Resting energy expenditure assessment needs in patients with pancreatogenic sepsis

Background. Nutritional support is an integral component of intensive care for pancreatogenic sepsis. Indirect calorimetry is currently the gold standard for analysis of Resting Energy Expenditure (REE), but this method is not widespread in hospitals for some reasons. In clinical practice, REE are most often determined empirically or using equations. Accuracy of these equations is increasingly being questioned. Objective. To compare the methods for assessing REE in patients with pancreatogenic sepsis and analyze their advisability in these patients in the absence of metabolographs in intensive care units. Material and methods. The study includes 38 patients aged 18—65 years diagnosed with infected pancreatic necrosis and sepsis. We compared the following equations: Harris-Benedict, Penn State (for patients on mechanical ventilation), Mifflin-Jeor, Owen, Ireton-Jones and Schofield. Empirical daily caloric intake implied multiplying the ideal (IBW) or actual (ABW) body weight by 25 kcal/kg/day. Patients underwent indirect calorimetry (CCM Express metabolograph, MGC Diagnostics). Results. The most accurate equations on the first day of stay in the ICU were the equation ABW×25 kcal/kg/day in patients with spontaneous breathing and the Penn State equation in patients on mechanical ventilation. After 3 days, the Harris-Benedict equation in patients with spontaneous breathing and indirect calorimetry in patients on mechanical ventilation had significant differences with all calculation equations. Therefore, all of them were considered inaccurate. The equation ABW×25 kcal/kg/day was the most accurate in both groups after 5 days. After 7 days, the Schofield equation was accurate in patients with spontaneous breathing, IBW×25 kcal/kg/day equation — in patients on mechanical ventilation. Conclusion. Among other things, improvement of diagnostics and monitoring of nutritional-metabolic status should be aimed at creating an equation capable of accurate prediction of resting energy expenditure in patients with pancreatogenic sepsis if metabolographs are absent in the intensive care unit.