Acute and Critical Care

Original Articles

Nutrition
Estimating resting energy expenditure in critically ill patients: a retrospective exploratory comparison of predictive equations and Fick-derived Weir estimates in Italy: Antonio Romanelli, Alessandro Calicchio, Salvatore Palmese, Sabato Pascarella, Bruna Pisapia, Renato Gammaldi; Acute Crit Care. 2025;40(3):491-504. Published online August 29, 2025; DOI: https://doi.org/10.4266/acc.001300; Correction in: Acute Crit Care 2025;40(4):642

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Background
Resting energy expenditure (REE) estimation is crucial in critically ill patients. While indirect calorimetry (IC) is the gold standard, its limited availability often necessitates alternative methods. In this exploratory study, we compared the accuracy of the stress factor-corrected Harris-Benedict (cREEHB) and weight-based (REEWB) equations with the Weir equation (REEW) using oxygen consumption (VO₂) and carbon dioxide production (VCO₂) estimated via the Fick principle. Methods: We included patients admitted to the intensive care unit (ICU) between January and August 2024, and computed cREEHB, REEWB (22.5 kcal/kg/day), and REEW. Agreement between methods was assessed through Bland-Altman analysis. Sensitivity and correlation analyses identified bias determinants. Multiple linear regression explored associations of REEW with VO₂, VCO₂, and cardiac output (CO). Results: The sample size consisted of 30 patients. No correlation was found between REEW and cREEHB (r=0.177, P=0.349) or REEWB (r=-0.006, P=0.975). Compared to REEW, cREEHB underestimated REE (mean bias, –47.9 kcal), while REEWB overestimated it (mean bias, +9.7 kcal). CREEHB bias was associated with sex, height, body surface area (BSA), VO2, and respiratory quotient (RQ); REEWB bias was influenced by actual body weight, body mass index, BSA, VO2, and RQ (all P<0.05). Multiple linear regression analysis showed that REEW was influenced by VO2 (P<0.001) and VCO2 (P<0.001) but not by CO (P=0.164). Conclusions: Predictive equations may not be interchangeable in ICU settings, leading to inaccurate metabolic assessments. Studies incorporating IC as a reference are needed to determine the most reliable approach for estimating REE and optimizing nutritional support in critical patients.

Citations

Citations to this article as recorded by

Interpreting Resting Energy Expenditure in Critically Ill Patients with Obesity: Clinical Impact of Weight Adjustment
Sebastián Chapela, Jaen Cagua-Ordoñez, Juan Marcos Parise-Vasco, Daniel Tettamanti Miranda, Claudia Kecskes, Natalia Llobera, Jesica Asparch, Mariana Rella, María Victoria Peroni, Martha Montalvan, María Jimena Reberendo, Facundo Gutierrez, Mario O. Pozo,
Journal of Clinical Medicine.2026; 15(5): 1677. CrossRef
Correction: Estimating resting energy expenditure in critically ill patients: a retrospective exploratory comparison of predictive equations and Fick-derived Weir estimates in Italy
Antonio Romanelli, Alessandro Calicchio, Salvatore Palmese, Sabato Pascarella, Bruna Pisapia, Renato Gammaldi
Acute and Critical Care.2025; 40(4): 642. CrossRef
Response to “Correction and clarification on reported percentage error of estimated continuous cardiac output”
Antonio Romanelli, Alessandro Calicchio, Salvatore Palmese, Sabato Pascarella, Bruna Pisapia, Renato Gammaldi
Acute and Critical Care.2025; 40(4): 640. CrossRef
Correction and clarification on reported percentage error of estimated continuous cardiac output
Ryoichi Ochiai
Acute and Critical Care.2025; 40(4): 638. CrossRef
Phase-Related Resting Energy Expenditure in Critically Ill Adults: Metabolic Phenotypes and Determinants of Weight-Normalized Indices—A Retrospective Study
Sebastián Chapela, Jaen Cagua-Ordoñez, Jaime Angamarca-Iguago, Daniel Tettamanti, Claudia Kecskes, Jesica Asparch, Facundo Javier Gutierrez, Natalia Llobera, Mariana Rella, Martha Montalván, María Jimena Reberendo, Mario Omar Pozo, Ludwig Álvarez-Córdova,
Journal of Clinical Medicine.2025; 15(1): 237. CrossRef

Nutrition
Effect of nutrition support team on 28-day mortality in Korean patients with acute respiratory failure: Inhan Lee, Junghyun Kim, Mihyun Ku, Yurim Choi, Sohyun Park, Jihyeon Bang, Joohae Kim; Acute Crit Care. 2025;40(2):313-321. Published online April 28, 2025; DOI: https://doi.org/10.4266/acc.003312

