Measured and predicted caloric expenditure in the acutely ill

Predicted energy requirements calculated from the Harris-Benedict basal energy expenditure (BEE) formulas, and caloric allowances recommended by the Food and Nutrition Board National Research Council, were compared to metabolic expenditures measured by indirect calorimetry, using a feedback-controlled gas replenishment technique with a prototype device for the continuous determination of oxygen consumption (VO2) and carbon dioxide production (VCO2). In a group of 50 acutely ill surgical patients, predicted metabolic requirements based on ideal body weight (1.75 BEE) averaged 59% greater than metabolic expenditures measured by indirect calorimetry. Metabolic requirements based on actual body weight averaged 52% greater; recommended caloric allowances averaged 39% greater. Thus, accepted methods of predicting metabolic requirements significantly overestimated the caloric needs of these acutely ill patients. These results should encourage the development of new bedside equipment for measuring VO2 and VCO2, so that indirect calorimetry can be used to guide nutritional support in the clinical setting.