Energy Expenditure

EE: Steady State (2005)

• Assessment
  In healthy adults, what is the acceptable coefficient of variation (CV) in oxygen consumption (vO2) and carbon dioxide (vCO2) production to reflect Steady State (SS) measure conditions and predict RMR?

  • Conclusion

    Use of a 10-minute protocol with 10% CV in vO2 and vCO2/minute using Steady State (SS) conditions and discarding the first 5 minutes of measurement, produces reliable results with minimal patient burden in an ambulatory, healthy population.

  • 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: What is the acceptable coefficient of variation to reflect steady state in indirect calorimetry?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • American Association for Respiratory Care (AARC). Metabolic measurement using indirect calorimetry during mechanical ventilation. Clinical practice guidelines. Respir Care. 1994;39(12):1170-1175.
      • Branson RD. The measurement of energy expenditure: Instrumentation, practical considerations, and clinical application.  Respiratory Care. 1990;35(7):640-658.  (Note:  Conference Proceedings:  Not appraised but reveiwed reference list.)
      • Cunningham KF, Aeberhardt LE, Wiggs BR, Phang T. Appropriate interpretation of indirect calorimetry for determining energy expenditure of patients in intensive care units. Am J Surg. 1994; 167: 547-549.
      • Frankenfield DC, Sarson GY, Blosser SA, Cooney RN, Smith JS. Validation of a five-minute steady state indirect calorimetry protocol for resting energy expenditure in critically ill patients. J Am College Nutr. 1996; 15: 397-402.
      • Frankenfield DC, Wiles II CE, Bagley S, Siegel JH. Relationships between resting and total energy expenditure in injured and septic patients.  Crit Care Med. 1994;22(11):1796-1804.
      • Horner NK, Lampe JW, Patterson RE, Neuhouser ML, Beresford SA, Prentice RL. Indirect calorimetry protocol development for measuring resting metabolic rate as a component of total energy expenditure in free-living postmenopausal women. J Nutr. 2001; 131 (8): 2,215-2,218.
      • McClave SA, Spain DA, Skolnick JL, Lowen CC, Kieber MJ, Wickerham PS, Vogt JR, Looney SW. Achievement of steady state optimizes results when performing indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003; 27(1): 16-20.
      • Petros S, Engelmann L. Validity of an abbreviated indirect calorimetry protocol for measurement of resting energy expenditure in mechanically ventilated and spontaneous breathing critically ill patients. Intensive Care Med 2001;27:1167-1168.
  In older or medically-stable or chronically ill adults living at home, what is the acceptable coefficient of variation (CV) in oxygen consumption (vO2) and carbon dioxide (VCO2) production to reflect Steady State (SS) measure conditions and predict RMR?

  • Conclusion

    There are no studies reporting on steady state or coefficient of variation in these populations.

  • 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 is the acceptable coefficient of variation to reflect steady state in indirect calorimetry?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • American Association for Respiratory Care (AARC). Metabolic measurement using indirect calorimetry during mechanical ventilation. Clinical practice guidelines. Respir Care. 1994;39(12):1170-1175.
      • Branson RD. The measurement of energy expenditure: Instrumentation, practical considerations, and clinical application.  Respiratory Care. 1990;35(7):640-658.  (Note:  Conference Proceedings:  Not appraised but reveiwed reference list.)
      • Cunningham KF, Aeberhardt LE, Wiggs BR, Phang T. Appropriate interpretation of indirect calorimetry for determining energy expenditure of patients in intensive care units. Am J Surg. 1994; 167: 547-549.
      • Frankenfield DC, Sarson GY, Blosser SA, Cooney RN, Smith JS. Validation of a five-minute steady state indirect calorimetry protocol for resting energy expenditure in critically ill patients. J Am College Nutr. 1996; 15: 397-402.
      • Frankenfield DC, Wiles II CE, Bagley S, Siegel JH. Relationships between resting and total energy expenditure in injured and septic patients.  Crit Care Med. 1994;22(11):1796-1804.
      • Horner NK, Lampe JW, Patterson RE, Neuhouser ML, Beresford SA, Prentice RL. Indirect calorimetry protocol development for measuring resting metabolic rate as a component of total energy expenditure in free-living postmenopausal women. J Nutr. 2001; 131 (8): 2,215-2,218.
      • McClave SA, Spain DA, Skolnick JL, Lowen CC, Kieber MJ, Wickerham PS, Vogt JR, Looney SW. Achievement of steady state optimizes results when performing indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003; 27(1): 16-20.
      • Petros S, Engelmann L. Validity of an abbreviated indirect calorimetry protocol for measurement of resting energy expenditure in mechanically ventilated and spontaneous breathing critically ill patients. Intensive Care Med 2001;27:1167-1168.
  In U.S.-residing non-white ethnic groups, what is the acceptable coefficient of variation (CV) in oxygen consumption (vO2) and carbon dioxide (VCO2) production to reflect Steady State (SS) measure conditions and predict RMR?

