Estimation of energy requirements for mechanically ventilated, critically ill patients using nutritional status.
BACKGROUND
There is very little information on what is considered an adequate energy intake for mechanically ventilated, critically ill patients. The purpose of the present study was to determine this energy requirement by making use of patients' nutritional status.


METHODS
The study was conducted in a multidisciplinary intensive care unit of Taichung Veterans General Hospital, Taiwan. Patients were hemodynamically stable and not comatose, and were requiring at least 7 days of mechanical ventilation. Fifty-four patients successfully completed this study. The resting energy expenditure was measured using indirect calorimetry. The total energy requirement was considered 120% of the measured energy expenditure. The daily nutrient intake was recorded. Nutritional status was assessed using single and multiple parameters, nitrogen balance, and medical records, and was performed within 24 hours of admission and after 7 days in the intensive care unit.


RESULTS
Fifteen patients were being underfed (<90% of total energy requirement), 20 patients were in the appropriate feeding (AF) group (within +/- 10% of total energy requirement), and 19 patients received overfeeding (>110% of total energy requirement). Patients in the underfeeding group received only 68.3% of their energy requirement, while the overfeeding group patients received up to 136.5% of their required calories. Only patients in the AF group had a positive nitrogen balance (0.04 +/- 5.1) on day 7. AF group patients had a significantly higher Nutritional Risk Index value at day 7 than at day 1.


CONCLUSIONS
AF patients had more improvement in nutritional status than patients in the other feeding groups. To provide at least 120% of the resting energy expenditure seemed adequate to meet the caloric energy needs of hemodynamically stable, mechanically ventilated, critically ill patients.
Kan
Mee-Nin
MN
Intensive Care Unit, Taichung Veterans General Hospital, Taiwan, ROC.
Chang
Han-Hsin
HH
Sheu
Woei-Fen
WF
Cheng
Chien-Hsiang
CH
Lee
Bor-Jen
BJ
Huang
Yi-Chia
YC
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D016638:Critical Illness; D004734:Energy Metabolism; D004750:Enteral Nutrition; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009752:Nutritional Status; D012121:Respiration, Artificial; D013624:Taiwan