Changes Of Resting Energy Expenditure In Patients Receiving Mechanical Ventilation And How To Choose Prediction Formula

Objective:To monitor the changes of resting energy expenditure in patients receiving invasive mechanical ventilation during a week and compare the resting energy expenditure measured by indirect calorimetry(IC)with formulas in patients receiving mechanical ventilation.Find a most suitable prediction formula and analyze the applicability of this formula in different patients.To analyze the correlation of REE with traditional nutritional indicators and evaluate the relationship between resting energy expenditure and the severity of disease.Methods:60 mechanical ventilation patients were selected,measure the daily resting energy consumption value(MREE)by indirect energy calorimetry in 1 week of mechanical ventilation,and record the data.Calculate daily resting energy consumption(HBE?PSE?SWE?AE?IE)by Harris-Benedict formula?Penn State formula?Swinamer formula?ACCP formula?Ireton-Jones formula.Test the biochemical indexes of patients such as albumin?serum precursor protein?transferring,and calculate acute physiology and chronic health evaluation II score(APACHE? score).To analyze the changes of resting energy consumption of patients in a week by rank sum test,and evaluate the correlation of REE with albumin?serum precursor protein and transferring.The Bland-Altman method is used for the consistency of the formulas and indirect calorimetry.Select the formula with high consistency with indirect calorimetry,The patients were divided into two groups according to age,weight,sex and severity,and analyze the difference between the predicted value and MREE.Results : MREE did not exhibit significant differences among a week(P >0.05).Within the week of invasive mechanical ventilation,the mean daily MREE of the 60 patients was higher than the mean daily HBE(P<0.01).There did not exhibit significant differences between MREE with PSE among day l,2,and 5(P>0.05);the agreement was poor(R2=0.37).There did not exhibit significant differences between MREE with SWE among a week(P>0.05),the agreement was general(R2=0.41).The mean daily MREE was higher than the mean daily AE(P<0.05);There did not exhibit significant differences between MREE with AE on the first day(P>0.05).MREE was not related to the albumin?prealbumin and transferrin(P>0.05).The most appropriate formula is Swinamer formula.There did not exhibit significant differences between MREE with SWE(P>0.05)under the condition of different gender,weight,APACHE II score,except the patients whose age?65.There was a difference between MREE and SWE on the first day of mechanical ventilation in those patients(P<0.05);There did not exhibit significant differences between MREE with AE on the first.There was a low correlation between MREE and APACHE II score(r=-0.124,P=0.027).Conclusions:There was no significant change in the resting energy consumption of mechanical ventilation patients during a week.A single MREE can be measured in a week to represent a week's resting energy consumption.There was no correlation between resting energy consumption with albumin?prealbumin and transferrin.It is not significant to evaluate the resting energy consumption of patients with albumin?prealbumin and transferrin.There was a low correlation between MREE and APACHE II score.APACHE ? score cannot be used to evaluate patients resting energy expenditure.The accuracy of Swinamer formula is higher than other formulas.It is suggested that the energy consumption of mechanical ventilation patients should be evaluated by Swinamer formula when IC is not available.