Monitoring Energy Metabolism with Indirect Calorimetry: Instruments,Interpretation,and Clinical Application

Abstract

Indirect calorimetry is the best measure to guide calorie administration during nutrition support. This article presents an update of the types of currently available indirect calorimeters and reviews the recent advances that guide the clinical application of indirect calorimetry. The emphasis of this report is placed on issues that the practicing clinician can use to evaluate, interpret, and apply measurements of energy expenditure.

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References

Flancbaum L, Choban PS, Sambucco S, Burge JC. Comparison of indirect calorimetry, the Fick method, and prediction equations in estimating energy requirements of critically ill patents. Am J Clin Nutr. 1999;69:461– 466.

Dickerson RN, Gervasio JM, Riley ML, et al. Accuracy of predictive methods to estimate resting energy expenditure of thermally-injured patents. JPEN J Parenter Enteral Nutr. 2002 ;26:17– 29.

Barak N, Wall-Alonso W, Sitrin MD. Evaluation of stress factors and body weight adjustments currently used to estimate energy expenditure in hospitalized patients. JPEN J Parenter Enteral Nutr. 2002 ;26:231– 238.

MacDonald A, Hilderbrandt L. Comparison of formulaic equations to determine energy expenditure in the critically ill patient. Nutrition. 2003 ;19:233– 239.

Reeves MM, Capra S. Predicting energy requirement in the clinical setting: are current methods evidence based? Nutr Rev. 2003 ;61:143– 151.

Compher C, Cato R, Bader J, Kinosion B. Harris-Benedict equations do not adequately predict energy requirements in elderly hospitalized African Americans. J Natl Med Assoc. 2004 ;96:209– 214.

McClave SA, Snider HL. Use of indirect calorimetry in clinical nutrition. Nutr Clin Pract. 1992 ;7:207– 221.

Ogawa AM, Shikora SA, Burke LM, Heetderks-Cox JE, Bergren CT, Muskat PC. The thermodilution technique for measuring resting energy expenditure does not agree with indirect calorimeter for the critically ill patient. JPEN J Parenter Enteral Nutr. 1998 ;22:347– 351.

Branson RD. The measurement of energy expenditure: instrumentation, practical considerations and clinical application. Respir Care. 1990;35:640– 659.

10.

McClave SA, Snider HL, Ireton-Jones C. Can we justify continued interest in indirect calorimetry? Nutr Clin Pract. 2002 ;17:133– 136.

11.

Lozano DD, Noordenbos J. Indirect calorimetry: a comparison of intermittent versus continuous monitoring. [A.A.S.T. Webnet website]. Available at: http://www.aast.org/03abstracts/03absPoster_104.html. Accessed July 8, 2003.

12.

Melanson EL, Coehlo LB, Tran ZV, Haugen HA, Kearney JF, Hill, JO. Validation of the BodyGem™ handheld indirect calorimeter [abstract]. JPEN J Parenter Enteral Nutr. 2003 ;27:S39 .

13.

Nieman DC, Trone GA, Austin MD. A new handheld device for measuring resting metabolic rate and oxygen consumption. J Am Diet Assoc. 2003;103:588– 593.

14.

St-Onge M-P, Rubiano F, Jones A, Heymsfield SB. A new handheld indirect calorimeter to measure postprandial energy expenditure. Obes Res. 2004;12:704– 709.

15.

McClave SA, Lowen CC, Kleber MJ, McConnell JW, Jung LY, Goldsmith LJ. Clinical use of the respiratory quotient obtained from indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003 ; 27:21– 26.

16.

Reeves MM, Davies PSW, Bauer J, Battistutta D. Reducing the period of steady state does not affect the accuracy of energy expenditure measurements by indirect calorimetry. Appl Physiol. 2004 ;10:(Epub ahead of print).

17.

McClave, SA, Spain DA, Skolnick JL, et al. Achievement of steady state optimizes results when performing indirect calorimetry. JPEN J Parenter Enteral Nutr. 2003 ;27:16– 20.

18.

Ravussin E, Rising R. Daily energy expenditure in humans: measurement in a respiratory chamber and by doubly labeled water. In: Kinney JM, Tucker HN, eds. Energy Metabolism. New York, NY: Raven Press; 1991:81– 96.

19.

Kleber MJ, Lowen CC, McClave SA, Jung LY, Looney SW. Is there a role for indirect calorimetry in maximizing patient outcome from nutritional alimentation in the long term nursing care setting? Nutr Clin Pract. 2000;15:227– 233.

20.

Matarese LE, Steiger E, Seidner DL. Body composition changes in cachectic patients receiving home parenteral nutrition. JPEN J Parenter Enteral Nutr. 2002 ;26:366– 371.

21.

McClave SA. Conducting indirect calorimetry. Nutrition Week Oral Presentation. San Antonio: January 22,2003 .

22.

Wooley JA, Sax HC. Indirect calorimetry: applications to practice. Nutr Clin Pract. 2003 ;18:434– 439.

23.

