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  • EE: Measuring Resting Metabolic Rate (RMR) in the Healthy and Non-Critically Ill Guideline (2014)
    • EE: Executive Summary of Recommendations (2014)
    • EE: Introduction (2014)
      • EE: Introduction (2014)
      • EE: Scope of Guideline (2014)
      • EE: Statement of Intent (2014)
      • EE: Guideline Methods (2014)
      • EE: Specific Methods (2014)
      • EE: Implementation of the Guideline (2014)
      • EE: Benefits and Risks/Harms of Implementation (2014)
    • EE: Major Recommendations (2014)
    • EE: Background Information (2014)
    • EE: References (2014)
  • EE: Measuring Resting Metabolic Rate (RMR) in the Critically Ill Guideline (2013)
    • EE: Executive Summary of Recommendations (2013)
    • EE: Introduction (2013)
      • EE: Introduction (2013)
      • EE: Scope of Guideline (2013)
      • EE: Statement of Intent (2013)
      • EE: Guideline Methods (2013)
      • EE: Specific Methods (2013)
      • EE: Implementation of the Guideline (2013)
      • EE: Benefits and Risks/Harms of Implementation (2013)
    • EE: Major Recommendations (2013)
    • EE: Algorithms (2013)
      • EE: Algorithms (2013)
      • EE: Nutrition Assessment (2013)
    • EE: Background Information (2013)
    • EE: References (2013)
  • Energy Expenditure (EE) Systematic Review (2013-2014)
    • EE: Measurement of Resting Metabolic Rate in the Critically Ill (2013)
      • EE: Body Positions (2013)
      • EE: Diurnal Variation (2013)
      • EE: Duration of Measurement (Steady State) (2013)
      • EE: Gas Collection Devices (2013)
      • EE: Respiratory Quotient (RQ) (2013)
      • EE: Rest Period Duration (2013)
      • EE: Room Conditions (2013)
      • EE: Thermic Effect of Feeding (2013)
    • EE: Measurement of Resting Metabolic Rate in the Non-Critically Ill (2013-2014)
      • EE: Body Positions (2014)
      • EE: Caffeine and Other Stimulants (2014)
      • EE: Diurnal Variation (2014)
      • EE: Duration of Measurement (Steady State) (2014)
      • EE: Gas Collection Devices (2013)
      • EE: Physical Activity (2013-2014)
      • EE: Respiratory Quotient (RQ) (2014)
      • EE: Rest Period Duration (2013)
      • EE: Room Conditions (2013)
      • EE: Smoking and Nicotine (2013)
      • EE: Thermic Effect of Food (2014)

  • Assessment
    In healthy adults, how long of a rest period is needed prior to initiating an RMR measure?
    • Conclusion

      A minimum rest period length of 10-20 minutes is an adequate testing condition to obtain an accurate measure of a 24-hour resting metabolic rate in healthy adults that have traveled to the test measurement site.

    • 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: What are the effects of different length rest periods on resting metabolic rate?
      • Detail
      • Quality Rating Summary
        For a summary of the Quality Rating results, click here.
      • Worksheets
        • Feurer I, Mullen JL. Bedside measurement of resting energy expenditure and respiratory quotient via indirect calorimetry. Nutr Clin Prac 1986; 1: 43-49.
        • Fredrix EWHM, Soeters PB, vonMeyenfeldt MF, Saris WHM. Measurement of resting energy expenditure in a clinical setting. Clin Nutr. 1990; 9: 299-304.
        • Igawa S, Sakamaki M, Miyazaki M. Examination of the reliability of the portable calorimeter. Clin Exp Pharmacol Physiol. 2002; 29(Suppl 4): S13-15.
        • Kashiwazaki H, Dejima Y, Suzuki T. Influence of upper and lower thermoneutral room termperatures (20°C) on fasting and post-prandial resting metabolism under different outdoor temperatures. Eur J Clin Nutr. 1990; 44: 405-413.
        • Matarese LE. Indirect calorimetry: Technical aspects. J Am Diet Assoc. 1997; 97 (Suppl 2): S154-S160.
        • McClave SA, Snider HL. Use of indirect calorimetry in clinical nutrition. Nutr Clin Pract. 1992; 7: 207-221.
        • Schols AMWJ, Schoffelen PFM, Ceulemans H, Wouters EFM, Saris WHM. Measurement of resting energy expenditure in patients with chronic obstructive pulmonary disease in a clinical setting. JPEN J Parenter Enteral Nutr. 1992; 16(4): 364-368.
        • Swinamer DL, Phang PT, Jones RL, Grace M, Garner King E. Twenty-four hour energy expenditure in critically ill patients. Crit Care Med. 1987;15(7):637-643.
        • Turley KR, McBride PJ, Wilmore JH. Resting metabolic rate measured after subjects spent the night at home vs. at a clinic. Am J Clin Nutr. 1993; 58 (2): 141-144.
        • Weissman C, Kemper M, Damask MC, Askanazi J, Hyman AI, Kinney JM. Effect of routine intensive care interactions on metabolic rate. Chest 1984;86:815-818. [Not used in Conclusion Statement Summary and Grade due to inability to determine "rest time" following activities].
        • Weissman C, Kemper M. Metabolic measurements in the critically ill. Crit Care Clin. 1995; 11(1): 169-197.
    In ill or hospitalized, adult patients, how long of a rest period is needed prior to initiating an RMR measure?
    • Conclusion

      One study of neutral quality rating (Swinamer, 1987) representing 10 critically ill individuals (27-79 y) with APACHE II score of 12-34, and a sepsis score of 0-23 indicates that during the first 30 minutes after patient activities (such as patient weighing, repositioning, and chest physiotherapy), a group mean RMR increase of 5.8±4.3% occurred. Shorter times were not reported. Two narrative reviews are most frequently cited for identifying rest period lengths provide the foundation for the currently accepted 30-minute rest length for adult patients in critical illness settings.

