Energy expenditure in critically ill patients estimated by population-based equations, indirect calorimetry and CO2-based indirect calorimetry

Mark Lillelund Rousing, Mie Hviid Hahn-Pedersen, Steen Andreassen, Ulrike Pielmeier, Jean-Charles Preiser

Indirect calorimetry (IC) is the reference method for measurement of energy expenditure (EE) in mechanically ventilated critically ill patients. When IC is unavailable, EE can be calculated by predictive equations or by VCO2-based calorimetry. This study compares the bias, quality and accuracy of these methods. EE was determined by IC over a 30-min period in patients from a mixed medical/postsurgical intensive care unit and compared to seven predictive equations and to VCO2-based calorimetry. The bias was described by the mean difference between predicted EE and IC, the quality by the root mean square error (RMSE) of the difference and the accuracy by the number of patients with estimates within 10 % of IC. Errors of VCO2-based calorimetry due to choice of respiratory quotient (RQ) were determined by a sensitivity analysis, and errors due to fluctuations in ventilation were explored by a qualitative analysis. In 18 patients (mean age 61 ± 17 years, five women), EE averaged 2347 kcal/day. All predictive equations were accurate in less than 50 % of the patients with an RMSE ≥ 15 %. VCO2-based calorimetry was accurate in 89 % of patients, significantly better than all predictive equations, and remained better for any choice of RQ within published range (0.76-0.89). Errors due to fluctuations in ventilation are about equal in IC and VCO2-based calorimetry, and filtering reduced these errors. This study confirmed the inaccuracy of predictive equations and established VCO2-based calorimetry as a more accurate alternative. Both IC and VCO2-based calorimetry are sensitive to fluctuations in respiration.