title: Predictive equations over-estimate the resting energy expenditure in amyotrophic lateral sclerosis patients who are dependent on invasive ventilation support.
abstract: BACKGROUND
  Amyotrophic lateral sclerosis (ALS) is a form of degenerative motor neuron disease. At the end stage of the disease artificial feeding is often required. Nevertheless, very little is known about the energy demand of those ALS patients who are chronically dependent on tracheostomy intermittent positive pressure ventilation. The objective of our study was to clarify the resting energy expenditure (REE) in mechanically ventilated ALS patients.
  
  
  METHODS
  We measured the REE of five ALS patients (four men, one female) twice during a 12 month-period using indirect calorimetry with two sampling flow settings (40 L/min and 80 L/min). The measured REEs (mREE) were compared with values calculated using five different predictive equations.
  
  
  RESULTS
  The mean (± SD) of all mREEs was 1130 ± 170 kcal/d. The measurements with different flow settings and at different time instances provided similar results. The mean of mREEs was 33.6% lower, as compared to the mean calculated with five different predictive equations REE (p < 0.001). Each of the predictive equations over-estimated the REE.
  
  
  CONCLUSIONS
  The mREE values were significantly lower for every patient than all the predicted ones. Determination of daily nutrition with predictive equations may therefore lead in mis-estimation of energy requirements. Because ALS patients may live years with artificial ventilation their nutritional support should be based on individual measurements. However, further study is needed due to the small number of subjects.
authors.affiliation: Department of Anaesthesiology, Intensive Care, Emergency Care and Pain Medicine, Turku University Hospital and University of Turku, Kiinamyllynkatu 4-8 FI-20520 Turku, Finland. tuwasi@utu.fi.
authors.forename: Waltteri
authors.initials: W
authors.lastname: Siirala
authors.forename: Klaus T
authors.initials: KT
authors.lastname: Olkkola
authors.forename: Tommi
authors.initials: T
authors.lastname: Noponen
authors.forename: Arno
authors.initials: A
authors.lastname: Vuori
authors.forename: Riku
authors.initials: R
authors.lastname: Aantaa
references.citation: Acute Care. 1988-1989;14-15:91-110
references.pmid: 3155338
references.citation: Palliat Med. 1993;7(4 Suppl):49-64
references.pmid: 7505711
references.citation: Nutrition. 1989 Sep-Oct;5(5):303-11; discussion 312-3
references.pmid: 2520314
references.citation: Crit Care Med. 1989 Oct;17(10):1041-7
references.pmid: 2676345
references.citation: JPEN J Parenter Enteral Nutr. 2005 Sep-Oct;29(5):380-7
references.pmid: 16107602
references.citation: Am J Clin Nutr. 2001 Sep;74(3):328-34
references.pmid: 11522556
references.citation: Biochim Biophys Acta. 1998 Aug 10;1366(1-2):211-23
references.pmid: 9714810
references.citation: J Neurol. 1995 Oct;242(10):695-8
references.pmid: 8568533
references.citation: Neurol Clin. 1996 May;14(2):399-420
references.pmid: 8827179
references.citation: Rinsho Shinkeigaku. 1991 Mar;31(3):255-9
references.pmid: 1909943
references.citation: Neurology. 2003 Jul 22;61(2):171-7
references.pmid: 12874394
references.citation: Ann Neurol. 1985 Sep;18(3):271-80
references.pmid: 4051456
references.citation: World Health Organ Tech Rep Ser. 1985;724:1-206
references.pmid: 3937340
references.citation: Neurology. 2003 Jul 8;61(1):135-7
references.pmid: 12847177
references.citation: Ann Neurol. 1985 Oct;18(4):419-31
references.pmid: 2416263
references.citation: J Neurol Sci. 1994 Jul;124 Suppl:96-107
references.pmid: 7807156
references.citation: Am J Clin Nutr. 1990 Feb;51(2):241-7
references.pmid: 2305711
references.citation: Int J Clin Monit Comput. 1987;4(3):167-77
references.pmid: 3116131
references.citation: Metabolism. 1988 Mar;37(3):287-301
references.pmid: 3278194
references.citation: J Neurol Sci. 1996 Aug;139 Suppl:123-8
references.pmid: 8899671
references.citation: Brain. 1995 Jun;118 ( Pt 3):707-19
references.pmid: 7600088
references.citation: Neurology. 2003 Mar 11;60(5):813-9
references.pmid: 12629239
references.citation: Arch Dis Child. 1992 Oct;67(10 Spec No):1207-11
references.pmid: 1444562
references.citation: Neurodegener Dis. 2005;2(3-4):202-7
references.pmid: 16909026
references.citation: Lancet. 2005 Oct 1;366(9492):1197-209
references.pmid: 16198769
references.citation: Curr Opin Clin Nutr Metab Care. 2004 Nov;7(6):635-9
references.pmid: 15534431
references.citation: Am J Clin Nutr. 1987 Dec;46(6):875-85
references.pmid: 3687821
references.citation: Am J Clin Nutr. 1986 Jul;44(1):1-19
references.pmid: 3728346
references.citation: J Physiol. 1949 Aug;109(1-2):1-9
references.pmid: 15394301
references.citation: Am J Clin Nutr. 1996 Jan;63(1):130-7
references.pmid: 8604660
references.citation: Proc Natl Acad Sci U S A. 1918 Dec;4(12):370-3
references.pmid: 16576330
references.citation: Chest. 2004 Nov;126(5):1502-7
references.pmid: 15539719
references.citation: J Clin Invest. 1990 Nov;86(5):1423-7
references.pmid: 2243122
references.citation: Respir Med. 2008 Mar;102(3):430-6
references.pmid: 18023334
references.citation: J Spinal Cord Med. 2008;31(4):361-72
references.pmid: 18959353
references.citation: Dermatol Nurs. 2002 Aug;14(4):249-2, 255-6
references.pmid: 12240502
references.citation: Helv Med Acta. 1951 Feb;18(1):23-44
references.pmid: 14813607
references.citation: Am J Clin Nutr. 1998 Dec;68(6):1223-7
references.pmid: 9846850
references.citation: Clin Nutr. 2002 Oct;21(5):385-8
references.pmid: 12381335
references.citation: Am J Clin Nutr. 1982 Mar;35(3):566-73
references.pmid: 6801963