Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 28 , ISSUE 6 ( June, 2024 ) > List of Articles

Original Article

Comparison between Effect of Indirect Calorimetry vs Weight-based Equation (25 kcal/kg/day)-guided Nutrition on Quadriceps Muscle Thickness as Assessed by Bedside Ultrasonography in Medical Intensive Care Unit Patients: A Randomized Clinical Trial

Aravind Chandrasekaran, Divya Pal, Rahul Harne, Sweta J Patel, KN Jagadeesh, Anant V Pachisia, Pooja Tyagi, Keerti Brar, Swagat Pattajoshi, Parimal B Patel, Ronak Zatakiya, Deepak Govil

Keywords : Caloric target, Critically ill, Indirect calorimetry, Intensive care unit–acquired weakness, Muscle wasting, Nutrition, Quadriceps muscle thickness, Sarcopenia, Ultrasound

Citation Information : Chandrasekaran A, Pal D, Harne R, Patel SJ, Jagadeesh K, Pachisia AV, Tyagi P, Brar K, Pattajoshi S, Patel PB, Zatakiya R, Govil D. Comparison between Effect of Indirect Calorimetry vs Weight-based Equation (25 kcal/kg/day)-guided Nutrition on Quadriceps Muscle Thickness as Assessed by Bedside Ultrasonography in Medical Intensive Care Unit Patients: A Randomized Clinical Trial. Indian J Crit Care Med 2024; 28 (6):587-594.

DOI: 10.5005/jp-journals-10071-24737

License: CC BY-NC 4.0

Published Online: 31-05-2024

Copyright Statement:  Copyright © 2024; The Author(s).


Aim and background: Sarcopenia is a substantial contributor to intensive care unit (ICU)-acquired weakness and is associated with significant short- and long-term outcomes. It can, however, be mitigated by providing appropriate nutrition. Indirect calorimetry (IC) is believed to be the gold standard in determining caloric targets in the dynamic environment of critical illness. We conducted this study to compare the effect of IC vs weight-based (25 kcal/kg/day) feeding on quadriceps muscle thickness (QMT) by ultrasound in critically ill patients. Materials and methods: A prospective study was conducted on 60 mechanically ventilated patients randomized to two groups [weight-based equation (WBE) group or the IC group] in medical ICU after obtaining institutional ethics committee approval, and fed accordingly. The right QMT measurement using ultrasound and caloric targets were documented on day 1, 3 and 7 and analyzed statistically. The IC readings were obtained from the metabolic cart E-COVX ModuleTM. Results: The baseline demographics, APACHE-II, NUTRIC score, and SOFA scores on day 1, 3, and 7 were comparable between the two groups. The resting energy expenditure (REE) obtained in the IC group was significantly less than the WBE energy targets and the former were fed with significantly less calories. A significantly less percent reduction of QMT in the IC group compared with the WBE group was observed from day 1 to day 3, day 3 to day 7, and day 1 to day 7. Conclusion: From our study, we conclude that IC-REE-based nutrition is associated with lesser reduction in QMT and lesser calories fed in critically ill mechanically ventilated patients compared from WBE. CTRI registration-CTRI/2023/01/049119.

