Bedside Calculation of Energy Expenditure Does Not Guarantee Adequate Caloric Prescription in Long-Term Mechanically Ventilated Critically Ill Patients: A Quality Control Study
Nutrition is essential in critically ill patients, but translating caloric prescriptions into adequate caloric intake remains challenging. Caloric prescriptions (P), effective intake (I), and caloric needs (N), calculated with modified Harris-Benedict formulas, were recorded during seven consecutive...
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Wiley
2012-01-01
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| Series: | The Scientific World Journal |
| Online Access: | http://dx.doi.org/10.1100/2012/909564 |
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| author | E. De Waele Herbert Spapen P. M. Honoré Sabrina Mattens Thomas Rose Luc Huyghens |
| author_facet | E. De Waele Herbert Spapen P. M. Honoré Sabrina Mattens Thomas Rose Luc Huyghens |
| author_sort | E. De Waele |
| collection | DOAJ |
| description | Nutrition is essential in critically ill patients, but translating caloric prescriptions into adequate caloric intake remains challenging. Caloric prescriptions (P), effective intake (I), and caloric needs (N), calculated with modified Harris-Benedict formulas, were recorded during seven consecutive days in ventilated patients. Adequacy of prescription was estimated by P/N ratio. I/P ratio assessed accuracy of translating a prescription into administered feeding. I/N ratio compared delivered calories with theoretical caloric needs. Fifty patients were prospectively studied in a mixed medicosurgical ICU in a teaching hospital. Basal and total energy expenditure were, respectively, 1361±171 kcal/d and 1649±233 kcal/d. P and I attained 1536±602 kcal/d and 1424±572 kcal/d, respectively. 24.6% prescriptions were accurate, and 24.3% calories were correctly administered. Excessive calories were prescribed in 35.4% of patients, 27.4% being overfed. Caloric needs were underestimated in 40% prescriptions, with 48.3% patients underfed. Calculating caloric requirements by a modified standard formula covered energy needs in only 25% of long-term mechanically ventilated patients, leaving many over- or underfed. Nutritional imbalance mainly resulted from incorrect prescription. Failure of “simple” calculations to direct caloric prescription in these patients suggests systematic use of more reliable methods, for example, indirect calorimetry. |
| format | Article |
| id | doaj-art-9bc28f4eef1d41d9a3bdce68ddf16092 |
| institution | Kabale University |
| issn | 1537-744X |
| language | English |
| publishDate | 2012-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | The Scientific World Journal |
| spelling | doaj-art-9bc28f4eef1d41d9a3bdce68ddf160922025-08-20T03:37:31ZengWileyThe Scientific World Journal1537-744X2012-01-01201210.1100/2012/909564909564Bedside Calculation of Energy Expenditure Does Not Guarantee Adequate Caloric Prescription in Long-Term Mechanically Ventilated Critically Ill Patients: A Quality Control StudyE. De Waele0Herbert Spapen1P. M. Honoré2Sabrina Mattens3Thomas Rose4Luc Huyghens5Department of Intensive Care Medicine, University Hospital, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, BelgiumDepartment of Intensive Care Medicine, University Hospital, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, BelgiumDepartment of Intensive Care Medicine, University Hospital, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, BelgiumDepartment of Dietetics, University Hospital, Vrije Universiteit Brussel, 1090 Brussels, BelgiumDepartment of Intensive Care Medicine, University Hospital, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, BelgiumDepartment of Intensive Care Medicine, University Hospital, Vrije Universiteit Brussel, Laarbeeklaan 101, 1090 Brussels, BelgiumNutrition is essential in critically ill patients, but translating caloric prescriptions into adequate caloric intake remains challenging. Caloric prescriptions (P), effective intake (I), and caloric needs (N), calculated with modified Harris-Benedict formulas, were recorded during seven consecutive days in ventilated patients. Adequacy of prescription was estimated by P/N ratio. I/P ratio assessed accuracy of translating a prescription into administered feeding. I/N ratio compared delivered calories with theoretical caloric needs. Fifty patients were prospectively studied in a mixed medicosurgical ICU in a teaching hospital. Basal and total energy expenditure were, respectively, 1361±171 kcal/d and 1649±233 kcal/d. P and I attained 1536±602 kcal/d and 1424±572 kcal/d, respectively. 24.6% prescriptions were accurate, and 24.3% calories were correctly administered. Excessive calories were prescribed in 35.4% of patients, 27.4% being overfed. Caloric needs were underestimated in 40% prescriptions, with 48.3% patients underfed. Calculating caloric requirements by a modified standard formula covered energy needs in only 25% of long-term mechanically ventilated patients, leaving many over- or underfed. Nutritional imbalance mainly resulted from incorrect prescription. Failure of “simple” calculations to direct caloric prescription in these patients suggests systematic use of more reliable methods, for example, indirect calorimetry.http://dx.doi.org/10.1100/2012/909564 |
| spellingShingle | E. De Waele Herbert Spapen P. M. Honoré Sabrina Mattens Thomas Rose Luc Huyghens Bedside Calculation of Energy Expenditure Does Not Guarantee Adequate Caloric Prescription in Long-Term Mechanically Ventilated Critically Ill Patients: A Quality Control Study The Scientific World Journal |
| title | Bedside Calculation of Energy Expenditure Does Not Guarantee Adequate Caloric Prescription in Long-Term Mechanically Ventilated Critically Ill Patients: A Quality Control Study |
| title_full | Bedside Calculation of Energy Expenditure Does Not Guarantee Adequate Caloric Prescription in Long-Term Mechanically Ventilated Critically Ill Patients: A Quality Control Study |
| title_fullStr | Bedside Calculation of Energy Expenditure Does Not Guarantee Adequate Caloric Prescription in Long-Term Mechanically Ventilated Critically Ill Patients: A Quality Control Study |
| title_full_unstemmed | Bedside Calculation of Energy Expenditure Does Not Guarantee Adequate Caloric Prescription in Long-Term Mechanically Ventilated Critically Ill Patients: A Quality Control Study |
| title_short | Bedside Calculation of Energy Expenditure Does Not Guarantee Adequate Caloric Prescription in Long-Term Mechanically Ventilated Critically Ill Patients: A Quality Control Study |
| title_sort | bedside calculation of energy expenditure does not guarantee adequate caloric prescription in long term mechanically ventilated critically ill patients a quality control study |
| url | http://dx.doi.org/10.1100/2012/909564 |
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