PhilSPEN Online Journal of Parenteral and Enteral Nutrition

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(Article 72 | POJ_0066)

Submitted Abstracts

PENSA 2017 Congress

Submitted: July 31, 2017

Abstract ID = 35 | Classification: (3) - Critical care and related issues

Title: Validity of predictive equations for estimation of resting energy expenditure among mechanically ventilated critically ill patients: Preliminary findings

Author(s): Pei Chien Tah (1,2), Vineya-Rai Hakumat-Rai (3), Bee Koon Poh (4), Mohd Basri Mat Nor (5), Hazreen Abdul Majid (6), Chee Cheong Kee (7), Mazuin Kamarul Zaman (8), Mohd Shahnaz Hasan (1)

Institution where study was conducted:

  1. Department of Anesthesiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  2. Department of Dietetics, University of Malaya Medical Centre, Kuala Lumpur, Malaysia
  3. School of Medicine, Taylor's University, Selangor, Malaysia
  4. Nutritional Sciences Programme, School of Healthcare Science, Faculty of Health Sciences, Universiti Kebangsaan Malaysia, Kuala Lumpur, Malaysia
  5. Department of Anesthesiology, International Islamic University Malaysia, Malaysia
  6. Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
  7. Epidemiology and Biostatistics Unit, Medical Research Resource Centre, Institute for Medical Research, Kuala Lumpur, Malaysia
  8. Centre of Nutrition and Dietetics Studies, Faculty of Health Sciences, Universiti Teknologi MARA, Malaysia

Keywords: resting energy expenditure, indirect calorimetry, metabolic determinants, critically ill

Background: Several predictive equations (PEs) have been developed for estimation of energy requirement but very few has been validated among mechanically ventilated critically ill patients in Asian population.

Objectives: This study aimed at determining the validity of 14 PEs for energy requirement and identifying metabolic determinants that influence resting energy expenditure (REE).

Methods: REE was measured among 90 ventilated critically ill patients by using Indirect Calorimetry (IC). 14 PEs used to estimate patients’ energy requirement was validated against IC using intraclass correlation coefficient (ICC) test. Metabolic determinants assessed were sex, body mass index (BMI), age, patient condition, mNUTRIC score and body cell mass (BCM) status. Recruitment is on-going until sample size of 314 is achieved.

Results: In the early phase (≤5days), mean REE for all critically ill patients was 1677±403kcal whereas for obese patients was 1926±438kcal. Penn State equation [PSU(m),2003b] shows highest correlation (ICC=0.635), 95%CI(0.49,0.75), p<0.001 with IC in estimating REE among all critically ill patients. Meanwhile, Harris Benedict Equation (variants) [HBEa(50)x1.25] shows highest correlation (ICC= 0.581), 95%CI(0.12,0.84), p=0.010 in estimating REE among obese patients. There was significant difference in REE by sex, BMI and BCM status during early and late phase (6-10days). During chronic phase (>10days), significant difference in REE was observed in patient condition and BCM status.

Conclusion: These preliminary results show that most available validated equations had poor to fair agreement with IC measurement. As such, we opine that it is crucial to determine a reliable PE for assessing energy requirement of Asian critically ill patients.