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Ann Clin Nutr Metab : Annals of Clinical Nutrition and Metabolism

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3 "Indirect calorimetry"
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Original Article
Comparison of Energy Requirements of Patients with Brain Injury of the Intensive Care Unit: Indirect Calorimetry vs. Predictive Equations
EunJoo Bae, SeongSuk Kang, MiYeon Kim, JinYoung Jang, HyunJung Lim, TaeGon Kim
J Clin Nutr 2020;12(2):41-47.   Published online December 31, 2020
DOI: https://doi.org/10.15747/jcn.2020.12.2.41
AbstractAbstract PDFePub
Purpose: The metabolic activity and demand usually increase in seriously ill patients, especially in patients with a brain injury (BI). These nutritional demands have been traditionally satisfied using predictive equations (PEs). Recently, indirect calorimetry (IC) has been used widely because it is more accurate than other methods. This study measured the energy expenditures (EE) using IC (GE, CARESCAPE B650, Helsinki, Finland) and calculated the PEs simultaneously in patients with BI.
Methods: This study was conducted on 55 patients with a BI for three years (2017.7∼2020.8), who were mechanically ventilated within a hospital for ≤seven days. The EE values using IC were measured once in each patient, and the EE values using PE were calculated using 5 PEs (ESPEN, Harris-Benedict, HB; Frankenfield, FK; Penn state, PS; and Faisy) at the same time. The 55 patients were divided into two groups, acute group (39 patients; ≤3 hospital days group, AG) and subacute group (16 patients; >3 hospital days group, SG) according to the time, and the values were obtained.
Results: There were no differences in the patient’s characteristics between the two groups, including age, gender, severity of the condition (Simplified Acute Physiology Score II), and anthropometric parameters. In AG, the energy expenditure values using PEs were significantly lower than those using IC in the three PEs (IC 1,712.0±476 kcal, ESPEN 1,558.6±324 kcal, P=0.038, HB 1,582.4±273 kcal, P=0.037, PS 1,530.8±340 kcal, P=0.005). In SG, the EE value using PEs did not differ significantly from that using IC.
Conclusion: An accurate assessment of EE is critical for seriously ill patients. These results showed that the previously well-known PEs might not be correct, particularly in acute patients with BI. Therefore, it is recommended that the EE values be obtained using IC, at least in acute patients with BI.
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Review Article
Nutrition Therapy in Major Burns
Yong Suk Cho
J Clin Nutr 2019;11(2):38-41.   Published online December 31, 2019
DOI: https://doi.org/10.15747/jcn.2019.11.2.38
AbstractAbstract PDFePub

Major burns lead to a hypermetabolic response that is more dramatic than that identified in any other disease or injury. In addition, major burns increase the metabolic demands of the body, which can lead to severe weight body loss and an increased risk of mortality. The hyper-metabolic response is accompanied by severe catabolism and a loss of lean body mass as well as by a progressive decline of host defenses that impairs the immunological response. The protective functions of an intact skin are lost, leading to an increased risk of infection and protein loss. Therefore, adequate and timely provision of nutritional support is a vital component of the care of critically ill burn patients. In addition, nutrition therapy is important in burn care from the early resuscitation phase until the end of rehabilitation. A careful assessment of the nutritional state of burn patients is also important for reducing infection, recovery time, and long-term results. The nutritional therapy in severe burns has evidence-based specificities that help improve the clinical outcomes. The thumb 25 equation (25 kcal/kg of actual body weight) can be used as an alternative method to estimate the energy requirements of patients with major burns in cases where indirect calorimetry is unavailable or not applicable.

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Original Article
Determination of the Stress Factor Calculated from the Changes in the Measured Resting Energy Expenditure with Indirect Calorimetry in Patients Undergoing Pancreaticoduodenectomy
Seon Hyeong Kim, Baik Hwan Cho, Sook Bae Kim, Mi Jin Jeong, Hee Chul Yu
J Clin Nutr 2017;9(2):62-67.   Published online December 31, 2017
DOI: https://doi.org/10.15747/jcn.2017.9.2.62
AbstractAbstract PDFePub

Purpose

To predict the energy expenditure using the stress factor representing the ratio of the metabolic variation between pre-operation and post-operation in a pancreaticoduodenectomy (PD).

Methods

This was a prospective study conducted on 17 patients (11 males and 6 females) who underwent PD at Chonbuk National University Hospital between March 2010 and October 2011. The rest energy expenditure was measured by indirect calorimetry 1 day before and 3 days after surgery. The height, weight, and fat free mass were also measured 1 day before surgery.

Results

The mean measured rest energy expenditure 1 day before PD (mREEpre) and 3 days after PD (mREEpost) were significantly different (16.8±2.6 vs. 18.8±3.5 kcal/kg/d, P=0.0076). The stress factor, representing the ratio of the metabolic changes between pre- and post-PD, was 1.12±0.17. The recommended energy requirement for PD patients is estimated to be 23∼24 kcal/ideal body weight/d [determined from the measured preoperative rest energy expenditure (16.8±2.6 kcal/kg/d)×activity factor (1.2∼1.3)×stress factor (1.12)].

Conclusion

PD patients maintained a hypermetabolic status and the applicable stress factor was 1.12.

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