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High correlation between increased negative calorie balance and morbidity in critically ill patients

Accurate energy balance is difficult to assess since prescribed energy intake is not always actual energy intake administered, intravenous dextrose given as part of a fluid program is not always taken into account and resting energy expenditure (REE) is not usually measured on a daily basis. We used a bedside computerized information system to measure daily and cumulative energy balance in critically ill ventilated patients to assess its impact on patient outcome.

Methods and patients

Twenty-five ventilated patients (mean age 54.7 ± 18.4 years, 19 males, six females) were prospectively followed during their ICU stay. Energy balance (REE) was measured daily using both indirect calorimetry (Deltatrac II, Datex-Ohmeda, Finland) and a bedside computerized information system (iMDsoft, Israel) which was able to collect data from all sources (enteral, parenteral nutrition and and IV fluids containing calories). Daily and total energy balance were calculated on a continuous basis. Morbidity (acquired organ dysfunction, pressure sores, need for surgery) and mortality were noted.


Mean body mass index was 26.9 ± 5.0 kg/m2 and mean APACHE II was 22.7 ± 7.2. The bedside information system revealed a mean IV calorie intake of 154 kcal/day and reaching 370 kcal/day in some patients. Mean cumulative balance for an overall ICU stay of 395 days was -4261 kcal (range 172 to -17,274 kcal). Six of 25 patients had a negative calorie balance > -10,000 kcal. A strong correlation (r = -0.75) was found between negative energy balance and complication rate, but not with length of ventilation, length of ICU stay or length of hospitalization. Six patients died (three had a negative energy balance > -10,000 kcal).


We conclude that a bedside information system provides online and accurate information regarding energy balance in critically ill patients and may allow for the early detection and prevention of severe negative energy balance, which is correlated with the occurrence of significant complications (organ dysfunction and pressure sores).

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Dvir, D., Gibstein, L., Grozovski, E. et al. High correlation between increased negative calorie balance and morbidity in critically ill patients. Crit Care 7, P013 (2003).

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  • Energy Balance
  • Energy Intake
  • Organ Dysfunction
  • Indirect Calorimetry
  • Pressure Sore