Elsevier

Clinical Nutrition

Volume 25, Issue 1, February 2006, Pages 37-44
Clinical Nutrition

ORIGINAL ARTICLE
Computerized energy balance and complications in critically ill patients: An observational study

https://doi.org/10.1016/j.clnu.2005.10.010Get rights and content

Summary

Background and aims

An accurate energy balance is difficult to achieve in hospitalized patients. The aim of the study was to measure the daily cumulative energy balance in critically ill patients receiving mechanical ventilation using a bedside computerized information system (CIS), and to assess its impact on outcome.

Methods

Fifty intensive care unit (ICU) patients (33 male, 17 female, mean age 59±18 years) were prospectively followed. Mean body mass index was 26.85±5.23 kg/m2 and mean APACHE II score, 23.1±7.7. Resting energy expenditure was measured daily with indirect calorimetry (Deltatrac II, Datex-Ohmeda, Finland), and daily macronutrient intake was measured with a bedside CIS (iMDsoft, Israel) connected to all caloric sources. End-point measures were morbidity (acquired organ dysfunction, pressure sores, need for surgery) and mortality. One- and two-way analysis of variance and stepwise logistic regression for predicted probability were used for statistical analysis.

Results

Mean energy intake was 1512 kcal/day and mean cumulative energy balance for an overall ICU stay of 566 days was −4767 kcal (range +4747 to −17,274). A strong association of maximum negative energy balance with adult respiratory distress syndrome (P=0.0003), sepsis (P=0.0035), renal failure (P=0.0001), pressure sores (P=0.013), need for surgery (P=0.023), and total complication rate (P=0.0001), but not with length of ventilation, ICU stay, or hospitalization, or mortality.

Conclusions

Negative energy balance may be correlated with the occurrence of complications in the ICU. The bedside CIS provides accurate information on energy balance in critically ill patients and may allow for early detection and prevention of severe negative energy balance and complications.

Section snippets

Study population

The study was conducted in the General Intensive Care Department of Rabin Medical Center, a university-affiliated tertiary hospital, between October 2002 and May 2003. During this period, 248 patients were treated in the 10 beds ICU. Only those requiring at least 96 h of mechanical ventilation were included in the study. Patients who received a fraction of inspired oxygen of >60% at the time of indirect calorimetry or who had air leaks around the respiratory circuit were excluded, as were

Results

Fifty patients (33 men, seven women) were found eligible for the study. Their background data are shown in Table 1. Mean caloric intake was 1512 kcal per 24 h (range 400–3210 kcal/day). Mean energy balance was −460 kcal per 24 h (range −1025 to +259 kcal/day), and mean cumulative energy balance,−4767 kcal. The cumulative energy balance was below −10,000 kcal in 11 patients, between −4000 and −10,000 kcal in 15 patients, and above −4000 kcal in 24. Mean IV dextrose intake was 163 kcal/day, or 12% of the

Discussion

This observational study shows that a negative energy balance is highly correlated to the occurrence of complications in the ICU. The use of a computerized bedside information system together with indirect calorimetry measurements increased the ability to assess energy balance on a daily basis. The literature contains an extensive body of data on the value of indirect calorimetry in assessing the caloric requirements of critically ill patients.17, 18, 19 However, only few studies in adults have

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