Clinical Applications of Indirect Calorimetry in the Intensive Care Setting

  • P. Singer
  • J. D. Cohen
Conference paper


Metabolic stress, a result of the rapidly changing and complex nature of severe illness, is common in critically ill patients. Although the importance of nutritional support has received increasing interest over recent years, this is usually provided in an empiric manner without necessarily taking into account the specific nutritional and, especially, energy requirements of a particular patient. These factors may be of considerable importance to patients in the intensive care unit (ICU). Under-nutrition, as indicated by a severely negative energy balance (>10000 kCal during the ICU stay) has been associated with a higher mortality in critically ill patients at risk for developing multiple organ failure (MOF) [1], while over-nutrition in artificially-fed patients especially with carbohydrates may increase postoperative length of stay, increase rates of infection and mortality [2]. It would, therefore, seem that an accurate daily and individualized evaluation of energy expenditure would be the best way to administer appropriate energy support in these metabolically brittle patients.


Systemic Inflammatory Response Syndrome Intensive Care Unit Stay Multiple Organ Failure Respiratory Quotient Indirect Calorimetry 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.


Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.


  1. 1.
    Barlett RH, Dechert RE, Mault JR, Ferguson SK, Kaiser AM, Erlandson EE (1982) Measurement of metabolism in multiple organ failure. Surgery 10: 771–779Google Scholar
  2. 2.
    Vo NM, Waycaster M, Acuff RV, Lefemine AA (1987) Effects of postoperative carbohydrate overfeeding. Am Surg 53: 632–635PubMedGoogle Scholar
  3. 3.
    van Lanschot JJB, Feenstra BWA, Vermeij CG, Bruining HA (1986) Calculation versus measurement of total energy expenditure. Crit Care Med 14: 981–985PubMedCrossRefGoogle Scholar
  4. 4.
    Flancbaum L, Choban PS, Sambucco S, Verducci J, Burge JC (1999) Comparison of indirect calorimetry, the Fick method, and predictive equations in estimating the energy requirements of critically ill patients. Am J Clin Nutr 69: 461–466PubMedGoogle Scholar
  5. 5.
    Coss-Bu JA, Jefferson LS, Walding D, David Y, Smith EO, Klish WJ (1998) Resting energy expenditure in children in a pediatric intensive care unit: comparison of Harris-Benedict andTalbot predictions with indirect calorimetry values. Am J Clin Nutr 67: 74–80PubMedGoogle Scholar
  6. 6.
    Casati A, Colombo S, Leggieri C, Muttini S, Capocasa T, Gallioli G (1996) Measured versus calculated energy expenditure in pressure support ventilated ICU patients. Minerva Anesthesiol 62: 165–170Google Scholar
  7. 7.
    McClave SA, Snider HL, Greene L, et al (1992) Effective utilization of indirect calorimetry during critical care. Nut Pract 9: 61–68Google Scholar
  8. 8.
    Singer P (1989) Measurement or estimation of energy Expenditure. In: Bursztein S, Elwyn DH, Askanazy J, Kinney JM (eds) Energy Metabolism, Indirect Calorimetry and Nutrition, 1st ed. Williams & Wilkins, Baltimore, pp 241–249Google Scholar
  9. 9.
    Verhoeven JJ, Hazelzet JA, van der Voort, Joosten KF (1998) Comparison of measured and predicted energy expenditure in mechanically ventilated children. Intensive Care Med 24: 464–468Google Scholar
  10. 10.
    Weissman C, Kemper M (1996) Metabolic measurements in the critically ill. Crit Care Clin 11: 169–197Google Scholar
  11. 11.
    Bursztein S (1989) The theoretical framework. In: Bursztein S, Elwyn DH, Askanazi J, Kinney JM (eds) Energy Metabolism, Indirect Calorimetry and Nutrition. Williams & Wilkins, Baltimore, pp 27–83Google Scholar
  12. 12.
    Bursztein S, Saphar P, Singer P, Elwyn DH (1989) A mathematical analysis of indirect calorimetry measurements in acutely ill patients. Am J Clin Nutr 50: 227–230PubMedGoogle Scholar
  13. 13.
    Brandi LS, Grana M, Mazzanti T, Giunta F, Natali A, Ferrannini E (1992) Energy expenditure and gas exchange measurement in postoperative patients: thermodilution vs indirect caloriemtry. Crit Care Med 20: 1273–1283PubMedCrossRefGoogle Scholar
  14. 14.
    McClave SA, Snider HL (1992) Use of indirect calorimetry in clinical nutrition. Nutr Clin Pract 7: 207–221PubMedCrossRefGoogle Scholar
  15. 15.
    Frankenfield DC, Wiles CE, Bagley S, Siegel JH (1994) Relationship between resting and total energy expenditure in injured and septic patients. Crit Care Med 22: 1796–1801PubMedGoogle Scholar
  16. 16.
    Weissman C, Kemper M, Elwyn DH, Askanazi J, Hyman AI, Kinney JM (1986) The energy expenditure of the mechanically ventilated critically ill patient: an analysis. Chest 89: 254–259PubMedCrossRefGoogle Scholar
  17. 17.
