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Critical Care |

Weight Based Prediction Equations Result in Hypocaloric Feeding of Obese Patients

Michael Vest, DO; Jillian Trabulsi, PhD; Patty McGraw, RN; Mary Shapiro, MS; James Halbert, DPT; Paul Kolm, PhD; Claudine Jurkovitz, MD
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Christiana Care Healthcare System, Newark, DE


Chest. 2015;148(4_MeetingAbstracts):232A. doi:10.1378/chest.2251699
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Abstract

SESSION TITLE: Critical Care Posters I

SESSION TYPE: Original Investigation Poster

PRESENTED ON: Wednesday, October 28, 2015 at 01:30 PM - 02:30 PM

PURPOSE: Enteral nutritional therapy is routinely administered to obese critically ill patients but there is limited data on the optimal approach to feeding. Some authors have advocated hypocaloric, high protein feedings. Our practice has been to utilize the American Society of Parenteral and Enteral Nutrition (ASPEN) equation of 25-30 kilocalories (kcal) per kilogram (kg) of ideal body weight (IBW) in obese patients using a high protein formula. The accuracy of this practice has seldom been tested. We conducted an interim analysis of 17 patients participating in a prospective cohort study of energy expenditure in obese mechanically ventilated patients receiving enteral nutrition.

METHODS: Mechanically ventilated patients in the medical, neurologic and cardiac intensive care units with a body mass index (BMI) ≥ 30 were eligible for enrollment. Patients were excluded if they could not receive tube feeding with the standard formula (i.e., severe kidney failure), had known high metabolic demands (traumatic brain injury or surgery patients), liver failure, or pregnancy. Enrolled patients underwent indirect calorimetry to measure resting energy expenditure (REE), and had 24 hour urine collected for urea nitrogen assessment.

RESULTS: Of the 17 patients, 29.4%were men, mean age was 57 years (±14) , mean BMI was 39.2 kg/m2 (±15.1). All of the patients were white. For the 10 patients who underwent indirect calorimetry, the 25 kcal/kg IBW formula resulted in a caloric goal that was a mean of 56% (±12%) of measured REE, while the 30 kcal/kg IBW formula resulted in a caloric goal of 65% (±15%) of measured REE. For the 12 patients who had 24 hour urine collected, the mean urine urea nitrogen was 8.16 g/24 hours (normal range 12-20 g/24 hours).

CONCLUSIONS: Use of 25-30 kcal/kg IBW to determine calories for feeding obese critically ill patients results in hypocaloric feeding in the range recommended by some authors. The low urine urea nitrogen found in our obese critically ill patients suggest negative protein balance; hence, these patients may benefit from additional protein supplementation.

CLINICAL IMPLICATIONS: While many authors have recommended the use of indirect calorimetry and more complex formulas, such as the Penn State Equation, to determine caloric needs of this patient population, our preliminary data suggest that the ASPEN equation may be adequate if the clinician is targeting hypocaloric feedings. However, our data also suggest that additional protein supplementation may be needed.

DISCLOSURE: The following authors have nothing to disclose: Michael Vest, Jillian Trabulsi, Patty McGraw, Mary Shapiro, James Halbert, Paul Kolm, Claudine Jurkovitz

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obesity

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