      Consensus of expert panel members recommend further research to determine if RMR measures following shorter rest periods (i.e., 5, 10, or 15 minutes) are statistically or clinically significant than RMR measures following a 30 minute rest period in all types of ill adults in the acute care settings.

       

    • Grade: IV
      • 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: What are the effects of different length rest periods on resting metabolic rate?
      • Detail
      • Quality Rating Summary
        For a summary of the Quality Rating results, click here.
      • Worksheets
        • Feurer I, Mullen JL. Bedside measurement of resting energy expenditure and respiratory quotient via indirect calorimetry. Nutr Clin Prac 1986; 1: 43-49.
        • Fredrix EWHM, Soeters PB, vonMeyenfeldt MF, Saris WHM. Measurement of resting energy expenditure in a clinical setting. Clin Nutr. 1990; 9: 299-304.
        • Igawa S, Sakamaki M, Miyazaki M. Examination of the reliability of the portable calorimeter. Clin Exp Pharmacol Physiol. 2002; 29(Suppl 4): S13-15.
        • Kashiwazaki H, Dejima Y, Suzuki T. Influence of upper and lower thermoneutral room termperatures (20°C) on fasting and post-prandial resting metabolism under different outdoor temperatures. Eur J Clin Nutr. 1990; 44: 405-413.
        • Matarese LE. Indirect calorimetry: Technical aspects. J Am Diet Assoc. 1997; 97 (Suppl 2): S154-S160.
        • McClave SA, Snider HL. Use of indirect calorimetry in clinical nutrition. Nutr Clin Pract. 1992; 7: 207-221.
        • Schols AMWJ, Schoffelen PFM, Ceulemans H, Wouters EFM, Saris WHM. Measurement of resting energy expenditure in patients with chronic obstructive pulmonary disease in a clinical setting. JPEN J Parenter Enteral Nutr. 1992; 16(4): 364-368.
        • Swinamer DL, Phang PT, Jones RL, Grace M, Garner King E. Twenty-four hour energy expenditure in critically ill patients. Crit Care Med. 1987;15(7):637-643.
        • Turley KR, McBride PJ, Wilmore JH. Resting metabolic rate measured after subjects spent the night at home vs. at a clinic. Am J Clin Nutr. 1993; 58 (2): 141-144.
        • Weissman C, Kemper M, Damask MC, Askanazi J, Hyman AI, Kinney JM. Effect of routine intensive care interactions on metabolic rate. Chest 1984;86:815-818. [Not used in Conclusion Statement Summary and Grade due to inability to determine "rest time" following activities].
        • Weissman C, Kemper M. Metabolic measurements in the critically ill. Crit Care Clin. 1995; 11(1): 169-197.
    In stable, acute care adult patients, what are the energy measurement differences if rest period lengths vary before measuring energy expenditure?
    • Conclusion

      An international study of negative research quality design (Schols, 1992) indicates individual RMR differences between a measurements performed on 12 older adult COPD patients after awakening, being transported in a wheelchair to the measurement site and allowing a 7-minute acclimatization period compared to a RMR measure taken after light physical activities and allowing a 20-minute rest were les than 70 kcals/day.

    • 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: What are the effects of different length rest periods on resting metabolic rate?
      • Detail
      • Quality Rating Summary
        For a summary of the Quality Rating results, click here.
      • Worksheets
        • Feurer I, Mullen JL. Bedside measurement of resting energy expenditure and respiratory quotient via indirect calorimetry. Nutr Clin Prac 1986; 1: 43-49.
        • Fredrix EWHM, Soeters PB, vonMeyenfeldt MF, Saris WHM. Measurement of resting energy expenditure in a clinical setting. Clin Nutr. 1990; 9: 299-304.
        • Igawa S, Sakamaki M, Miyazaki M. Examination of the reliability of the portable calorimeter. Clin Exp Pharmacol Physiol. 2002; 29(Suppl 4): S13-15.
        • Kashiwazaki H, Dejima Y, Suzuki T. Influence of upper and lower thermoneutral room termperatures (20°C) on fasting and post-prandial resting metabolism under different outdoor temperatures. Eur J Clin Nutr. 1990; 44: 405-413.
        • Matarese LE. Indirect calorimetry: Technical aspects. J Am Diet Assoc. 1997; 97 (Suppl 2): S154-S160.
        • McClave SA, Snider HL. Use of indirect calorimetry in clinical nutrition. Nutr Clin Pract. 1992; 7: 207-221.
        • Schols AMWJ, Schoffelen PFM, Ceulemans H, Wouters EFM, Saris WHM. Measurement of resting energy expenditure in patients with chronic obstructive pulmonary disease in a clinical setting. JPEN J Parenter Enteral Nutr. 1992; 16(4): 364-368.
        • Swinamer DL, Phang PT, Jones RL, Grace M, Garner King E. Twenty-four hour energy expenditure in critically ill patients. Crit Care Med. 1987;15(7):637-643.
        • Turley KR, McBride PJ, Wilmore JH. Resting metabolic rate measured after subjects spent the night at home vs. at a clinic. Am J Clin Nutr. 1993; 58 (2): 141-144.
        • Weissman C, Kemper M, Damask MC, Askanazi J, Hyman AI, Kinney JM. Effect of routine intensive care interactions on metabolic rate. Chest 1984;86:815-818. [Not used in Conclusion Statement Summary and Grade due to inability to determine "rest time" following activities].
        • Weissman C, Kemper M. Metabolic measurements in the critically ill. Crit Care Clin. 1995; 11(1): 169-197.
 
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