In this new review, the authors identify the pros and cons of Indirect Calorimetry (IC) to estimate Resting Energy Expenditure (REE) and define individual nutritional energy targets among critically ill patients.
Indirect Calorimetry (IC) is a monitoring tool that provides factual information on metabolism. There is significant evidence to show an important association between mortality and calorie intake in early critical illness. The importance of identifying individual energy demands and preventing overfeeding and underfeeding cannot be ignored.
In a systematic review and meta-analysis published in 2020, no improved outcomes were found when IC was used, although prescribed energy targets were more closely met with IC informed energy delivery than predictive equations. Findings from the review suggest that IC feedback can improve feeding performance and may help prevent underfeeding and overfeeding in critically ill patients.
Some of the costs associated with IC include device investment costs, consumables, calibration gas, and service. In addition, staff times should also be considered. A typical IC procedure takes approximately 5 to 10 minutes. However, the cost of IC is compensated with improved patient outcomes, as reported in several studies. Optimisation of nutritional performance can have an impact on readmission rates, long-term functional outcomes and quality of life.
Overall, IC is the gold standard for measuring energy expenditure to set nutrition therapy goals during critical illness. However, there is a need to address the technical and patient-related limitations of IC and to identify future developments that could monitor REE continuously and during oxygen therapy and non-invasive ventilation.
- Title: Routine use of indirect calorimetry in critically ill patients: pros and cons
- Authors: Elisabeth De Waele and Arthur R. H. van Zanten
- Published in: Critical Care - May 2022
- Link: https://doi.org/10.1186/s13054-022-04000-5