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Cited by 122Clinical Nutrition and GastroenterologyHyperglycemia and glycemic control in critically ill and hospitalized patientsSepsis Diagnosis and Treatment

Energy delivery guided by indirect calorimetry in critically ill patients: a systematic review and meta-analysis

Open access
Duan, Jing-Yi, Zheng, Wen-He, Zhou, Hua, Xu, Yuan, Huang, Hui-Bin·2021·Critical Care
DOI 10.1186/s13054-021-03508-6PMC PMC7913168

Published version of a preprint

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Abstract

Background: The use of indirect calorimetry (IC) is increasing due to its precision in resting energy expenditure (REE) measurement in critically ill patients. Thus, we aimed to evaluate the clinical outcomes of an IC-guided nutrition therapy compared to predictive equations strategy in such a patient population. Methods: We searched PubMed, EMBASE, and Cochrane library databases up to October 25, 2020. Randomized controlled trials (RCTs) were included if they focused on energy delivery guided by either IC or predictive equations in critically ill adults. We used the Cochrane risk-of-bias tool to assess the quality of the included studies. Short-term mortality was the primary outcome. The meta-analysis was performed with the fixed-effect model or random-effect model according to the heterogeneity. Results: Eight RCTs with 991 adults met the inclusion criteria. The overall quality of the included studies was moderate. Significantly higher mean energy delivered per day was observed in the IC group, as well as percent delivered energy over REE targets, than the control group. IC-guided energy delivery significantly reduced short-term mortality compared with the control group (risk ratio = 0.77; 95% CI 0.60 to 0.98; I 2 = 3%, P = 0.03). IC-guided strategy did not significantly prolong the duration of mechanical ventilation (mean difference [MD] = 0.61 days; 95% CI − 1.08 to 2.29; P = 0.48), length of stay in ICU (MD = 0.32 days; 95% CI − 2.51 to 3.16; P = 0.82) and hospital (MD = 0.30 days; 95% CI − 3.23 to 3.83; P = 0.87). Additionally, adverse events were similar between the two groups. Conclusions: This meta-analysis indicates that IC-guided energy delivery significantly reduces short-term mortality in critically ill patients. This finding encourages the use of IC-guided energy delivery during critical nutrition support. But more high-quality studies are still needed to confirm these findings.

AI snapshot

Written from the paper’s full text.

TL;DR

This systematic review and meta-analysis of 8 RCTs found that indirect calorimetry (IC)-guided energy delivery significantly reduced short-term mortality in critically ill adults compared with predictive equations. IC guidance increased delivered energy and protein but did not significantly change duration of mechanical ventilation, ICU/hospital length of stay, or adverse events.

Key findings

  • Short-term mortality was lower with IC-guided energy delivery: RR = 0.77; 95% CI 0.60 to 0.98; I² = 3%; P = 0.03 (6 RCTs, n = 887).
  • Mean energy delivered/day was significantly higher in the IC group: MD = 622 kcal/day; 95% CI 407 to 837; I² = 85%; P < 0.00001. Mean protein delivered/day was also higher: MD = 20 g/day; 95% CI 16 to 25; I² = 4%; P < 0.00001. Percent delivered energy over measured REE was 89–106% in the IC group versus 56–79% in controls.
  • No significant differences were found for duration of mechanical ventilation (MD = 0.61 days; 95% CI −1.08 to 2.29; P = 0.48), ICU length of stay (MD = 0.32 days; 95% CI −2.51 to 3.16; P = 0.82), or hospital length of stay (MD = 0.30 days; 95% CI −3.23 to 3.83; P = 0.87). Adverse events were similar between groups, and long-term mortality was similar in the two trials reporting it.

Methods

  • Systematic review and meta-analysis conducted per PRISMA and registered as INPLASY2020110084. PubMed, EMBASE, and CENTRAL were searched through October 25, 2020, for RCTs of critically ill adults (≥18 years) receiving energy guided by repeated IC versus predictive equations.
  • Eight RCTs were included; the abstract reports 991 adults, while the results and discussion report 911 patients (489 IC vs 484 control). All included trials recruited ventilated patients, and 7 of 8 were single-center studies published from 2011 to 2020.
  • Risk of bias was assessed with the Cochrane tool. Pooled risk ratios and mean differences were calculated, with fixed- or random-effect models based on I²; median/IQR data were converted to mean/SD before analysis. Publication bias was assessed by funnel plots.

