title: A comparison of predictive equations of energy expenditure and measured energy expenditure in critically ill patients.
abstract: OBJECTIVE
  Multiple equations exist for predicting resting energy expenditure (REE). The accuracy of these for estimating energy requirements of critically ill patients is not clear, especially for obese patients. We sought to compare REE, calculated with published formulas, with measured REE in a cohort of mechanically ventilated subjects.
  
  
  METHODS
  We retrospectively identified all mechanically ventilated patients with measured body mass index who underwent indirect calorimetry in the intensive care unit. Limits of agreement and Pitman's test of difference in variance were performed to compare REE by equations with REE measured by indirect calorimetry.
  
  
  RESULTS
  A total of 927 patients were identified, including 401 obese patients. There were bias and poor agreement between measured REE and REE predicted by the Harris-Benedict, Owen, American College of Chest Physicians, and Mifflin equations (P > .05). There was poor agreement between measured and predicted REE by the Ireton-Jones equation, stratifying by sex. Ireton-Jones was the only equation that was unbiased for men and those in weight categories 1 and 2. In all cases except Ireton-Jones, predictive equations underestimated measured REE.
  
  
  CONCLUSIONS
  None of these equations accurately estimated measured REE in this group of mechanically ventilated patients, most underestimating energy needs. Development of improved predictive equations for adequate assessment of energy needs is needed.
authors.affiliation: Division of Pulmonary and Critical Care Medicine, University of Washington Medical Center, Seattle, WA 98104, USA. ekross@u.washington.edu
authors.forename: Erin K
authors.initials: EK
authors.lastname: Kross
authors.forename: Matthew
authors.initials: M
authors.lastname: Sena
authors.forename: Karyn
authors.initials: K
authors.lastname: Schmidt
authors.forename: Renee D
authors.initials: RD
authors.lastname: Stapleton
mesh_terms: D015992:Body Mass Index; D002153:Calorimetry, Indirect; D016638:Critical Illness; D003661:Decision Support Techniques; D004734:Energy Metabolism; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009751:Nutritional Requirements; D009765:Obesity / Q000503:physiopathology*; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012121:Respiration, Artificial; D012189:Retrospective Studies; D014861:Washington