  • Conclusion

    Although minimal or no representation, this conclusion statement can be generalized to include U.S.-residing ethnic groups of African Americans, Asian and Pacific Islanders, American Indians, Alaskan Natives and Hispanic populations.

  • 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 is the acceptable coefficient of variation to reflect steady state in indirect calorimetry?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • American Association for Respiratory Care (AARC). Metabolic measurement using indirect calorimetry during mechanical ventilation. Clinical practice guidelines. Respir Care. 1994;39(12):1170-1175.
      • Branson RD. The measurement of energy expenditure: Instrumentation, practical considerations, and clinical application.  Respiratory Care. 1990;35(7):640-658.  (Note:  Conference Proceedings:  Not appraised but reveiwed reference list.)
      • Cunningham KF, Aeberhardt LE, Wiggs BR, Phang T. Appropriate interpretation of indirect calorimetry for determining energy expenditure of patients in intensive care units. Am J Surg. 1994; 167: 547-549.
      • Frankenfield DC, Sarson GY, Blosser SA, Cooney RN, Smith JS. Validation of a five-minute steady state indirect calorimetry protocol for resting energy expenditure in critically ill patients. J Am College Nutr. 1996; 15: 397-402.
      • Frankenfield DC, Wiles II CE, Bagley S, Siegel JH. Relationships between resting and total energy expenditure in injured and septic patients.  Crit Care Med. 1994;22(11):1796-1804.
      • Horner NK, Lampe JW, Patterson RE, Neuhouser ML, Beresford SA, Prentice RL. Indirect calorimetry protocol development for measuring resting metabolic rate as a component of total energy expenditure in free-living postmenopausal women. J Nutr. 2001; 131 (8): 2,215-2,218.
      • McClave SA, Spain DA, Skolnick JL, Lowen CC, Kieber MJ, Wickerham PS, Vogt JR, Looney SW. Achievement of steady state optimizes results when performing indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003; 27(1): 16-20.
      • Petros S, Engelmann L. Validity of an abbreviated indirect calorimetry protocol for measurement of resting energy expenditure in mechanically ventilated and spontaneous breathing critically ill patients. Intensive Care Med 2001;27:1167-1168.
  In critically ill, ventilated patients, what is the acceptable coefficient of variation (CV) in oxygen consumption (vO2) and carbon dioxide (VCO2) production to reflect Steady State (SS) measure conditions and predict RMR?

  • Conclusion

    For critically-ill, ventilator dependent patients, attaining 5-minute measures at <5% CV or 30-minutes with <10% CV provide results comparable to longer duration measures of energy expenditure, and the 5-minute and 30-minute measures are highly correlated. Sedation has a significant positive impact on successfully achieving the SS criteria. For spontaneously breathing, critically ill patients, the 5-minute SS protocol produces reliable RMR with minimal patient burden.