Limitations

  • The paper states that only 8 studies were included; most were unblinded and single-center and may have been underpowered. It also notes heterogeneity from different IC devices, non-nutritional calories, enteral/parenteral formulas, EN intolerance, and uneven underlying diseases, and that some randomized IC studies were excluded by design. The effect of protein delivery on ICU outcomes could not be investigated.
  • Evident from the text: the sample size is inconsistently reported as 991 versus 911 patients. Heterogeneity was high for energy delivered/day (I² = 85%), ICU length of stay (I² = 84%), and duration of mechanical ventilation (I² = 72%). Short-term mortality pooled only 6 RCTs, and long-term mortality was reported by only 2 trials.

Model-written summary. Check it against the paper before relying on it.

Integrity signals

Registry

Crossref · 10.1186/s13054-021-03508-6

Cites

27 of 27 references verified0 citation errors · 0 not checkable

Statistics

Nothing to recompute.

Claims the paper makes

0 of 55 cited sources checked · 0 supported · 0 flagged

  • Findingown data

    Eight RCTs with 911 patients met the inclusion criteria and were included in the final analysis.

    “Our literature search yielded 964 potentially eligible articles through database searching. Further screening of 14 full texts identified 8 RCTs with 911 patients that fulfilled our inclusion criteria and was included in the final analysis [7, 13–15, 20–23].”
    • Also stated in: § Discussion · plain
      “The present systematic review and meta-analysis of eight RCTs (911 patients) showed that IC-guided energy delivery significantly reduced short-term mortality in critically ill adults compared with predictive equations.”
    Quote in the paperSubstantial claim
  • Findingown data

    IC-guided energy delivery significantly reduced short-term mortality compared with the control group (RR = 0.77; 95% CI 0.60 to 0.98; I2 = 3%; P = 0.03).

    “The pooled analysis showed that compared with the control, IC improved short-term mortality (n = 887; RR = 0.77; 95% CI 0.60 to 0.98; I2 = 3%; P = 0.03) (Fig. 2).”
    • Also stated in: § Results · plain
      “IC-guided energy delivery significantly reduced short-term mortality compared with the control group (risk ratio = 0.77; 95% CI 0.60 to 0.98; I2 = 3%, P = 0.03).”
    • Also stated in: § Conclusions · hedged
      “This meta-analysis indicates that IC-guided energy delivery significantly reduces short-term mortality in critically ill patients.”
    Quote in the paperSubstantial claim
  • Findingown data

    IC-guided strategy did not significantly affect length of stay in hospital (MD = 0.30 days; 95% CI −3.23 to 3.83; P = 0.87).

    “Hospital LOS was available in 4 RCTs, which was similar between IC and control groups (n = 775; MD = 0.30 days; 95% CI − 3.23 to 3.83; I2 = 0%; P = 0.87) [7, 14, 20, 21] (Fig. 3c).”
    Quote in the paperNot a substantial claim
  • Findingcitation

    The IC group received energy intake closer to the measured target (89-106%) than the control group (56-79%).

    “Moreover, the IC group received a energy intake (89–106%) closer to the measured target than the control group (56–79%) [7, 14, 20, 21].”
    • Also stated in: § Results · plain
      “as well as percent delivered energy over REE targets, than the control group.”
    Quote in the paperSubstantial claim
  • Findingown data

    Adverse events were similar between the IC and control groups.

    “Additionally, adverse events were similar between the two groups.”
    • Also stated in: § Discussion · plain
      “Additionally, using IC-guided energy delivery did not prolong the MV duration, length of stay in ICU or hospital, and increase AEs and long-term mortality.”
    Quote in the paperNot a substantial claim
  • Classified as probably not a substantial claim. 12
  • May combine two claims. 24

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Findingcitation

    Seven out of the eight included trials were single-center studies.

    “Seven out of the eight trials were single-center studies [7, 12, 15, 20–23].”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Findingown data

    All eight included RCTs recruited ventilated patients, with sample sizes ranging from 40 to 417 cases, and 489 in the IC group and 484 in the control group.

    “All the eight RCTs recruited ventilated patients (sample size ranges from 40 to 417 cases), with 489 in the IC group and 484 in the control group, respectively.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductnone given

    Discrepancies were identified and resolved by consensus or in discussion with a senior author.