Driscoll DF, Bistrian BR. Parenteral nutrition; macronutrient fuels. In: Shikora SA, Martindale RG, Schwaitzberg S, eds. Nutritional Considerations in the Intensive Care Unit. Dubuque, IA: Kendall/Hunt; 2002:45– 46.

24.

Ireton-Jones CS, Turner WW. Actual or ideal body weight: which should be used to predict energy expenditure? J Am Diet Assoc. 1991;91:193– 195.

25.

McClave SA, Lowen CC, Kleber MJ, et al. Are patients fed appropriately according to their caloric requirements? JPEN J Parenter Enteral Nutr. 1998 ;22:175– 181.

26.

Alberda C, Snowden L, McCargar L, Gramlich L. Energy requirements in critically ill patents: how close are our estimates? Nutr Clin Pract. 2002;17:38– 42.

27.

Barak N, Wall-Alonso E, Sitrin MD. Which patients are likely to benefit from indirect calorimetry measurement [abstract]? JPEN J Parenter Enteral Nutr. 2004 ;28:S16– S17.

28.

Mault J. Energy balance and outcome in critically ill patients: results of a multi-center, prospective, randomized trial by the ICU nutrition study group [abstract]. JPEN J Parenter Enteral Nutr. 200;24: S4.

29.

Noordenbos J, Hansbrough JF, Gutmacher H, Dore C, Hansbrough WB. Enteral nutritional support and wound excision and closure do not prevent post burn hypermetabolism as measured by continuos metabolic monitoring. J Trauma. 2000;49:667– 672.

30.

Headley JM. Indirect calorimetry: a trend toward contiguous metabolic assessment. AACN Clin Issues. 2003 ;14:155– 167.

31.

Ireton-Jones C, Jones JD. Improved equations for predicting energy expenditure in patients: the Ireton-Jones equations. Nutr Clin Pract. 2002;17:29– 31.

32.

Hart DA, Wolf SE, Chinkes DL, et al. Effects of early excision and aggressive enteral feeding on burn hypermetabolism, catabolism, and sepsis after severe burn, J Trauma. 2003 ;54:755– 764.

33.

Zaloga G. Permissive underfeeding. New Horiz. 1994;2:257– 263.

34.

McCowen KC, Friel C, Sternberg J, Forse RA, Bistrian BR. Hypocaloric total parenteral nutrition (TPN): effectiveness in prevention of hyperglycemia and infectious complications: a randomized clinical trial. Crit Care Med. 2000 ;28:3606– 3611.

35.

Krishnan JA, Parce PB, Martinez A, Brower RG. Caloric intake in medical ICU patients: consistency of care with guidelines and relationship to clinical outcomes. Chest. 2003 ;124:297– 305.

36.

Bartlett RH, Dechert RE, Mault JR, Ferguson SK, Kaiser AM, Erlandson EE. Measurement of metabolism in multiple organ failure. Surgery. 1982;92:771– 779.

37.

Hart DW, Wolf SE, Herndon DN, et al. Energy expenditure and caloric balance after burn: increased feeding leads to fat rather than lean mass accretion. Ann Surg. 2002 ;235:152– 161.

38.

Plank LD, Hill GH. Energy balance in critical illness. Proc Nutr Soc. 2003 ;62:545– 552.

39.

Reid CL, Campbell IT, Little RA. Muscle wasting and energy balance in critical illness. Clin Nutr. 2004 ;23:273– 280.

40.

Ireton-Jones C, Kindle R. Effects of home parenteral nutrition on energy expenditure: a case study [abstract]. Nutr Clin Pract 2004;19:107 .

41.

Elia M. Organ and tissue contribution to metabolic rate. In: Kinney JM, Tucker HN, eds. Energy Metabolism. New York, NY: Raven Press; 1991;61– 79.

42.

Heymsfield SB, Gallagher D, Wang Z. Body composition modeling: application to exploration of the resting energy expenditure fat-free mass relationship. Ann N Y Acad Sci. 2000 ;904:290– 297.

43.

Wang Z, Heshka S, Gallagher D, Boozer CN, Kotler DP, Heymsfield SB. Resting energy expenditure-fat-free mass relationship: new insights provided by body composition modeling. Am J Physiol Endocrinol Metab. 2000;279:E539– E545.

44.

Yu Y-M, Tompkins RG, Ryan CM. The metabolic basis of the increase in energy expenditure in severely burned patients. JPEN J Parenter Enteral Nutr. 199;22:160– 168.

45.

Heymsfiled SB. Measurement of energy balance. Acta Diabetol. 2003;40(Suppl 1):S117– S121.

46.

Hill GL. Body composition research: implications for the practice of clinical nutrition. JPEN J Parenter Enteral Nutr. 1992 ;16:197– 218.

47.

Ahmad A, Duerksen DR, Munroe S. An evaluation of resting energy expenditure in hospitalized, severely underweight patents. Nutrition. 1999 ;15:384– 388.

48.

Heymsfiled SB. Heat and life: the ongoing scientific odyssey. JPEN J Parenter Enteral Nutr. 2002 ;26:319– 332.

49.

Weir V. A new method for calculating metabolic rate with special reference to protein metabolism. J Physiol. 1949 ;109:1– 9.