Optimal nutritional therapy is important to improve outcome in critically ill population in an intensive care unit (ICU). Although indirect calorimetry (IC) is currently a gold standard for resting energy expenditure (REE) measurement, yet it is still not routinely used in the ICU. A total of 146 mechanically ventilated patients were randomised to receive enteral nutrition (EN) with energy targeted based on continuous indirect calorimetry (IC) measurements (IC group, n=73) or according to 25 kcal/kg/day (SWB group, n=73). Patient characteristics were equally distributed and the IC group showed lower mean measured REE (1668.1 + 231.7 vs 1512.0 + 177.1 kcal, p<0.001). Results also showed a significant deficiency in the daily (-148.8 + 105.1 vs. -4.99 + 44.0 kcal, p<0.001) and total cumulative energy balances (-1165.3 + 958.1 vs. 46.5 + 369.5 kcal, p<0.001) in the SWB group as compared to the IC group. From the Kaplan-Meier survival analysis, we found that ICU mortality was significantly lower in the IC group with better survival probability compared to the SWB group (log-rank test, p = 0.03). However, both groups showed comparable results in terms of ICU length of stay, duration of mechanical ventilation and incidence of feeding intolerance. In conclusion, this study showed that tightly supervised nutritional therapy based on continuous IC measurement provides significantly less mean daily and cumulative energy deficits as well as significantly reduced ICU mortality rate.
A Comparison between Continuous Indirect Calorimetry and Single Weight-Based Formula in Estimating Resting Energy Expenditure in Nutritional Therapy: A Prospective Randomized Controlled Study in Critically Ill Patients
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Nutrisi yang optimum adalah penting dalam kalangan pesakit kritikal di unit rawatan rapi. Alatan kalorimetri tidak langsung kini merupakan penilaian yang piawai untuk mengukur keperluan tenaga ketika rehat pada pesakit kritikal. Untuk kajian ini, sebanyak 146 pesakit yang memerlukan alatan pernafasan di unit rawatan rapi diasingkan secara rawak kepada 2 kumpulan samada untuk menerima nutrisi berdasarkan pengukuran kalorimetri tidak langsung secara berterusan (kumpulan kajian, n=73) atau mengikut kiraan berat badan 25 kcal/kg/hari (kumpulan kawalan, n=73). Daripada keputusan kajian ini, kita mendapati bahawa tiada perbezaan dalam pemboleh ubah asas di antara kedua-dua kumpulan. Sementara itu, kita juga mendapati bahawa tenaga ketika rehat pada kumpulan kajian adalah lebih rendah berbanding dengan kumpulan kawalan (1668.1 + 231.7 vs 1512.0 + 177.1 kcal, p<0.001). Keseimbangan tenaga pesakit, samada harian (-148.8 + 105.1 vs. -4.99 + 44.0 kcal, p<0.001) atau kumulatif (-1165.3 + 958.1 vs. 46.5 + 369.5 kcal, p<0.001), adalah lebih seimbang dalam kumpulan kajian berbanding dengan kumpulan kawalan. Daripada kajian graf Kaplan-Meier, kita mendapati bahawa kematian di unit rawatan rapi adalah lebih rendah di dalam kumpulan kajian (log-rank test, p=0.03) tetapi tiada perbezaan dalam kalangan kumpulan kajian dan kumpulan kawalan dalam tempoh tinggal di unit rawatan rapi, tempoh keperluan alatan pernafasan dan kejadian intoleransi makanan. Kajian ini telah menyimpulkan bahawa terapi pemakanan yang dikawal secara ketat berdasarkan pengukuran kalorimetri tidak langsung dapat mencapai keseimbangan tenaga yang signifikan dan juga pengurangan kadar kematian di unit rawatan rapi.
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