Is Energy Delivery Guided by Indirect Calorimetry Associated With Improved Clinical Outcomes in Critically Ill Patients? A Systematic Review and Meta-analysis
Open accessAbstract
Background: Indirect calorimetry (IC) is recommended to guide energy delivery over predictive equations in critical illness due to its precision. However, the impact of using IC to measure energy expenditure on clinical outcomes is uncertain. Objective: To evaluate whether using IC to measure energy expenditure to inform energy delivery reduced hospital mortality and improved other important outcomes compared to using predictive equations in critically ill adults. Methods: A systematic literature review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-analyses guideline. Medline, Embase, CINAHL, and the Cochrane Library were searched for studies using IC to guide energy delivery compared to a predictive equation in adult critically ill patients with the primary outcome (hospital mortality) or any of the secondary outcomes reported (including but not limited to hospital and intensive care unit (ICU) length of stay (LOS) and duration mechanical ventilation (MV). Risk of bias within studies was assessed using the Cochrane “Risk of Bias” 1 tool. Random-effect meta-analyses were used when heterogeneity between studies existed (I 2 > 50%). Data are reported as median (interquartile range [IQR]), binomial outcomes as odds ratio (OR), 95% confidence interval (CI), and continuous outcomes as mean difference (MD). Results: Of 4060 articles, 4 randomized controlled trials were identified with 396 patients included in analysis. Three studies were considered low risk of bias and 1 as high risk. Two studies reported hospital mortality (n = 130 and 40 participants, respectively). When combined, no association between IC-guided energy delivery and hospital mortality was found (OR = 0.81, 95% CI = [0.25, 2.67], P = 0.73, I 2 = 52). No differences were reported with ICU mortality and hospital LOS between groups, but ICU LOS and duration of MV varied across all studies. According to the meta-analysis, no differences were observed in ICU LOS (MD = 1.39, 95% CI = [–5.01, 7.79], P = 0.67, I 2 = 81%), although the duration of MV was increased when energy delivery was guided by IC (MD = 2.01, 95% CI = [0.45, 3.57], P = 0.01, I 2 = 26%). In all 4 studies, prescribed energy targets were more closely met when energy delivery was informed by IC compared to a predictive equation. Three studies reported the percentage delivered versus the prescribed energy target, with the median (IQR) delta between the IC and predictive equation arms 19% (10%-32%). Conclusion: Limited data exist to assess the impact of using IC to inform energy delivery in comparison to predictive equations on hospital mortality. The association of IC use with other important outcomes, including duration of MV, needs to be further explored before definitive conclusions can be made.
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That published meta-analysis included only four studies.
“However, only four studies have been included.”
From Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis (2021) · cites this paper as [11]
A recent meta-analysis by Tatucu-Babet et al. reported that an IC-guided energy delivery regimen showed no between-groups difference regarding mortality and ICU LOS but a longer duration of MV.
“This finding contrasts with a most recent meta-analysis by Tatucu-Babet et al. [11]. They reported an IC-guided energy delivery regimen showed no between-groups difference regarding mortality (both hospital and ICU mortality) and ICU LOS but a longer duration of MV.”
From Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis (2021) · cites this paper as [11]
A published meta-analysis showed that compared with predictive equations, the IC-guided energy delivery strategy was not more effective in reducing hospital mortality, duration of MV, and LOS in ICU or hospital.
“A published meta-analysis showed that compared with predictive equations, the IC-guided energy delivery strategy was not more effective in reducing hospital mortality, duration of MV, and length of stay (LOS) in ICU or hospital [11].”
From Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis (2021) · cites this paper as [11]
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- Authors
- Tatucu-Babet, O. A., Fetterplace, K., Lambell, K., Miller, E., Deane, A. M., & Ridley, E. J.
- Affiliations
- Monash University (AU)
- The Royal Melbourne Hospital (AU)
- The Alfred Hospital (AU)
- Corresponding author
- Ridley, Emma J
- Venue
- Nutrition and Metabolic Insights
- Publisher
- SAGE Publications
- Published
- 2020-01
- Volume
- 13
- Pages
- 1178638820903295-1178638820903295
- ISSN
- 1178-6388 (ISSN-L)
- PMC
- PMC7082874
- OpenAlex
- W3011059922
- Cited by
- 51
- References
- 27
- Citations by year
- 2026: 8 · 2025: 12 · 2024: 9 · 2023: 5 · 2022: 3 · 2021: 9 · 2020: 4 · 2018: 1
- FWCI
- 0.64
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Nutrition and Metabolic Insights (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Minerva Access (University of Melbourne) (submittedVersion, cc-by-nc)
- Topics
- Health Sciences › Nursing › Nutrition and Dietetics › Clinical Nutrition and Gastroenterology
- Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hyperglycemia and glycemic control in critically ill and hospitalized patients
- Health Sciences › Medicine › Epidemiology › Sepsis Diagnosis and Treatment
- Keywords
- indirect calorimetry, energy expenditure, energy delivery, critically ill patients, in-hospital mortality, ICU length of stay, mechanical ventilation duration, prediction equations, clinical outcomes, ICU mortality, length of hospital stay, risk of bias, risk of bias assessment, risk of bias summary table
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