Conclusion

    One positive research quality study was reviewed for this evidence analysis question. The Brandi equation was unbiased toward non-obese patients with accuracy of 61%.  It was biased for obese patients with accuracy of 48%.

  • 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 adult critically ill patients, what is the relationship between resting metabolic rate (RMR) and RMR predicted by the Brandi equation?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • Frankenfield DC, Coleman A, Alam S, Cooney R. Analysis of estimation methods for resting metabolic rate in critically ill adults. J Parenter Enteral Nutr. 2009; 33: 27.
  • Search Plan and Results: CI: Determination of RMR 2009