    Smyrnios NA, Curley FJ, Shaker KG (1997) Accuracy of 30-minute indirect calorimetry studies in predicting 24-hour energy expenditure in mechanically ventilated critically ill patients. JPEN J Parenter Enteral Nutr 21: 168–174PubMedCrossRefGoogle Scholar
  18. 18.
    Petros S, Engelmann L (2001) Validity of an abbreviated indirect calorimetry protocol for measurement of resting energy expenditure in mechanically ventilated and spontaneously breathing critically ill patients. Intensive Care Med 27: 1107–1109CrossRefGoogle Scholar
  19. 19.
    Bracco D, Chiolero R, Pasche O, Revelly P (1995) Failure in measuring gas exchange in the ICU. Chest 104: 1406–1410CrossRefGoogle Scholar
  20. 20.
    Ultman J, Bursztein S (1981) Analysis of error in the determination of respiratory gas exchange at varying FIO2. J Appl Physiol 50: 210–216PubMedGoogle Scholar
  21. 21.
    Tissot S, Delafosse B, Bernard O, Bouffard Y, Viale JP, Annat G (1995) Clinical validation of the Deltatrac monitoring system in mechanically ventilated patients. Crit Care Med 21: 149–153Google Scholar
  22. 22.
    Browning JA, Linberg SE, Turney SF, Chodoff P (1982) The effects of fluctuating FIO2 on metabolic measurements in mechanically ventilated patients. Crit Care Med 10: 82–85PubMedCrossRefGoogle Scholar
  23. 23.
    Henneberg S, Soderberg D, Groth T, Stjernsrom H, Wiklund L (1987) Carbon dioxide production during mechanical ventrilation. Crit Care Med 15: 8–13PubMedCrossRefGoogle Scholar
  24. 24.
    Mc Lellan S, Walsh T, Burdess A, Lee A (2002) Comparison between the Datex-Ohmeda MCOVX metabolic monitor and the Deltatrac II in mechanically ventilated patients. Intensive Care Med 28: 870–876CrossRefGoogle Scholar
  25. 25.
    Bruder N, Raynal M, Pellisier D, Courtinat C, Francois G (1998) Influence of body temperature, with or without sedation, on energy expenditure in severe head-injured patients. Crit Care Med 26: 568–572PubMedCrossRefGoogle Scholar
  26. 26.
    Just B, Delva E, Camus Y, Lienhard A (1992) Oxygen uptake during recovery following naloxone. Relationship with intraoperative heat loss. Anesthesiology 76: 60–64PubMedCrossRefGoogle Scholar
  27. 27.
    Benoventura J, Pittoni G, Michielan F, et al (1995) Energy expenditure (EE) and substrate utilization (SU) in the perioperative period in orthotopic live transplantation. Rocz Akad Med Bialymst 40: 195–208Google Scholar
  28. 28.
    Hart DW, Wolf SE, Chinkes DL, Lal SO, Ramzy PI, Herndon DN (2002) Beta-blockade and growth hormone after Burn. Ann Surg 236: 450–457PubMedCrossRefGoogle Scholar
  29. 29.
    Green CJ, Frazer RS, Underhill S, Maycock P, Fairhurst JA, Campbell IT (1992) Metabolic effects of dobutamine in normal man. Clin Sci 82: 77–83PubMedGoogle Scholar
  30. 30.
    Schaffartzik W, Sanft C, Scharfer JH, Spies C (2000) Different dosages of dobutamine in septic shock patients: determining oxygen consumption with a metabolic monitor integrated in a ventilator. Intensive Care Med 26: 1719–1722CrossRefGoogle Scholar
  31. 31.
    Pelaez Fernandez J, Asensio Martin MJ, Sanchez Sanchez M, Garcia de Lorenzo Mateos A, Jimenez Lendinez M (1999) Non-metabolic application of indirect calorimetry. Nutr Hosp 14: 23–30Google Scholar
  32. 32.
    Talpers SS, Romberger DJ, Gunce SB, Pingleton SK (1992) Nutritional associated increased carbon dioxide production: excess total calories vs high proportion of carbohydrate calories. Chest 102: 551–555PubMedCrossRefGoogle Scholar
  33. 33.
    Moriyama S, Okamoto K, Tabira Y, et al (1999) Evaluation of oxygen consumption and resting energy expenditure in critically ill patients with systemic inflammatory response syndrome. Crit Care Med 27: 2133–2136PubMedCrossRefGoogle Scholar
  34. 34.
    Kreymann G, Grosser S, Buggisch P, Gottschall C, Matthaei S, Grten H (1993) Oxygen consumption and resting metabolic rate in sepsis, sepsis syndrome and septic shock. Crit Care Med 21: 1012–1019PubMedCrossRefGoogle Scholar
  35. 35.
    Forsberg E, Soop M, Thorne A (1991) Energy expenditure and outcome in patients with multiple organ failure following abdominal injury. Intensive Care Med 17: 403–409PubMedCrossRefGoogle Scholar
  36. 36.
    Hart DW, Wolf SE, Herndon DN, et al (2002) Energy expenditure and caloric balance after burn: increased feeding leads to fat rather than lean mass accretion. Ann Surg 235: 152–161PubMedCrossRefGoogle Scholar
  37. 37.
    Kelly KM (1996) Does increasing oxygen delivery improve outcome? Yes. Crit Care Clin 12: 635–644PubMedCrossRefGoogle Scholar
  38. 38.
    Schaffartzik W, Sanft C, Schaefer JH, Spies C (2000) Different dosages of dobutamine in septic shock patients: determining oxygen consumption with a metabolic monitor integrated in a ventilator. Intensive Care Med 26: 1740–1746PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2003

Authors and Affiliations

  • P. Singer
  • J. D. Cohen

There are no affiliations available

Personalised recommendations