Expanding the use of indirect calorimetry in critical care settings to determine the impact on nutrition interventions and compare to predictive equations: A quality improvement initiative.

BACKGROUND: Critical illness leads to a hypermetabolic state, increasing the risk of malnutrition, infectious complications, and poor outcomes. Current guidelines recommend early enteral nutrition (EN) support; however, determining appropriate caloric provision remains challenging. Indirect calorimetry (IC) is the gold standard for assessing resting energy expenditure (REE) in critically ill patients, yet its use is limited due to various constraints.

METHODS: A quality improvement initiative was launched at the Mayo Clinic to increase the use of IC among critically ill adults. The primary objective was to compare REE measurements obtained via IC with those predicted using common predictive equations and weight-based nomograms. The study involved a diverse cohort of patients in the intensive care unit (ICU), focusing on the accuracy and applicability of caloric needs assessment.

RESULTS: Preliminary findings indicated substantial discrepancies between REE determined by IC and values derived from predictive equations, with numerous instances of underfeeding identified. The use of weight-based nomograms also demonstrated variability in accuracy compared to IC measurements, highlighting the potential risks of relying on these traditional methods. IC measurement resulted in significant adjustment of nutrition therapy plan.

CONCLUSIONS: This quality improvement initiative highlights the importance of integrating indirect calorimetry into routine practice for critically ill patients, as demonstrated through this investigation. Enhanced utilization of IC may lead to more accurate caloric provision, ultimately improving patient outcomes and reducing the incidence of nutrition-related complications in the ICU setting. Further studies are required to refine protocols for broader implementation in clinical practice.