Indirect Calorimetry in Mechanically Ventilated Patients: A Prospective, Randomized, Clinical Validation of 2 Devices Against a Gold Standard

Matilde Jo Allingstrup; Jens Kondrup; Anders Perner; Poul Lunau Christensen; Tom Hartvig Jensen; Steen Winther Henneberg

doi:10.1177/0148607116662000

Indirect Calorimetry in Mechanically Ventilated Patients: A Prospective, Randomized, Clinical Validation of 2 Devices Against a Gold Standard

Matilde Jo Allingstrup^*, Jens Kondrup, Anders Perner, Poul Lunau Christensen, Tom Hartvig Jensen, Steen Winther Henneberg

^*Corresponding author for this work

Department of Clinical Medicine

10 Citations (Scopus)

Abstract

Background and Aims: The 2 currently available indirect calorimeters, CCM Express Indirect Calorimeter (MedGraphics, St Paul, MN) and Quark RMR ICU Indirect Calorimeter (COSMED, Rome, Italy), have not been validated against a gold standard in mechanically ventilated patients. Our aim was to do so using a gold-standard, modified Tissot bell-spirometer method in mechanically ventilated patients who were hemodynamically, respiratory, and metabolically stable. Methods: We studied 30 patients undergoing general anesthesia and major gynecological surgery. We measured oxygen consumption ((Formula presented.) O₂) and resting energy expenditure (REE) in a randomized, sequential, crossover design with double determination of each device. Results: Compared with the modified Tissot bell-spirometer, the CCM Express Indirect Calorimeter demonstrated a mean Δ-REE of +361 kcal/d, corresponding to a 31% overestimation of energy requirements. Bland-Altman analysis for REE showed a mean (SD) bias of 384 (124) with limits of agreement 142–627 kcal/d. QUARK RMR ICU demonstrated a mean Δ-REE of 81 kcal/d, corresponding to a 7% overestimation of energy requirements. Bland-Altman plot analysis showed a mean (SD) bias of 77 (167) with limits of agreement −249 to 404 kcal/d. Conclusions: The QUARK RMR ICU Indirect Calorimeter compared better with the gold standard for values of (Formula presented.) O₂ and REE than did the CCM Express Indirect Calorimeter in mechanically ventilated patients who were circulatory and respiratory stable. Both indirect calorimeters had low precision.

Original language	English
Journal	Journal of Parenteral and Enteral Nutrition
Volume	41
Issue number	8
Pages (from-to)	1272-1277
Number of pages	6
ISSN	0148-6071
DOIs	https://doi.org/10.1177/0148607116662000
Publication status	Published - Nov 2017

Keywords

indirect calorimetry
intensive care
mechanical ventilation
oxygen consumption
resting energy expenditure (REE)
validation

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Indirect Calorimetry in Mechanically Ventilated Patients : A Prospective, Randomized, Clinical Validation of 2 Devices Against a Gold Standard. / Allingstrup, Matilde Jo; Kondrup, Jens; Perner, Anders et al.

In: Journal of Parenteral and Enteral Nutrition, Vol. 41, No. 8, 11.2017, p. 1272-1277.

Research output: Contribution to journal › Journal article › Research › peer-review

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title = "Indirect Calorimetry in Mechanically Ventilated Patients: A Prospective, Randomized, Clinical Validation of 2 Devices Against a Gold Standard",

abstract = "Background and Aims: The 2 currently available indirect calorimeters, CCM Express Indirect Calorimeter (MedGraphics, St Paul, MN) and Quark RMR ICU Indirect Calorimeter (COSMED, Rome, Italy), have not been validated against a gold standard in mechanically ventilated patients. Our aim was to do so using a gold-standard, modified Tissot bell-spirometer method in mechanically ventilated patients who were hemodynamically, respiratory, and metabolically stable. Methods: We studied 30 patients undergoing general anesthesia and major gynecological surgery. We measured oxygen consumption ((Formula presented.) O2) and resting energy expenditure (REE) in a randomized, sequential, crossover design with double determination of each device. Results: Compared with the modified Tissot bell-spirometer, the CCM Express Indirect Calorimeter demonstrated a mean Δ-REE of +361 kcal/d, corresponding to a 31% overestimation of energy requirements. Bland-Altman analysis for REE showed a mean (SD) bias of 384 (124) with limits of agreement 142–627 kcal/d. QUARK RMR ICU demonstrated a mean Δ-REE of 81 kcal/d, corresponding to a 7% overestimation of energy requirements. Bland-Altman plot analysis showed a mean (SD) bias of 77 (167) with limits of agreement −249 to 404 kcal/d. Conclusions: The QUARK RMR ICU Indirect Calorimeter compared better with the gold standard for values of (Formula presented.) O2 and REE than did the CCM Express Indirect Calorimeter in mechanically ventilated patients who were circulatory and respiratory stable. Both indirect calorimeters had low precision.",

keywords = "indirect calorimetry, intensive care, mechanical ventilation, oxygen consumption, resting energy expenditure (REE), validation",

author = "Allingstrup, {Matilde Jo} and Jens Kondrup and Anders Perner and Christensen, {Poul Lunau} and Jensen, {Tom Hartvig} and Henneberg, {Steen Winther}",

year = "2017",

month = nov,

doi = "10.1177/0148607116662000",

language = "English",

volume = "41",

pages = "1272--1277",

journal = "Journal of Parenteral and Enteral Nutrition",

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T1 - Indirect Calorimetry in Mechanically Ventilated Patients