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Abstract PDF: Background
Providing optimal nutrition to patients with acute respiratory failure is difficult because nutritional requirements vary according to disease severity and comorbidities. In 2021, the National Medical Center initiated a protocol for screening upon admission and regular monitoring by a multidisciplinary nutritional support team (NST), for all patients in the medical intensive care unit (ICU). This study aimed to evaluate the effects of routine NST monitoring and active intervention on the clinical outcomes of patients with acute respiratory failure.
Methods
Patients with acute respiratory failure requiring high-flow nasal cannula, non-invasive ventilation, or mechanical ventilation were included. The primary outcome was 28-day mortality after ICU admission. Secondary outcomes included the supplied/target calorie ratio, supplied/target protein ratio on day 7, and complications.
Results
In total, 152 patients were included in the analysis. The patients were divided into a pre-monitoring (n=96) and post-monitoring groups (n=56). More patients in the post-monitoring group received NST intervention and had earlier initiation of enteral feeding. In survival analysis, 28-day mortality was significantly lower in post-monitoring group (adjusted hazard ratio, 0.42; 95% CI, 0.24–0.74). The ratio of achievement for required calories and protein on day 7 was higher, but not significantly, in the post-monitoring group. No significant differences were observed in the incidence of complications.
Conclusions
Regular NST monitoring in the ICU could have contributed to a reduced risk of 28-day mortality in critically ill patients with acute respiratory failure.

Meta-analysis
Effect of a nutritional support protocol on enteral nutrition and clinical outcomes of critically ill patients: a retrospective cohort study: Heemoon Park, Sung Yoon Lim, Sebin Kim, Hyung-Sook Kim, Soyeon Kim, Ho Il Yoon, Young-Jae Cho; Acute Crit Care. 2022;37(3):382-390. Published online July 19, 2022; DOI: https://doi.org/10.4266/acc.2022.00220

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Abstract PDF Supplementary Material

Background
Enteral nutrition (EN) supply within 48 hours after intensive care unit (ICU) admission improves clinical outcomes. The “new ICU evaluation & development of nutritional support protocol (NICE-NST)” was introduced in an ICU of tertiary academic hospital. This study showed that early EN through protocolized nutritional support would supply more nutrition to improve clinical outcomes.
Methods
This study screened 170 patients and 62 patients were finally enrolled; patients who were supplied nutrition without the protocol were classified as the control group (n=40), while those who were supplied according to the protocol were classified as the test group (n=22).
Results
In the test group, EN started significantly earlier (3.7±0.4 days vs. 2.4±0.5 days, P=0.010). EN calorie (4.0±1.0 kcal/kg vs. 6.7±0.9 kcal/kg, P=0.006) and protein (0.17±0.04 g/kg vs. 0.32±0.04 g/kg, P=0.002) supplied were significantly higher in the test group. Although EN was supplied through continuous feeding in the test group, there was no difference in complications such as feeding hold due to excessive gastric residual volume or vomit, and hyper- or hypo-glycemia between the two groups. Hospital mortality was significantly lower in the group that started EN within 1.5 days (42.9% vs. 11.8%, P=0.018). The proportion of patients who started EN within 1.5 days was higher in the test group (40.9% vs. 17.5%, P=0.044).
Conclusions
The NICE-NST may improve EN supply and mortality of critically ill patients without increasing complications.

Citations

Citations to this article as recorded by

Effect of nutrition support team on 28-day mortality in Korean patients with acute respiratory failure
Inhan Lee, Junghyun Kim, Mihyun Ku, Yurim Choi, Sohyun Park, Jihyeon Bang, Joohae Kim
Acute and Critical Care.2025; 40(2): 313. CrossRef
Nutritional support for patients with abdominal surgical pathology: the view of a surgeon and an anesthesiologist — opponents or allies?
Natalya P. Shen, Svetlana Yu. Mukhacheva
Clinical nutrition and metabolism.2023; 3(4): 181. CrossRef
Provision of Enteral Nutrition in the Surgical Intensive Care Unit: A Multicenter Prospective Observational Study
Chan-Hee Park, Hak-Jae Lee, Suk-Kyung Hong, Yang-Hee Jun, Jeong-Woo Lee, Nak-Jun Choi, Kyu-Hyouck Kyoung
Annals of Clinical Nutrition and Metabolism.2022; 14(2): 66. CrossRef

Analysis of Nutritional Support Status in the Intensive Care Unit: Seong Shin Moon, Hyungsun Lim, Jin Wook Choi, Deok Kyu Kim, Jeong Woo Lee, Seonghoon Ko, Dong Chan Kim; Korean J Crit Care Med. 2009;24(3):129-133.; DOI: https://doi.org/10.4266/kjccm.2009.24.3.129

