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Nutrition. 2018 Nov;55-56:71-75. doi: 10.1016/j.nut.2018.05.001. Epub 2018 May 9.

Should we calculate or measure energy expenditure? practical aspects in the ICU.

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Division of Clinical Nutrition, Department of Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand. Electronic address:
Department of General Intensive Care, Rabin Medical Center, Petah Tikva and Sackler School of Medicine, Tel Aviv University, Israel.


Indirect calorimetry is currently a gold standard of resting energy expenditure (REE) assessment in critically ill patients. Many predictive equations of energy expenditure have been proved to imprecisely predict REE and lead to under- or overfeeding. The benefits of indirect calorimetry-guided nutrition therapy rather than calculation-based strategy have been demonstrated in randomized controlled trials. To minimize energy debt in the intensive care unit, we support early enteral feeding. REE should be measured as soon as the patient's conditions allow and the target of delivered calorie should be around 0.7 to 1 of measured REE to avoid overfeeding. The supplemental parenteral nutrition should be prescribed to close the caloric gap if the goal is not reached by enteral nutrition alone.


Critical care; Energy balance; Energy expenditure; Enteral nutrition; Indirect calorimetry; Parenteral nutrition


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