    “Discrepancies were identified and resolved by consensus or in discussion with a senior author (H-BH).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationcitation

    In the EAT-ICU study, median cumulative energy balance was close to and slightly below target values (−249 and −747 kcal, respectively), caloric supply in both groups was in the optimal range, and clinical results were indistinguishable between groups.

    “In contrast, in the EAT-ICU study [20], the median cumulative energy balance was closely related and close to and slightly below their target values (− 249 and − 747 kcal, respectively). Caloric supply in both groups was in the optimal range, and therefore, the clinical results were indistinguishable between the two groups.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [20] Allingstrup MJ, Kondrup J, Wiis J, Claudius C, Pedersen UG, Hein-Rasmussen R, Bjerregaard MR, Steensen M, Jensen TH, Lange T, et al. Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive Care Med. 2017;43(11):1637–47. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The systematic review and meta-analysis was performed according to the PRISMA statement.

    “We performed the current meta-analysis and systematic review according to the preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement [16].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [16] Moher D, Liberati A, Tetzlaff J, Altman DG, Group P. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–41. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductreasoning

    The effect of protein delivery on ICU outcomes could not be investigated because it was not the study target.

    “However, we could not investigate the effect of protein delivery on ICU outcomes since it was not the study target in the current study.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Study design and conductown data

    Two authors independently extracted data and independently evaluated potential evidence of bias.

    “Two authors (J-YD and HZ) independently extracted data from included RCTs on study design, sample size, patient characteristics, IC measurements, and predictive equations measurements), and predefined outcomes. J-YD and HZ also independently evaluated potential evidence of bias using the Cochrane risk-of-bias tool for RCTs [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clinical Research ed). 2003;327(7414):557–60. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Differences among included trials in IC devices, non-nutritional calories, enteral and parenteral formula, and patient intolerance of EN might result in observed heterogeneity and compromise the robustness of the findings.

    “Third, there were differences among included trials with regards to the adopted IC measured devices, non-nutritional calories such as propofol and dextrose 5% used during the study period, enteral and parenteral formula, and patient intolerance of EN, which might result from the observed heterogeneity and thus compromise the robustness of our findings.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The meta-analysis protocol was registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols database (INPLASY2020110084).

    “Our protocol was registered on the International Platform of Registered Systematic Review and Meta-analysis Protocols database (INPLASY2020110084) and is available in full on inplasy.com (https://doi.org/10.37766/inplasy2020.11.0084).”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationreasoning

    IC-guided nutrition therapy allows for capturing daily variations of REE and matching energy supply and demand, thus avoiding adverse effects of under- and overfeeding due to low precision of calculation-based REE strategy.

    “Therefore, an IC-guided nutrition therapy allows for capturing the daily variations of REE and matching energy supply and demand, thus avoiding the known adverse effects of under- and overfeeding due to the low precision of calculation-based REE strategy.”
    Quote in the paperSubstantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductcitation

    The uneven distribution of different underlying diseases among included studies might exert a prognostic value.

    “Forth, the uneven distribution of different underlying diseases among included studies might also exert a prognostic value.”
    Quote in the paperNot a substantial claim

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Study design and conductown data

    The Cochrane risk-of-bias tool was used to assess the quality of included studies.

    “J-YD and HZ also independently evaluated potential evidence of bias using the Cochrane risk-of-bias tool for RCTs [18].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [18] Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ (Clinical Research ed). 2003;327(7414):557–60. source

      Not checked in the free run.

  • Classified as probably not a substantial claim. May combine two claims.

    Premisecitation

    A U-shaped relationship exists between caloric supply and mortality, with best survival when around 70% REE was provided.

    “Their results indicated a U-shaped relationship between caloric supply and mortality, with the best survival when around 70% REE was provided.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [1] Zusman O, Theilla M, Cohen J, Kagan I, Bendavid I, Singer P. Resting energy expenditure, calorie and protein consumption in critically ill patients: a retrospective cohort study. Crit Care (London, England). 2016;20(1):367. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationcitation

    In the TICACOS study, despite a large difference in cumulative energy balance between groups, the IC-guided group tended to overfeed while the control group was underfed, and a negative result was observed.