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Abstract PDF

BACKGROUND
Nutritional support is important in intensive care for critically ill patients in an effort to decrease the mortality and morbidity. This study was conducted to evaluate the propriety of nutritional support and to understand the effect of a nutrition consultationin critically ill patients to assess and analyze nutritional status.
METHODS
Between January and December 2006, patients who were admitted to the intensive care unit (ICU) > or = 7 days and between 20 and 80 years of age were included. Patients transferred to another hospital, patients discharged against medicine advice, and patients with unknown weight were excluded. Two hundred sixty-two patients were enrolled. The demographic data of patients and the state of nutritional support were reviewed by medical records.
RESULTS
Two hundred sixty-two patients stayed in the ICU a mean of 16.0 +/- 9.8 days and received nutrition support for 11.0 +/- 8.4 days. Except 15 patients who did not receivenutritional support, the mean daily calculated caloric requirement of 247 patients was 1,406.2 +/- 253.8 kcal, the mean daily delivered caloric amount was 899.5 +/- 338.7 kcal, and the total delivered/required caloric ratio was 66.4 +/- 28.1%. The total delivered/required caloric ratio of the patients who received a nutritional consultation and the patients who did not receive nutritional consultation were 72.6 +/- 25.8% and 55.9 +/- 33.3%.
CONCLUSIONS
In this study, we identified that critically ill patients received insufficient nutritional support. We recommend continuous monitoring and management for nutritional support by systematic administration of nutritional support teams.

Citations

Citations to this article as recorded by

Analysis of Current Status and Predisposing Factors for Nutritional Support of Patients in Surgical Intensive Care Unit
Byung Chul Kim, In Kyu Lee, Eun Young Kim
Surgical Metabolism and Nutrition.2016; 7(2): 32. CrossRef
The effect of nutritional supply on clinical outcomes and nutritional status in critically ill patients receiving continuous renal replacement therapy
Ju Yeun Kim, Ji-Myung Kim, Yuri Kim
Journal of Nutrition and Health.2015; 48(3): 211. CrossRef
Nutritional Assessment of ICU Inpatients with Tube Feeding
Yu-Jin Kim, Jung-Sook Seo
Journal of the Korean Dietetic Association.2015; 21(1): 11. CrossRef
Nutrition-Related Factors Predicted Pressure Ulcers in Intensive Care Unit Patients*
Ha Nee Lee, Jeong Sook Park
Journal of Korean Academy of Fundamentals of Nursing.2014; 21(4): 413. CrossRef
Comparison of nutritional status indicators according to feeding methods in patients with acute stroke
Sanghee Kim, Youngsoon Byeon
Nutritional Neuroscience.2014; 17(3): 138. CrossRef
Nutritional Support, Gastric Residual Volume and Nutritional Status during Enteral Nutrition in Intensive Care Unit Patients
Minju Lee, Jiyeon Kang
Korean Journal of Adult Nursing.2014; 26(6): 621. CrossRef
Development and Evaluation of an Enteral Nutrition Protocol for Dysphagia in Patients with Acute Stroke
Sung-Hee Yoo, So-Sun Kim
Journal of Korean Academy of Nursing.2014; 44(3): 280. CrossRef
Nutrition Support in the Intensive Care Unit of 6 Korean Tertiary Teaching Hospitals: A National Multicenter Observational Study
Song Mi Lee, Seon Hyeung Kim, Yoon Kim, Eunmee Kim, Hee Joon Baek, Seungmin Lee, Hosun Lee, Chul Ho Chang, Cheung Soo Shin
Korean Journal of Critical Care Medicine.2012; 27(3): 157. CrossRef
Healthcare Professional's Knowledge, Perception and Performance on Early Enteral Nutrition for Critically Ill Patients
Sun Hee Yun, Sun Jung Kim, Eui Geum Oh
Korean Journal of Critical Care Medicine.2012; 27(1): 36. CrossRef
Effects of Nutrition Support Team Services on Outcomes in ICU Patients
Yeon Hwa MO, Jinnie RHEE, Eui-Kyung LEE
YAKUGAKU ZASSHI.2011; 131(12): 1827. CrossRef
Degree of Nutritional Support and Nutritional Status in MICU Patients
Soo Na Chi, Jea Young Ko, Su Ha Lee, Eun Hwa Lim, Kuk Hwan Kown, Mi Seon Yoon, Eun Sook Kim
The Korean Journal of Nutrition.2011; 44(5): 384. CrossRef
Physician Compliance with Tube Feeding Protocol Improves Nutritional and Clinical Outcomes in Acute Lung Injury Patients
Sungwon Na, Hosun Lee, Shin Ok Koh, Ai Soon Park, A Reum Han
The Korean Journal of Critical Care Medicine.2010; 25(3): 136. CrossRef

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