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A Comparison Between Ventilation Modes: How Does Activity Level Affect Energy Expenditure Estimates?

From the ¹ Central Intensive Care Unit, Complexo Hospitalar Santa Casa, Porto Alegre, Brazil;² Pavilhão Pereira Filho, Complexo Hospitalar Santa Casa, and Centro Universitário FEEVALE and Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil; ³ School of Medicine, Fundação Federal Faculdade de Ciências Médicas de Porto Alegre, Porto Alegre, Brazil; and⁴ Pavilhão Pereira Filho, Complexo Hospitalar Santa Casa, and Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil.

Address correspondence to: Jorge A. Hoher, MD, PhD, Rua Anita Garibaldi, 1161, apto 502, Bairro Mont'Serrat, CEP 90.450-001, Porto Alegre, RS, Brazil; e-mail: jah{at}via-rs.net.

Background: An appropriate diet is essential to avoid complications of overfeeding or underfeeding in mechanically ventilated intensive care unit (ICU) patients. The paucity of consistent comparative data on energy expenditure for each ventilation mode complicates diet prescription. This study evaluates caloric requirements by comparing estimated and measured energy expenditure values for 2 ventilation modes. Methods: The energy expenditure of 100 ICU patients on assisted or controlled mechanical ventilation was measured by indirect calorimetry for 20 minutes. Values were calculated for a 24-hour period and compared with Harris-Benedict estimates multiplied by an injury factor and either multiplied or not by a 10% activity factor. Results: The mean Harris-Benedict estimate was 1858.87 ± 488.67 kcal/24 h when multiplied by an injury factor and a 10% activity factor. The mean energy expenditure values measured by indirect calorimetry were 1712.76 ± 491.95 kcal/24 h for controlled and 1867.33 ± 542.67 kcal/24 h for assisted ventilation. The mean total energy expenditure for assisted ventilation was 10.71% greater than the mean for controlled ventilation (P < .001). For controlled ventilation, Harris-Benedict results overestimated indirect calorimetry values by 141.10 ± 10 kcal/24 h (8.2%, P = .012) when multiplied by injury and activity factors, and underestimated values by 44.28 ± 28 kcal/24 h (2.6%, P = .399) when the equation was calculated without the activity factor. For assisted ventilation, Harris-Benedict results underestimated indirect calorimetry values by 198.84 ± 84 kcal/24 h (10.7%, P = .001) when not multiplied by the activity factor and by 13.46 kcal/24 h (0.75%) when the activity factor was used, but differences were not statistically significant (P = .829). Conclusions: Results suggest that a 10% activity factor should be adopted only for assisted ventilation because multiplication by an activity factor may lead to overfeeding of patients on controlled ventilation.

Key Words: energy expenditure • indirect calorimetry • mechanical ventilation • nutrition

Journal of Parenteral and Enteral Nutrition, Vol. 32, No. 2, 176-183 (2008)
DOI: 10.1177/0148607108314761


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