T2 - A Prospective, Randomized, Clinical Validation of 2 Devices Against a Gold Standard

AU - Allingstrup, Matilde Jo

AU - Kondrup, Jens

AU - Perner, Anders

AU - Christensen, Poul Lunau

AU - Jensen, Tom Hartvig

AU - Henneberg, Steen Winther

PY - 2017/11

Y1 - 2017/11

N2 - Background and Aims: The 2 currently available indirect calorimeters, CCM Express Indirect Calorimeter (MedGraphics, St Paul, MN) and Quark RMR ICU Indirect Calorimeter (COSMED, Rome, Italy), have not been validated against a gold standard in mechanically ventilated patients. Our aim was to do so using a gold-standard, modified Tissot bell-spirometer method in mechanically ventilated patients who were hemodynamically, respiratory, and metabolically stable. Methods: We studied 30 patients undergoing general anesthesia and major gynecological surgery. We measured oxygen consumption ((Formula presented.) O2) and resting energy expenditure (REE) in a randomized, sequential, crossover design with double determination of each device. Results: Compared with the modified Tissot bell-spirometer, the CCM Express Indirect Calorimeter demonstrated a mean Δ-REE of +361 kcal/d, corresponding to a 31% overestimation of energy requirements. Bland-Altman analysis for REE showed a mean (SD) bias of 384 (124) with limits of agreement 142–627 kcal/d. QUARK RMR ICU demonstrated a mean Δ-REE of 81 kcal/d, corresponding to a 7% overestimation of energy requirements. Bland-Altman plot analysis showed a mean (SD) bias of 77 (167) with limits of agreement −249 to 404 kcal/d. Conclusions: The QUARK RMR ICU Indirect Calorimeter compared better with the gold standard for values of (Formula presented.) O2 and REE than did the CCM Express Indirect Calorimeter in mechanically ventilated patients who were circulatory and respiratory stable. Both indirect calorimeters had low precision.

AB - Background and Aims: The 2 currently available indirect calorimeters, CCM Express Indirect Calorimeter (MedGraphics, St Paul, MN) and Quark RMR ICU Indirect Calorimeter (COSMED, Rome, Italy), have not been validated against a gold standard in mechanically ventilated patients. Our aim was to do so using a gold-standard, modified Tissot bell-spirometer method in mechanically ventilated patients who were hemodynamically, respiratory, and metabolically stable. Methods: We studied 30 patients undergoing general anesthesia and major gynecological surgery. We measured oxygen consumption ((Formula presented.) O2) and resting energy expenditure (REE) in a randomized, sequential, crossover design with double determination of each device. Results: Compared with the modified Tissot bell-spirometer, the CCM Express Indirect Calorimeter demonstrated a mean Δ-REE of +361 kcal/d, corresponding to a 31% overestimation of energy requirements. Bland-Altman analysis for REE showed a mean (SD) bias of 384 (124) with limits of agreement 142–627 kcal/d. QUARK RMR ICU demonstrated a mean Δ-REE of 81 kcal/d, corresponding to a 7% overestimation of energy requirements. Bland-Altman plot analysis showed a mean (SD) bias of 77 (167) with limits of agreement −249 to 404 kcal/d. Conclusions: The QUARK RMR ICU Indirect Calorimeter compared better with the gold standard for values of (Formula presented.) O2 and REE than did the CCM Express Indirect Calorimeter in mechanically ventilated patients who were circulatory and respiratory stable. Both indirect calorimeters had low precision.

KW - indirect calorimetry

KW - intensive care

KW - mechanical ventilation

KW - oxygen consumption

KW - resting energy expenditure (REE)

KW - validation

U2 - 10.1177/0148607116662000

DO - 10.1177/0148607116662000

M3 - Journal article

C2 - 27488830

AN - SCOPUS:85035023590

SN - 0148-6071

VL - 41

SP - 1272

EP - 1277

JO - Journal of Parenteral and Enteral Nutrition

JF - Journal of Parenteral and Enteral Nutrition

IS - 8

ER -

Indirect Calorimetry in Mechanically Ventilated Patients: A Prospective, Randomized, Clinical Validation of 2 Devices Against a Gold Standard

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Keywords

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