    “In the TICACOS study, despite the large difference of cumulative energy balance between groups, the IC-guided group tends to overfeed, while the control group was underfed. Thus, a negative result was observed [7].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Singer P, Anbar R, Cohen J, Shapiro H, Shalita-Chesner M, Lev S, Grozovski E, Theilla M, Frishman S, Madar Z. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med. 2011;37(4):601–9. source

      Not checked in the free run.

  • May combine two claims.

    Study design and conductreasoning

    Most included RCTs are unblinded and single-center in design and may be underpowered to demonstrate actual differences in clinical and functional recovery outcomes.

    “Second, most of the included RCTs are unblinded and single-center in design and maybe likely underpowered to demonstrate actual differences in clinical and functional recovery outcomes.”
    Quote in the paperNot a substantial claim

  • May combine two claims.

    Interpretationnone given

    Early full energy target feeding might lead to overfeeding and increase endogenous energy production.

    “Early full energy target feeding might lead to overfeeding and increase endogenous energy production.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The exclusion of some randomized studies guided by IC, including two trials showing reduction of infectious complications, was by design because they did not compare IC-guided strategy with equations.

    “Fifth, another limitation is the non-conclusion of some randomized studies guided by IC, including two randomized trials showing a reduction of infectious complications in the patients receiving the energy determined by REE [5, 6]. This exclusion was by design as the two studies did not compare IC-guided strategy with equations.”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [5] Berger MM, Pantet O, Jacquelin-Ravel N, Charrière M, Schmidt S, Becce F, Audran R, Spertini F, Tappy L, Pichard C. Supplemental parenteral nutrition improves immunity with unchanged carbohydrate and protein metabolism in critically ill patients: The SPN2 randomized tracer study. Clin Nutr (Edinburgh, Scotland). 2019;38(5):2408–16. source

      Not checked in the free run.

    • cites [6] Higgins JP, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, Savovic J, Schulz KF, Weeks L, Sterne JA. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ (Clinical Research ed). 2011;343:d5928. source

      Not checked in the free run.

  • May combine two claims.

    Interpretationreasoning

    Overfeeding during the early period of critical illness may contribute to increased MV duration, length of ICU or hospital stay, and infection rate, thus diluting the benefit of REE guided by IC.

    “Again, the overfeeding during the early period of critical illness may contribute to the increased MV duration, length of ICU or hospital stay among these trials, and even infection rate, thus diluting the benefit of REE guided by IC.”
    Quote in the paperSubstantial claim

  • May combine two claims.

    Study design and conductreasoning

    The present meta-analysis had a larger sample size than the previous meta-analysis by Tatucu-Babet et al. and more power to assess the effect.

    “By contrast, our meta-analysis had a larger sample size than the previous meta-analysis as it added four other trials published recently [12–15, 23], with more power to assess this effect.”
    Quote in the paperSubstantial claim0 of 5 sources checked
    • cites [12] Azevedo JRA, Lima HCM, Montenegro WS, Souza SCC, Nogueira I, Silva MM, Muniz NA. Optimized calorie and high protein intake versus recommended caloric-protein intake in critically ill patients: a prospective, randomized, controlled phase II clinical trial. Revista Brasileira de terapia intensiva. 2019;31(2):171–9. source

      Not checked in the free run.

    • cites [13] Shi J, Xi L, Chi T, Song J, Wang Z. Application value of resting energy monitoring in nutritional support therapy for mechanical ventilation patients. Zhonghua wei zhong bing ji jiu yi xue. 2019;31(1):98–101.

      Not checked in the free run.

    • cites [14] Singer P, De Waele E, Sanchez C, Ruiz Santana S, Montejo JC, Laterre PF, Soroksky A, Moscovici E, Kagan I. TICACOS international: a multi-center, randomized, prospective controlled study comparing tight calorie control versus Liberal calorie administration study. Clin Nutr (Edinburgh, Scotland). 2020;40:380–7. source

      Not checked in the free run.

    • cites [15] Zhao S, Duan L, Yu G, Zou Q, Wu Q, Wang H, He X. Changing laws of rest energy expenditure in critically ill patients and the intervention effect for nutritional support: a prospective study. Zhonghua wei zhong bing ji jiu yi xue. 2019;31(12):1512–6.

      Not checked in the free run.

