EE: Rest Period Duration (2013)
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.
- Measure cumulative 24-h energy expenditure.
- Mechanical ventilation FIO2<0.60
- Critically ill
- Admission into Univ Alberta Hospital.
- Refusal to consent
- Not meeting inclusion criteria.
- Ht measured? Not specified
- Wt measured? Not specified.
Resting energy expenditure
Outcome(s) and other measures
- Measured REE [(VO2, l/min), VCO2 (l/min; ml/kg/min), RQ, ventilation (l/min)]
- Predicted RMR using: HB
- Independent variables: Nutrient intake; APACHE score, spesi score; PEEP, FIO2
Blinding used: No.
- N=10; 8 M, 2 F
- Mean age: 63+15 y
- Studied 7±4 days after ICU admission.
|Energy, predicted using Harris-Benedict, kcals||1501±202||1085-1770|
|Energy, resting measured, kcals||2192±334||1706-2761|
|Energy, TOTAL measured, kcals||2342±371||1793-2997|
- The degree to which resting energy expenditure exceeded predicted EE correlated significantly with admission APACHE II score (r=0.64, p<0.02)
- Mean Measured resting energy expenditure published in Table 3 (Analyst note mean measured REE of 2192±334 kcals did NOT match text 2186±343 kcals; verified using EXCEL and Table 3 is accurate); Therefore, measured REE was 47.3% above predicted REE using Harris-Benedict.
- Total EE averaged 2342±371 [Analyst note: Text erroneously reported 2242±371] and represented a negative energy balance of -626 kcal/d (the correct value)]
- During the activities (where each activity and the amount of time to complete it was measured) and expressed as a proportion of REE), weighing the pt on a sling bed type scale, repositioning, and chest physiotherapy incurred 36±12%, 31±11%, and 20±10% increases above REE. Although certain activities caused considerable elevations in EE, contribution to total daily EE was small because of short duration.
- During the 30 min after an activity (postevent resting EE), on average, energy expenditure increased by 5.8%±4.3%.
- Several factors most likely contribute to the discrepancy in REE in critically ill pt: nutrient intake, sedation and/or analgesia, and degree of stress and illness. Weissman (Chest, 1984) indicates finding an initial reference state from which to calculate the EE for the critically ill pt is a difficult task. In our study, measured REE was 47.3% above predicted EE by Harris-Benedict.
- “[In 2 patients], the periods during which they received larger amounts of sedatives were associated with a significant (P<0.05 decrease in EE)."
- “To further emphasize the importance of sedation on EE, 8 of 10 pt averaged 3.3±1.9 h of agitation and/or restlessness during 24-h and represented 15.0±8.2% contribution to total EE.”
- “Although large EE increases above REE were observed during various activities, their contributions to TEE was relative small; the range of increase above REE was 1.4-10.6%”
- “For this study, it appears that an activity factor of 10% above REE measures should adequately meet the EE associated with routine ICU activities.”
- “Actual REE should be measured before the 10% activity factor is applied.”
- “One limitation of our study is no distinction was made between EE during sleep and rest.”
- “Did not define steady state;” and training of measurer
- “Study biases include non-randomized sample so a selection bias"
- An intervening variable not measured dehydration and weight loss changes; lean muscle mass and fat mass
- Difficult to apply findings to Conclusion statement due to text not matching Table 3; In addition, the length of time for each activity is not reported and so a mean of a 5 min procedure v. mean of a 30 min procedure is proportionately different on RMR (Fig 2A). YET, the contribution toward 30 min post-event rest may be significantly different and cannot be detected by the reporting.
