Measured Energy Expenditure Compared With Best-Practice Recommendations for Obese, Critically Ill Patients—A Prospective Observational Study

Background: This study aimed to compare recommendations in the American Society for Parenteral and Enteral Nutrition (ASPEN) Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient with measured energy expenditure in obese, critically ill adults. Methods: After enrollment, measured energy expenditure was attempted at baseline and twice weekly to extubation or day 14. Data are reported as median [interquartile range]. Results: Twenty patients were included. The median baseline and subsequent measured energy expenditures were 2438 [1807–2703] kcal and 2919 [2318–3362] kcal, respectively. Baseline measured energy expenditures were −491 [−788 to −323] kcal lower than subsequent measurements, and week 1 measurements were lower than those of week 2. The median bias between the guideline recommendation of 11–14 kcal/kg of actual body weight and measured expenditure at baseline was −950 [−1254 to −595] kcal/d and −1618 [−1820 to −866] kcal/d at subsequent measurements. Conclusion: Clinically significant variation was observed between measured expenditure and guideline recommendations at all time points.