    • cites [23] Yang X, Ma G, Wang LJ, Ma XD. Comparison of respiratory indirect calorimetry and Harris–Benedict coefficient in guiding energy target in patients with sepsis. Chin J Clin Nutr. 2016;24(004):193–8.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    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].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Tatucu-Babet OA, Fetterplace K, Lambell K, Miller E, Deane AM, Ridley EJ. Is energy delivery guided by indirect calorimetry associated with improved clinical outcomes in critically ill patients? A systematic review and meta-analysis. Nutr Metab Insights. 2020;13:1178638820903295. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The TICACOS study reported a significant day-to-day variation in measured REE by IC, though mean EE was comparable between the IC-guided and control groups.

    “As shown in the TICACOS study [7], the authors reported a significant day-to-day variation in measured REE by IC, though the mean EE was comparable between the IC-guided and the control groups.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [7] Singer P, Anbar R, Cohen J, Shapiro H, Shalita-Chesner M, Lev S, Grozovski E, Theilla M, Frishman S, Madar Z. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med. 2011;37(4):601–9. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Indirect calorimetry is a validated, century-long studied technique that assesses REE by measuring oxygen consumption and carbon dioxide production.

    “IC is a validated, century-long studied technique that assesses REE by measuring the oxygen consumption and carbon dioxide production [4].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [4] Porter C, Cohen NH. Indirect calorimetry in critically ill patients: role of the clinical dietitian in interpreting results. J Am Diet Assoc. 1996;96(1):49–57. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Recently, several studies on this topic have been published, and some have a modest sample size while the conclusions are inconsistent.

    “Recently, several studies on this topic have been published [12–15], and some of these studies have a modest sample size, while the conclusions are inconsistent.”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [12] Azevedo JRA, Lima HCM, Montenegro WS, Souza SCC, Nogueira I, Silva MM, Muniz NA. Optimized calorie and high protein intake versus recommended caloric-protein intake in critically ill patients: a prospective, randomized, controlled phase II clinical trial. Revista Brasileira de terapia intensiva. 2019;31(2):171–9. source

      Not checked in the free run.

    • cites [13] Shi J, Xi L, Chi T, Song J, Wang Z. Application value of resting energy monitoring in nutritional support therapy for mechanical ventilation patients. Zhonghua wei zhong bing ji jiu yi xue. 2019;31(1):98–101.

      Not checked in the free run.

    • cites [14] Singer P, De Waele E, Sanchez C, Ruiz Santana S, Montejo JC, Laterre PF, Soroksky A, Moscovici E, Kagan I. TICACOS international: a multi-center, randomized, prospective controlled study comparing tight calorie control versus Liberal calorie administration study. Clin Nutr (Edinburgh, Scotland). 2020;40:380–7. source

      Not checked in the free run.

    • cites [15] Zhao S, Duan L, Yu G, Zou Q, Wu Q, Wang H, He X. Changing laws of rest energy expenditure in critically ill patients and the intervention effect for nutritional support: a prospective study. Zhonghua wei zhong bing ji jiu yi xue. 2019;31(12):1512–6.

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Predictive equations fail to consider the diversity of ICU populations and the factors that influence REE.

    “This is because these equations fail to consider the diversity of the ICU populations and the factors that influence REE [3].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [3] Mtaweh H, Tuira L, Floh AA, Parshuram CS. Indirect calorimetry: history, technology, and application. Front Pediatr. 2018;6:257. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    In the 2018 ESPEN guideline, Singer et al. performed a meta-analysis of RCTs that focused only on using IC as a calorie target and found a trend (P = 0.07) to improve short-term mortality.

    “In the 2018 ESPEN guideline on ICU nutrition [10], Singer et al. performed a meta-analysis of RCTs that focused only on using IC as a calorie target and found a trend (P = 0.07) to improve the short-term mortality.”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, Hiesmayr M, Mayer K, Montejo JC, Pichard C, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr (Edinburgh, Scotland). 2019;38(1):48–79. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Tatucu-Babet et al. reviewed only four trials with a total of 398 patients.

    “However, the authors reviewed only four trials with a total of 398 patients [7, 20–22].”
    Quote in the paperSubstantial claim0 of 4 sources checked
    • cites [7] Singer P, Anbar R, Cohen J, Shapiro H, Shalita-Chesner M, Lev S, Grozovski E, Theilla M, Frishman S, Madar Z. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med. 2011;37(4):601–9. source

      Not checked in the free run.

