背景:患有肥胖症的重症患者具有独特而复杂的营养需求,与临床实践指南在推荐的能量目标方面存在冲突。本系统评价的目的是1)描述文献中报道的测量的静息能量消耗(mREE);2)当肥胖的危重患者无法使用间接量热法时,使用欧洲(ESPEN)和美国(ASPEN)指南建议将mREE与预测的能量目标进行比较。
方法:该方案是事先注册的,文献一直搜索到3月17日,2022年。如果原始研究使用间接量热法报告肥胖危重患者(BMI≥30kg/m2)的mREE,则将其包括在内。根据主要出版物,使用平均值±标准偏差或中位数[四分位数范围]报告组水平mREE数据。在有个别患者数据的情况下,Bland-Altman分析用于评估指南建议与mREE目标之间的平均偏差(95%的一致性限制)(即BMI30-50,11-14kcal/kg实际体重与70%mREE相比的ASPEN和ESPEN20-25kcal/kg调整体重与100%mREE相比)。准确性通过mREE目标的±10%内的估计值的百分比(%)进行评估。
结果:在搜索了8019篇文章之后,包括24项研究。mREE范围为1607±385至2919[2318-3362]kcal和12-32kcal/实际体重。对于11-14千卡/千克的ASPEN建议,平均偏差为-18%(-50%至+13%)和4%(-36%至+44%)。分别(n=104)。对于ESPEN建议20-25千卡/千克,偏差为-22%(-51%至+7%)和-4%(-43%至+34%),被观察到,分别(n=114)。指南建议能够在30%-39%的情况下(实际11-14kcal/kg)和15%-45%的情况下(调整后20-25kcal/kg)准确预测mREE目标,对于ASPEN和ESPEN建议,分别。
结论:肥胖危重患者的能量消耗是可变的。使用ASPEN和ESPEN临床指南中推荐的预测方程生成的能量目标与mREE的一致性较差,并且通常无法在mREE的±10%内准确预测。最常见的是低估了能源需求。
Critically ill patients with obesity have unique and complex nutritional needs, with clinical practice
guidelines conflicting regarding recommended energy targets. The aim of this systematic review was to 1) describe measured resting energy expenditure (mREE) reported in the literature and; 2) compare mREE to predicted energy targets using the European (ESPEN) and American (ASPEN)
guideline recommendations when indirect calorimetry is not available in critically ill patients with obesity.
The protocol was registered apriori and literature was searched until 17th March, 2022. Original studies were included if they reported mREE using indirect calorimetry in critically ill patients with obesity (BMI≥30 kg/m2). Group-level mREE data was reported as per the primary publication using mean ± standard deviation or median [interquartile range]. Where individual patient data was available, Bland-Altman analysis was used to assess mean bias (95% limits of agreement) between
guideline recommendations and mREE targets (i.e. ASPEN for BMI 30-50, 11-14 kcal/kg actual weight compared to 70% mREE and ESPEN 20-25 kcal/kg adjusted weight compared to 100% mREE). Accuracy was assessed by the percentage (%) of estimates within ±10% of mREE targets.
After searching 8019 articles, 24 studies were included. mREE ranged from 1607 ± 385 to 2919 [2318-3362]kcal and 12-32kcal/actual body weight. For the ASPEN recommendations of 11-14 kcal/kg, a mean bias of -18% (-50% to +13%) and 4% (-36% to +44%) was observed, respectively (n = 104). For the ESPEN recommendations 20-25 kcal/kg, a bias of -22% (-51% to +7%) and -4% (-43% to +34%), was observed, respectively (n = 114). The
guideline recommendations were able to accurately predict mREE targets on 30%-39% occasions (11-14 kcal/kg actual) and 15%-45% occasions (20-25 kcal/kg adjusted), for ASPEN and ESPEN recommendations, respectively.
Measured energy expenditure in critically ill patients with obesity is variable. Energy targets generated using predictive equations recommended in both the ASPEN and ESPEN clinical
guidelines have poor agreement with mREE and are frequently not able to accurately predict within ±10% of mREE, most commonly underestimating energy needs.