  • 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: What is the acceptable coefficient of variation to reflect steady state in indirect calorimetry?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • American Association for Respiratory Care (AARC). Metabolic measurement using indirect calorimetry during mechanical ventilation. Clinical practice guidelines. Respir Care. 1994;39(12):1170-1175.
      • Branson RD. The measurement of energy expenditure: Instrumentation, practical considerations, and clinical application.  Respiratory Care. 1990;35(7):640-658.  (Note:  Conference Proceedings:  Not appraised but reveiwed reference list.)
      • Cunningham KF, Aeberhardt LE, Wiggs BR, Phang T. Appropriate interpretation of indirect calorimetry for determining energy expenditure of patients in intensive care units. Am J Surg. 1994; 167: 547-549.
      • Frankenfield DC, Sarson GY, Blosser SA, Cooney RN, Smith JS. Validation of a five-minute steady state indirect calorimetry protocol for resting energy expenditure in critically ill patients. J Am College Nutr. 1996; 15: 397-402.
      • Frankenfield DC, Wiles II CE, Bagley S, Siegel JH. Relationships between resting and total energy expenditure in injured and septic patients.  Crit Care Med. 1994;22(11):1796-1804.
      • Horner NK, Lampe JW, Patterson RE, Neuhouser ML, Beresford SA, Prentice RL. Indirect calorimetry protocol development for measuring resting metabolic rate as a component of total energy expenditure in free-living postmenopausal women. J Nutr. 2001; 131 (8): 2,215-2,218.
      • McClave SA, Spain DA, Skolnick JL, Lowen CC, Kieber MJ, Wickerham PS, Vogt JR, Looney SW. Achievement of steady state optimizes results when performing indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003; 27(1): 16-20.
      • Petros S, Engelmann L. Validity of an abbreviated indirect calorimetry protocol for measurement of resting energy expenditure in mechanically ventilated and spontaneous breathing critically ill patients. Intensive Care Med 2001;27:1167-1168.
  In chronically ill and medically stable institutionalized adults, what is the acceptable coefficient of variation (CV) in oxygen consumption (vO2) and carbon dioxide (VCO2) production to reflect Steady State (SS) measure conditions and predict RMR?

  • Conclusion
    There are no studies reporting on steady state or coefficient of variation in these populations.
  • 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 is the acceptable coefficient of variation to reflect steady state in indirect calorimetry?
    • Detail
    • Quality Rating Summary
      For a summary of the Quality Rating results, click here.
    • Worksheets
      • American Association for Respiratory Care (AARC). Metabolic measurement using indirect calorimetry during mechanical ventilation. Clinical practice guidelines. Respir Care. 1994;39(12):1170-1175.
      • Branson RD. The measurement of energy expenditure: Instrumentation, practical considerations, and clinical application.  Respiratory Care. 1990;35(7):640-658.  (Note:  Conference Proceedings:  Not appraised but reveiwed reference list.)
      • Cunningham KF, Aeberhardt LE, Wiggs BR, Phang T. Appropriate interpretation of indirect calorimetry for determining energy expenditure of patients in intensive care units. Am J Surg. 1994; 167: 547-549.
      • Frankenfield DC, Sarson GY, Blosser SA, Cooney RN, Smith JS. Validation of a five-minute steady state indirect calorimetry protocol for resting energy expenditure in critically ill patients. J Am College Nutr. 1996; 15: 397-402.
      • Frankenfield DC, Wiles II CE, Bagley S, Siegel JH. Relationships between resting and total energy expenditure in injured and septic patients.  Crit Care Med. 1994;22(11):1796-1804.
      • Horner NK, Lampe JW, Patterson RE, Neuhouser ML, Beresford SA, Prentice RL. Indirect calorimetry protocol development for measuring resting metabolic rate as a component of total energy expenditure in free-living postmenopausal women. J Nutr. 2001; 131 (8): 2,215-2,218.
      • McClave SA, Spain DA, Skolnick JL, Lowen CC, Kieber MJ, Wickerham PS, Vogt JR, Looney SW. Achievement of steady state optimizes results when performing indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003; 27(1): 16-20.
      • Petros S, Engelmann L. Validity of an abbreviated indirect calorimetry protocol for measurement of resting energy expenditure in mechanically ventilated and spontaneous breathing critically ill patients. Intensive Care Med 2001;27:1167-1168.