Parenteral nutrition recommendations for critically ill obese patients

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“The Society of Critical Care Medicine and A.S.P.E.N. recommend that obese, critically ill patients receive 11–14 kcal/kg/d using actual body weight (ABW) or 22–25 kcal/kg/d using ideal body weight (IBW), because feeding these patients 50%-70% maintenance needs while administering high protein may improve outcomes” Mogensen et al (2015).

Reference:

Mogensen, K.M., Andrew, B.Y., Corona, J.C. and Robinson, M.K. (2015) Validation of the Society of Critical Care Medicine and American Society for Parenteral and Enteral Nutrition Recommendations for Caloric Provision to Critically Ill Obese Patients:A Pilot Study. Journal of Parenteral & Enteral Nutrition. April 20th. [epub ahead of print].

Abstract

Background: The Society of Critical Care Medicine and A.S.P.E.N. recommend that obese, critically ill patients receive 11–14 kcal/kg/d using actual body weight (ABW) or 22–25 kcal/kg/d using ideal body weight (IBW), because feeding these patients 50%-70% maintenance needs while administering high protein may improve outcomes. It is unknown whether these equations achieve this target when validated against indirect calorimetry, perform equally across all degrees of obesity, or compare well with other equations.

Methods: Measured resting energy expenditure (MREE) was determined in obese (body mass index [BMI] ≥30 kg/m2), critically ill patients. Resting energy expenditure was predicted (PREE) using several equations: 12.5 kcal/kg ABW (A.S.P.E.N.-Actual BW), 23.5 kcal/kg IBW (A.S.P.E.N.-Ideal BW), Harris-Benedict (adjusted-weight and 1.5 stress-factor), and Ireton-Jones for obesity. Correlation of PREE to 65% MREE, predictive accuracy, precision, bias, and large error incidence were calculated.

Results: All equations were significantly correlated with 65% MREE but had poor predictive accuracy, had excessive large error incidence, were imprecise, and were biased in the entire cohort (N = 31). In the obesity cohort (n = 20, BMI 30–50 kg/m2), A.S.P.E.N.-Actual BW had acceptable predictive accuracy and large error incidence, was unbiased, and was nearly precise. In super obesity (n = 11, BMI >50 kg/m2), A.S.P.E.N.-Ideal BW had acceptable predictive accuracy and large error incidence and was precise and unbiased.

Conclusions: SCCM/A.S.P.E.N-recommended body weight equations are reasonable predictors of 65% MREE depending on the equation and degree of obesity. Assuming that feeding 65% MREE is appropriate, this study suggests that patients with a BMI 30–50 kg/m2 should receive 11–14 kcal/kg/d using ABW and those with a BMI >50 kg/m2 should receive 22–25 kcal/kg/d using IBW.

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