Measured Energy Expenditure Using Indirect Calorimetry in Post-Intensive Care Unit Hospitalized Survivors: A Comparison with Predictive Equations.

Actual energy needs after a stay in intensive care units (ICUs) are unknown. The aims of this observational study were to measure the energy expenditure (mEE) of ICU survivors during their post-ICU hospitalization period, and to compare this to the estimations of predictive equations (eEE). Survivors of an ICU stay ≥ 7 days were enrolled in the general ward during the first 7 days after ICU discharge. EE was measured using the Q-NRG calorimeter in canopy mode. This measure was compared to the estimated EE using the Harris-Benedict (HB) equation multiplied by a 1.3 stress factor, the Penn-State (PS) equation or the 30 kcal weight-based (WB) equation. A total of 55 adults were included (67.3% male, age 60 (52-67) y, body mass index 26.1 (22.2-29.7) kg/m 2 ). Indirect calorimetry was performed 4 (3-6) d after an ICU stay of 12 (7-16) d. The mEE was 1682 (1328-1975) kcal/d, corresponding to 22.9 (19.1-24.2) kcal/kg/day. The eEE values derived using HB and WB equations were significantly higher than mEE: 3048 (1805-3332) and 2220 (1890-2640) kcal/d, respectively (both p < 0.001). There was no significant difference between mEE and eEE using the PS equation: 1589 (1443-1809) kcal/d ( p = 0.145). The PS equation tended to underestimate mEE with a bias of -61.88 kcal and a wide 95% limit of agreement (-717.8 to 594 kcal). Using the PS equation, agreement within 15% of the mEE was found in 32/55 (58.2%) of the patients. In the present cohort of patients who survived a prolonged ICU stay, mEE was around 22-23 kcal/kg/day. In this post-ICU hospitalization context, none of the tested equations were accurate in predicting the EE measured by indirect calorimetry.