PDF Share
  1. Compher C, Bingham AL, McCallM, Patel J, Rice TW, Braunschweig C, et al. Guidelines for the provision of nutrition support therapy in the adult critically ill patient: The American Society for Parenteral and Enteral Nutrition. JPEN J Parenter Enteral Nutr 2022;46(1):12–41. DOI: 10.1002/jpen.2267.
  2. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019;38(1):48–79. DOI: 10.1016/j.clnu.2018.08.037.
  3. Arabi YM, Aldawood AS, Haddad SH, Al-Dorzi HM, Tamim HM, Jones G, et al. PermiT Trial Group. permissive underfeeding or standard enteral feeding in critically ill adults. N Engl J Med 2015;372(25):2398–2408. DOI: 10.1056/NEJMoa1502826.
  4. Heyland DK, Lee Z-Y, Lew CCH, Ortiz LA, Patel J, Stoppe C. Nutritional prescription: Use of indirect calorimetry vs. predictive equations. Critical Care Nutrition: Systematic Reviews 2021.
  5. Moisey LL, Mourtzakis M, Cotton BA, Premji T, Heyland DK, Wade CE, et al. Skeletal muscle predicts ventilator-free days, ICU-free days, and mortality in elderly ICU patients. Crit Care 2013;17(5):R206. DOI: 10.1186/cc12901.
  6. Weijs PJ, Looijaard WG, Dekker IM, Stapel SN, Girbes AR, Oudemans-van Straaten HM, et al. Low skeletal muscle area is a risk factor for mortality in mechanically ventilated critically ill patients. Crit Care 2014;18(2):R12. DOI: 10.1186/cc13189.
  7. Gariballa S, Alessa A. Sarcopenia: Prevalence and prognostic significance in hospitalized patients. Clin Nutr 2013;32(5):772–776. DOI: 10.1016/j.clnu.2013.01.010.
  8. Heyland DK, Stapleton RD, Mourtzakis M, Hough CL, Morris P, Deutz NE, et al. Combining nutrition and exercise to optimize survival and recovery from critical illness: Conceptual and methodological issues. Clin Nutr 2016;35(5):1196–1206. DOI: 10.1016/j.clnu.2015.07.003.
  9. Heidegger CP, Berger MM, Graf S, Zingg W, Darmon P, Costanza MC, et al. Optimisation of energy provision with supplemental parenteral nutrition in critically ill patients: A randomised controlled clinical trial. Lancet 2013;381(9864):385–393. DOI: 10.1016/S0140-6736(12)61351-8.
  10. Petros S, Horbach M, Seidel F, Weidhase L. Hypocaloric vs normocaloric nutrition in critically ill patients: A prospective randomized pilot trial. J Parenter Enter Nutr 2016;40(2):242–249. DOI: 10.1177/014860 7114528980.
  11. Allingstrup MJ, Kondrup J, Wijs J, Claudius C, Pedersen UG, Hein-Rasmussen R, et al. Early goal-directed nutrition vs standard of care in adult intensive care patients: The single centre, randomised, outcome assessor-blinded EATICU trial. Intensive Care Med 2017;43(11): 1637–1647. DOI: 10.1007/s00134-017-4880-3.
  12. Puthucheary ZA, Rawal J, McPhail M, Connolly B, Ratnayake G, Chan P, et al. Acute skeletal muscle wasting in critical illness. JAMA 2013;310(15):1591–1600. DOI: 10.1001/jama.2013.278481.
  13. Guerreiro AC, Tonelli AC, Orzechowski R, Dalla Corte RR, Moriguchi EH, de Mello RB. Bedside ultrasound of quadriceps to predict rehospitalization and functional decline in hospitalized elders. Front Med (Lausanne) 2017;4:122. DOI: 10.3389/fmed.2017.00122.
  14. Parry SM, El-Ansary D, Cartwright MS, Sarwal A, Berney S, Koopman R, et al. Ultrasonography in the intensive care setting can be used to detect changes in the quality and quantity of muscle and is related to muscle strength and function. J Crit Care 2015;30(5):1151.e9–e14. DOI: 10.1016/j.jcrc.2015.05.024.
  15. Osler SW. The principles and practice of medicine: Designed for the use of practitioners and students of medicine. 1st ed. Edinburgh: Young J. Putland; 1892.
  16. De Jonghe B, Sharshar T, Lefaucheur J, Authier FJ, Durand-Zaleski I, Boussarsar M, et al. Paresis acquired in the intensive care unit: A prospective multicenter study. JAMA 2002;288(22):2859–2867. DOI: 10.1001/jama.288.22.2859.
  17. Pardo E, El Behi H, Boizeau P, Verdonk F, Alberti C, Lescot T. Reliability of ultrasound measurements of quadriceps muscle thickness in critically ill patients. BMC Anesthesiol 2018;18(1):205. DOI: 10.1186/s12871-018-0647-9.
  18. Hadda V, Khilnani GC, Kumar R, Dhunguna A, Mittal S, Khan MA, et al. Intra- and inter-observer reliability of quadriceps muscle thickness measured with bedside ultrasonography by critical care physicians. Indian J Crit Care Med 2017;21(7):448–452. DOI: 10.4103/ijccm.IJCCM_426_16.
  19. Katari Y, Srinivasan R, Arvind P, Hiremathada S. Point-of-care ultrasound to evaluate thickness of rectus femoris, vastus intermedius muscle, and fat as an indicator of muscle and fat wasting in critically ill patients in a multidisciplinary intensive care unit. Indian J Crit Care Med 2018;22(11):781–788. DOI: 10.4103/ijccm.IJCCM_394_18.
  20. Sabatino A, Theilla M, Hellerman M, Singer P, Maggiore U, Barbagallo M, et al. Energy and protein in critically ill patients with AKI: A prospective, multicenter observational study using indirect calorimetry and protein catabolic rate. Nutrients 2017;9(8):802. DOI: 10.3390/nu9080802.
  21. Tignanelli CJ, Andrews AG, Sieloff KM, Pleva MR, Reichert HA, Wooley JA, et al. Are predictive energy expenditure equations in ventilated surgery patients accurate? J Intensive Care Med 2019;34(5):426–431. DOI: 10.1177/0885066617702077.
  22. Arabi YM, Tamim HM, Dhar GS, Al-Dawood A, Al-Sultan M, Sakkijha MH, et al. Permissive underfeeding and intensive insulin therapy in critically ill patients: A randomized controlled trial. Am J Clin Nutr 2011;93(3):569–577. DOI: 10.3945/ajcn.110.005074.
  23. Dandona P, Mohanty P, Ghanim H, Aljada A, Browne R, Hamouda W, et al. The suppressive effect of dietary restriction and weight loss in the obese on the generation of reactive oxygen species by leukocytes, lipid peroxidation, and protein carbonylation. J Clin Endocrinol Metab 2001;86(1):355–362. DOI: 10.1210/jcem.86.1.7150.
  24. Gredilla R, Sanz A, Lopez-Torres M, Barja G. Caloric restriction decreases mitochondrial free radical generation at complex I and lowers oxidative damage to mitochondrial DNA in the rat heart. FASEB J 2001;15(9):1589–1591. DOI: 10.1096/fj.00-0764fje.
  25. Hyun DH, Emerson SS, Jo DG, Mattson MP, de Cabo R. Calorie restriction up-regulates the plasma membrane redox system in brain cells and suppresses oxidative stress during aging. Proc Natl Acad Sci USA 2006;103(52):19908–19912. DOI: 10.1073/pnas. 0608008103.
  26. Bloch S, Polkey MI, Griffiths M, Kemp P. Molecular mechanisms of intensive care unit-acquired weakness. Eur Respir J 2012;39(4): 1000–1011. DOI: 10.1183/09031936.00090011.
  27. Cahill GF. Starvation in man. N Engl J Med 1970;282(12):668–675. DOI: 10.1056/NEJM197003192821209.
  28. Dulloo AG, Jacquet J. The control of partitioning between protein and fat during human starvation: Its internal determinants and biological significance. Br J Nutr 1999;82(5):339–356. DOI: 10.1017/s0007114599001580.
  29. Reid CL, Campbell IT, Little RA. Muscle wasting and energy balance in critical illness. Clin Nutr 2004;23(2):273–280. DOI: 10.1016/S0261-5614(03)00129-8.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.