Evaluation of three indirect calorimetry devices in mechanically ventilated patients: Which device compares best with the Deltatrac II® ? A prospective observational study

• Published in: Clinical nutrition (Edinburgh, Scotland) Vol. 34; no. 1; pp. 60 - 65
• Main Authors: Graf, Séverine, Karsegard, Véronique Laurie, Viatte, Valérie, Heidegger, Claudia Paula, Fleury, Yvan, Pichard, Claude, Genton, Laurence
• Format: Journal Article
• Language: English
• Published: England Elsevier Ltd 01.02.2015
• Subjects: Adult; Aged; Calorimetry, Indirect - instrumentation; Critical Care; Energy expenditure; Energy Intake; Energy Metabolism; Female; Gastroenterology and Hepatology; Humans; Indirect calorimetry; Intensive care unit; Intensive Care Units; Male; Mechanical ventilation; Middle Aged; Nutritional Support - methods; Oxygen Consumption; Positive-Pressure Respiration; Prospective Studies; Pulmonary Gas Exchange; Respiration, Artificial; Energy expenditure; Indirect calorimetry; Mechanical ventilation; Intensive care unit
• ISSN: 0261-5614; 1532-1983
• DOI: 10.1016/j.clnu.2014.01.008

Summary Background & aims Indirect calorimetry (IC) is the gold standard to measure energy expenditure (EE) in hospitalized patients. The popular 30 year-old Deltatrac II® (Datex) IC is no more commercialized, but other manufacturers have developed new devices. This study aims at comparing for the first time simultaneously, two new IC, the CCM express® (Medgraphics) and the Quark RMR® (Cosmed) with the Deltatrac II® to assess their potential use in intensive care unit (ICU) patients. Methods ICU patients on mechanical ventilation, with positive end-expiratory pressure <9 cm H2 O and fraction of inspired oxygen <60%, underwent measurements by the three IC simultaneously connected during 20 min to the ventilator (Evita XL® , Dräger). Patients' characteristics, VO2 consumption, VCO2 production, respiratory quotient and EE were recorded. Data were presented as mean (SD) and compared by linear regression, repeated measure one-way ANOVA and Bland & Altman diagrams. Results Forty patients (23 males, 60(17) yrs, BMI 25.4(7.0) kg/m2 ) were included. For the Deltatrac II® , VO2 was 227(61) ml/min, VCO2 189(52) ml/min and EE 1562(412) kcal/d. VO2, VCO2, and EE differed significantly between Deltatrac II® and CCM express® ( p  < 0.001), but not between Deltatrac II® and Quark RMR® . For EE, diagrams showed a mean difference (2SD) of 25.2(441) kcal between Deltatrac II® vs. the Quark RMR® , and −273 (532) kcal between Deltatrac II® vs CCM express®. Conclusion Quark RMR® compares better with Deltatrac II® than CCM express® , but it suffers an EE variance of 441 kcal, which is not acceptable for clinical practice. New indirect IC should be further improved before recommending their clinical use in ICU.