Quality Criteria Checklist: Primary Research
|1.||Would implementing the studied intervention or procedure (if found successful) result in improved outcomes for the patients/clients/population group? (Not Applicable for some epidemiological studies)||Yes|
|2.||Did the authors study an outcome (dependent variable) or topic that the patients/clients/population group would care about?||Yes|
|3.||Is the focus of the intervention or procedure (independent variable) or topic of study a common issue of concern to dieteticspractice?||Yes|
|4.||Is the intervention or procedure feasible? (NA for some epidemiological studies)||Yes|
|1.||Was the research question clearly stated?||Yes|
|1.1.||Was (were) the specific intervention(s) or procedure(s) [independent variable(s)] identified?||N/A|
|1.2.||Was (were) the outcome(s) [dependent variable(s)] clearly indicated?||N/A|
|1.3.||Were the target population and setting specified?||N/A|
|2.||Was the selection of study subjects/patients free from bias?||Yes|
|2.1.||Were inclusion/exclusion criteria specified (e.g., risk, point in disease progression, diagnostic or prognosis criteria), and with sufficient detail and without omitting criteria critical to the study?||N/A|
|2.2.||Were criteria applied equally to all study groups?||N/A|
|2.3.||Were health, demographics, and other characteristics of subjects described?||N/A|
|2.4.||Were the subjects/patients a representative sample of the relevant population?||N/A|
|3.||Were study groups comparable?||N/A|
|3.1.||Was the method of assigning subjects/patients to groups described and unbiased? (Method of randomization identified if RCT)||N/A|
|3.2.||Were distribution of disease status, prognostic factors, and other factors (e.g., demographics) similar across study groups at baseline?||N/A|
|3.3.||Were concurrent controls or comparisons used? (Concurrent preferred over historical control or comparison groups.)||N/A|
|3.4.||If cohort study or cross-sectional study, were groups comparable on important confounding factors and/or were preexisting differences accounted for by using appropriate adjustments in statistical analysis?||N/A|
|3.5.||If case control study, were potential confounding factors comparable for cases and controls? (If case series or trial with subjects serving as own control, this criterion is not applicable.)||N/A|
|3.6.||If diagnostic test, was there an independent blind comparison with an appropriate reference standard (e.g., "gold standard")?||N/A|
|4.||Was method of handling withdrawals described?||Yes|
|4.1.||Were follow-up methods described and the same for all groups?||N/A|
|4.2.||Was the number, characteristics of withdrawals (i.e., dropouts, lost to follow up, attrition rate) and/or response rate (cross-sectional studies) described for each group? (Follow up goal for a strong study is 80%.)||N/A|
|4.3.||Were all enrolled subjects/patients (in the original sample) accounted for?||N/A|
|4.4.||Were reasons for withdrawals similar across groups?||N/A|
|4.5.||If diagnostic test, was decision to perform reference test not dependent on results of test under study?||N/A|
|5.||Was blinding used to prevent introduction of bias?||No|
|5.1.||In intervention study, were subjects, clinicians/practitioners, and investigators blinded to treatment group, as appropriate?||N/A|
|5.2.||Were data collectors blinded for outcomes assessment? (If outcome is measured using an objective test, such as a lab value, this criterion is assumed to be met.)||N/A|
|5.3.||In cohort study or cross-sectional study, were measurements of outcomes and risk factors blinded?||N/A|
|5.4.||In case control study, was case definition explicit and case ascertainment not influenced by exposure status?||N/A|
|5.5.||In diagnostic study, were test results blinded to patient history and other test results?||N/A|
|6.||Were intervention/therapeutic regimens/exposure factor or procedure and any comparison(s) described in detail? Were interveningfactors described?||Yes|
|6.1.||In RCT or other intervention trial, were protocols described for all regimens studied?||N/A|
|6.2.||In observational study, were interventions, study settings, and clinicians/provider described?||N/A|
|6.3.||Was the intensity and duration of the intervention or exposure factor sufficient to produce a meaningful effect?||N/A|
|6.4.||Was the amount of exposure and, if relevant, subject/patient compliance measured?||N/A|
|6.5.||Were co-interventions (e.g., ancillary treatments, other therapies) described?||N/A|
|6.6.||Were extra or unplanned treatments described?||N/A|
|6.7.||Was the information for 6.4, 6.5, and 6.6 assessed the same way for all groups?||N/A|
|6.8.||In diagnostic study, were details of test administration and replication sufficient?||N/A|
|7.||Were outcomes clearly defined and the measurements valid and reliable?||No|
|7.1.||Were primary and secondary endpoints described and relevant to the question?||N/A|
|7.2.||Were nutrition measures appropriate to question and outcomes of concern?||N/A|
|7.3.||Was the period of follow-up long enough for important outcome(s) to occur?||N/A|
|7.4.||Were the observations and measurements based on standard, valid, and reliable data collection instruments/tests/procedures?||N/A|
|7.5.||Was the measurement of effect at an appropriate level of precision?||N/A|
|7.6.||Were other factors accounted for (measured) that could affect outcomes?||N/A|
|7.7.||Were the measurements conducted consistently across groups?||N/A|
|8.||Was the statistical analysis appropriate for the study design and type of outcome indicators?||Yes|
|8.1.||Were statistical analyses adequately described and the results reported appropriately?||N/A|
|8.2.||Were correct statistical tests used and assumptions of test not violated?||N/A|
|8.3.||Were statistics reported with levels of significance and/or confidence intervals?||N/A|
|8.4.||Was "intent to treat" analysis of outcomes done (and as appropriate, was there an analysis of outcomes for those maximally exposed or a dose-response analysis)?||N/A|
|8.5.||Were adequate adjustments made for effects of confounding factors that might have affected the outcomes (e.g., multivariate analyses)?||N/A|
|8.6.||Was clinical significance as well as statistical significance reported?||N/A|
|8.7.||If negative findings, was a power calculation reported to address type 2 error?||N/A|
|9.||Are conclusions supported by results with biases and limitations taken into consideration?||No|
|9.1.||Is there a discussion of findings?||N/A|
|9.2.||Are biases and study limitations identified and discussed?||N/A|
|10.||Is bias due to study's funding or sponsorship unlikely?||No|
|10.1.||Were sources of funding and investigators' affiliations described?||N/A|
|10.2.||Was the study free from apparent conflict of interest?||N/A|