Predictive equations over-estimate the resting energy expenditure in spinal cord injured patients who are dependent on invasive ventilation support: a case series.
Wong S, Subong P, Ahmed W, Derry F, Graham A, Saif M, Belci M
National Spinal Injuries Centre, Stoke Mandeville Hospital, Aylesbury, , United kingdom
Objectives: The impact of mechanical ventilation on energy expenditure after spinal cord injury (SCI) is limited. Commonly used predictive equations tend to overestimate resting metabolic rate (RMR) by 5-32.4%1. The objective of this case-series is to (1) measured 15-minutes energy expenditure to determine 24-hours RMR (m-RMR) using QUARK indirect calorimeter (IC); (2) compare the m-RMR with estimated RMR (e-RMR) using four commonly used predictive equations (Harris-Benedicts2, Mifflin-St. Jeor3, Oxford-Henry4 and Schofield5).
Methods: We measured the RMR of two SCI patients (two female) with complete tetraplegic (AIS: A) SCI (C2 and C4) SCI patients (mean age: 76) twice during a week interval using an IC with two sampling flow setting in September 2017.
Results: The mean (+ SD) of all mRMRs was 1079 + 106 kcal/d. The measurement with different ventilator’s flow settings and at different time instances provided similar results. The mean of mRMR was 31.3% lower, as compared to the mean calculated with four different eRMR using predictive equations. All four predictive equations were overestimated RMR in tetraplegic patients by 4.1 to 55% (Harris-Benedict: 28.8-53.2%; Mifflin-St. Jeor: 6.9-41.6%; Oxford-Henry: 4.1-55% and; Schofiled: 6-55%).
Conclusion: Although predictive equations are sensitive to estimate RMR in able-bodied control, there is high variability in SCI patients, especially in tetraplegic patients who require mechanical ventilation. The use of predictive equations may lead to mis-estimation of energy requirements. High cervical SCI patients may require prolonged artificial ventilation, their nutrition support should be based on individual measurements. However further study is needed due to the small number of subjects. Development of validated RMR equation in SCI population is warranted.
1. Wong S et al (2016) Proc Nutr Soc 75 (OCE1), E25.
2. Harris JA & Benedict FG (1919) A Biometric Study of Basal Metabolism in Man,
publication no. 270. Washington DC: Carnegie Institute of Washington.
3. Mifflin MD, et al (1990) Am J Clin Nutr 51, 241-247.
4. Henry C (2005) Public Health Nutr 8, 1133-1152.
5. Schofield W, et al (1985) Hum Nutr: Clin Nutr 39, 1-96.
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