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Allan, Kirstie, Grimble, George, Whelan, Kevin and Illingworth, Sarah (2025) Comparison of measured and predicted energy expenditure among patients undergoing coronary artery bypass surgery. Clinical Nutrition ESPEN, 68. pp. 869-870. ISSN 2405-4577
Background:
There is a lack of consensus on estimating energy requirements among critically-ill patients whose metabolic state shifts after surgery (1). The current validated prediction equations frequently used are often outdated and based on earlier populations which differ from contemporary patients who tend to be older, more ethnically diverse and with more co-morbidities, including obesity (2). This leads to potential inaccurate estimations of energy expenditure which has been found to be detrimental on patient outcomes (3).
Aims:
This study assessed the validity of prediction equations in reflecting energy expenditure in relation to metabolic response in patients undergoing coronary artery bypass (CABG) surgery.
Methods:
Energy expenditure was measured using indirect calorimetry in patients undergoing CABG surgery pre-operatively (12 - 72 hours before surgery); post-operatively (1 - 4 hours after surgery); and in rehabilitation (6 - 10 days after surgery). A systematic literature search identified appropriate validated prediction equations for comparison. The level of agreement between measured total energy expenditure (mTEE) and predicted total energy expenditure (pTEE) (Mifflin St. Jeor, ESPEN 22.5kcal/kg, ESPEN 27.5kcal/kg and ESPEN ventilated) was explored through Pearson’s correlation, Bland Altman plots and limits of agreement (LOA) were established through the mean ± standard deviation multiplied by 1.96. G*power version 3.1.9.4 was used to determine observed power for Pearson’s correlation.
Results:
Eleven males undergoing CABG were recruited to this study. There were significant correlations between mTEE and pTEE for ESPEN ventilated (p<0.001) in post-operative stage and Mifflin St. Jeor and ESPEN 27.5kcal/kg in rehabilitation stage (p = 0.007 and p= 0.025 respectively). ESPEN ventilated and ESPEN 27.5kcal/kg found to be more accurate overall in estimating TEE. However, inaccuracies were identified for both equations.
Conclusions:
The most acceptable prediction equation was seen to be ESPEN ventilated in post-operative stage and ESPEN 27.5kcal/kg in rehabilitation stage. Findings from this study agree with current ESPEN guidelines in critical care (4), recommending the use of ESPEN ventilated in the absence of IC, as well of the use of body weight equations for predicting energy expenditure.
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