    • cites [20] Allingstrup MJ, Kondrup J, Wiis J, Claudius C, Pedersen UG, Hein-Rasmussen R, Bjerregaard MR, Steensen M, Jensen TH, Lange T, et al. Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive Care Med. 2017;43(11):1637–47. source

      Not checked in the free run.

    • cites [21] Gonzalez-Granda A, Schollenberger A, Haap M, Riessen R, Bischoff SC. Optimization of nutrition therapy with the use of calorimetry to determine and control energy needs in mechanically ventilated critically ill patients: the ONCA study, a randomized, prospective pilot study. JPEN J Parenter Enteral Nutr. 2019;43(4):481–9. source

      Not checked in the free run.

    • cites [22] Landes S, McClave SA, Frazier TH, Lowen CC, Hurt RT. Indirect calorimetry: is it required to maximize patient outcome from nutrition therapy? Curr Nutr Rep. 2016;5(3):233–9. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    The SPN study measured REE by IC on day 3 to guide PN supplement and found that delivery of 100% of the energy target from days 4 with EN plus supplemental PN significantly reduced nosocomial infections.

    “A previous large RCT (SPN study) measured REE by IC on day 3 to guide PN supplement and found the delivery of 100% of the energy target from days 4 with EN plus supplemental PN significantly reduced nosocomial infections [9].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [9] Heidegger CP, Berger MM, Graf S, Zingg W, Darmon P, Costanza MC, Thibault R, Pichard C. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet (London, England). 2013;381(9864):385–93. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

    Premisecitation

    Four RCTs were identified in that meta-analysis, of which two were included in the present meta-analysis.

    “Four RCTs were identified, of which two were included in the present meta-analysis [7, 20].”
    Quote in the paperNot a substantial claim0 of 2 sources checked
    • cites [7] Singer P, Anbar R, Cohen J, Shapiro H, Shalita-Chesner M, Lev S, Grozovski E, Theilla M, Frishman S, Madar Z. The tight calorie control study (TICACOS): a prospective, randomized, controlled pilot study of nutritional support in critically ill patients. Intensive Care Med. 2011;37(4):601–9. source

      Not checked in the free run.

    • cites [20] Allingstrup MJ, Kondrup J, Wiis J, Claudius C, Pedersen UG, Hein-Rasmussen R, Bjerregaard MR, Steensen M, Jensen TH, Lange T, et al. Early goal-directed nutrition versus standard of care in adult intensive care patients: the single-centre, randomised, outcome assessor-blinded EAT-ICU trial. Intensive Care Med. 2017;43(11):1637–47. source

      Not checked in the free run.

  • Probably not a substantial claim: may not pass S3 (load-bearing).

    Premisecitation

    The 2018 ESPEN guideline made a weak recommendation (grade B) favoring the use of IC to determine energy requirements in critically ill ventilated patients.

    “Thus, the 2018 ESPEN guideline made a weak recommendation (grade B) favoring the use of IC to determine energy requirements in critically ill ventilated patients [10].”
    Quote in the paperNot a substantial claim0 of 1 sources checked
    • cites [10] Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, Hiesmayr M, Mayer K, Montejo JC, Pichard C, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr (Edinburgh, Scotland). 2019;38(1):48–79. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Further RCTs using IC as an energy target showed significant reduction in nosocomial infections and improved immunity or less systemic inflammation.

    “Results from further RCTs using IC as a energy target showed significant reduction in nosocomial infections [9] and improved immunity or less systemic inflammation [5].”
    Quote in the paperSubstantial claim0 of 2 sources checked
    • cites [9] Heidegger CP, Berger MM, Graf S, Zingg W, Darmon P, Costanza MC, Thibault R, Pichard C. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: a randomised controlled clinical trial. Lancet (London, England). 2013;381(9864):385–93. source

      Not checked in the free run.

    • cites [5] Berger MM, Pantet O, Jacquelin-Ravel N, Charrière M, Schmidt S, Becce F, Audran R, Spertini F, Tappy L, Pichard C. Supplemental parenteral nutrition improves immunity with unchanged carbohydrate and protein metabolism in critically ill patients: The SPN2 randomized tracer study. Clin Nutr (Edinburgh, Scotland). 2019;38(5):2408–16. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    Even after adjustment by patient populations and modification factors, estimated energy deviations still exist and can be as high as 60%.

