title: Resting Energy Expenditure in Critically Ill Patients With Spontaneous Intracranial Hemorrhage.
abstract: BACKGROUND
  Data on energy requirements of patients with spontaneous intracranial hemorrhage (SICH) are scarce. The objective of this study was to determine the resting energy expenditure (REE) in critically ill patients with SICH and to compare it with the predicted basal metabolic rate (BMR).
  
  
  METHODS
  In 30 nonseptic patients with SICH, the REE was measured during the 10 first posthemorrhage days with the use of indirect calorimetry (IC). Predicted BMR was also evaluated by the Harris-Benedict (HB) equation. Bland-Altman analysis was used to evaluate the agreement between measured and predicted values. The possible effect of confounding factors (demographics, disease, and severity of illness score) on the evolution of continuous variables was also tested.
  
  
  RESULTS
  mean predicted BMR, calculated by the HB equation, was 1580.3 ± 262 kcal/d, while measured REE was 1878.9 ± 478 kcal/d (117.5% BMR). Compared with BMR, measured REE values showed a statistically significant increase at all studied points (P < .005). Measured and predicted values showed a good correlation (r = 0.73, P < .001), but the test of agreement between the 2 methods with the Bland-Altman analysis showed a mean bias (294.6 ± 265.6 kcal/d) and limits of agreement (-226 to 815.29 kcal/d) that were beyond the clinically acceptable range. REE values presented a trend toward increase over time (P = .077), reaching significance (P < .005) after the seventh day. Significant correlation was found between REE and temperature (P = .002, r = 0.63), as well as between REE and cortisol level (P = .017, r = 0.62) on the 10th day. No correlation was identified between REE and depth of sedation, as well as Acute Physiology and Chronic Health Evaluation II, Glasgow Coma Scale, and Hunt and Hess scores.
  
  
  CONCLUSIONS
  During the early posthemorrhagic stage, energy requirements of critically ill patients with SICH are increased, presenting a trend toward increase over time. Compared with IC, the HB equation underestimates energy requirements and is inefficient in detecting individual variability of REE in this group of patients.
authors.affiliation: ICU Department, G. Papanikolaou Hospital, Thessaloniki, Greece.
authors.forename: Pagona
authors.initials: P
authors.lastname: Koukiasa
authors.affiliation: ICU Department, G. Papanikolaou Hospital, Thessaloniki, Greece millybi@otenet.gr.
authors.forename: Militsa
authors.initials: M
authors.lastname: Bitzani
authors.affiliation: ICU Department, University Hospital, Democritus University of Trace, Alexandroupolis, Greece.
authors.forename: Vasileios
authors.initials: V
authors.lastname: Papaioannou
authors.affiliation: ICU Department, University Hospital, Democritus University of Trace, Alexandroupolis, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Pnevmatikos
mesh_terms: D018806:APACHE; D000328:Adult; D000368:Aged; D001481:Basal Metabolism; D001831:Body Temperature; D002153:Calorimetry, Indirect; D003128:Coma / Q000378:metabolism; D016638:Critical Illness; D005260:Female; D006470:Hemorrhage; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D006993:Hypnotics and Sedatives; D007362:Intensive Care Units; D020300:Intracranial Hemorrhages / Q000378:metabolism*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D012121:Respiration, Artificial; D012146:Rest / Q000502:physiology*
chemical_list: D006993:Hypnotics and Sedatives; D006854:Hydrocortisone
keywords: calorimetry; critical care; nutrition; nutrition assessment; research and diseases; spontaneous intracranial hemorrhage