    “Though adjusted by patient populations and modification factors, the estimated energy deviations still exist, and even high up to 60% [26].”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [26] Zusman O, Kagan I, Bendavid I, Theilla M, Cohen J, Singer P. Predictive equations versus measured energy expenditure by indirect calorimetry: a retrospective validation. Clin Nutr (Edinburgh, Scotland). 2019;38(3):1206–10. source

      Not checked in the free run.

  • May combine two claims.

    Premisecitation

    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.”
    Quote in the paperSubstantial claim0 of 1 sources checked
    • cites [11] Tatucu-Babet OA, Fetterplace K, Lambell K, Miller E, Deane AM, Ridley EJ. Is energy delivery guided by indirect calorimetry associated with improved clinical outcomes in critically ill patients? A systematic review and meta-analysis. Nutr Metab Insights. 2020;13:1178638820903295. source

      Not checked in the free run.

32 of 32

  • The paper relies on this without support.

    One previous study showed that higher REE in severe sepsis is associated with higher mortality.

    “For instance, one previous study showed that the higher the REE in severe sepsis, the higher the mortality.”

  • The paper relies on this without support.

    Another large retrospective study found that in patients receiving less than 40% of REE, the increase in energy debt harmed clinical outcomes.

    “Another large retrospective study found that in patients receiving less than 40% of REE, the increase in energy debt harmed clinical outcomes.”

  • The paper relies on this without support.

    ICU discharge was not always determined by the patients' condition.

    “Second, for critically ill patients, ICU discharge was not always determined by the patients' condition.”

  • The paper relies on this without support.

    The early phase of critical illness is usually a period for resuscitation with frequent treatment adjustment, which may hinder the accuracy of REE by IC.

    “Moreover, the early phase of the illness is usually a period for resuscitation with frequent treatment adjustment for critically ill patients, which may hinder the accuracy of REE by IC.”
4 of 4

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

Each contradiction between two passages listed here was confirmed by an independent check.

  • Total patient count does not match the study sizes

    Major

    The eight study sizes in Table 1 sum to 991 patients, not 911. The abstract also reports 991 patients.

    Reported 911 · recomputed 991

  • Control-group energy-intake range omits a listed value

    Minor

    The stated control-group range ends at 79%, but Table 2 lists 81% for Singer 2011, one of the cited trials.

2 of 2

Cites

Flagged first, then by citations

Research works printed but not linked: 1

  1. Yang X, Ma G, Wang LJ, Ma XD. Comparison of respiratory indirect calorimetry and Harris–Benedict coefficient in guiding energy target in patients with sepsis. Chin J Clin Nutr. 2016;24(004):193–8.

Cited by

Sorted by citations

Authors
Duan, J.-Y., Zheng, W.-H., Zhou, H., Xu, Y., & Huang, H.-B.
Affiliations
  • Fujian University of Traditional Chinese Medicine (CN)
  • Beijing Tsinghua Chang Gung Hospital (CN)
Corresponding author
Huang, Hui-Bin
ORCID
Venue
Critical Care
Publisher
Springer Science and Business Media LLC
Published
2021-02-27
Volume
25
Issue
1
Pages
88-88
ISSN
1364-8535 (ISSN-L)
DOI
10.1186/s13054-021-03508-6
PMC
PMC7913168
OpenAlex
W3107733690
Cited by
122
References
27
Citations by year
2026: 22 · 2025: 24 · 2024: 30 · 2023: 26 · 2022: 16 · 2021: 3
FWCI
2.49
Type
journal article
Language
en
Open access
Licence
Locations
  • Critical Care (publishedVersion, cc-by)
  • Research Square (acceptedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
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, resting energy expenditure, energy delivery, critically ill patients, nutritional therapy, prediction equations, short-term mortality, mechanical ventilation duration, ICU length of stay
MeSH terms
Calorimetry, Indirect, Energy Metabolism, Humans, Length of Stay, Critical Illness, Nutritional Support

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Claims read by deepseek-v4.1-flash under definition version 3 (extract-v3) on 2026-10-06.

Classified by jev-1.13-20260917 (gold-guideline-v0.2) on 2026-10-06.

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