Estimating energy requirements in burned children: a new approach derived from measurements of resting energy expenditure13 Michael

I Goran,

Lyle

Broemeling,

ABSTRACI’

We examined

ergy

expenditure

(REE)

dren.

Predicted

area

(r2

basal and

0.76).

Days

postburn

for 21%,

and

accounted

body

REE above PBEE. was PBEE (REE

=

did

the

not

activity

used was

X PBEE);

X PBEE,

which

(1 .55

X PBEE)

to 2 X PBEE.

95%

of other

When

the

measurements

of energy

valid

approach

to estimating

Nutr

199 1;54:35-40.

KEY

WORDS

our

variables

data

lower

than

for larger

The energy

energy

presented

expenditure,

balance

energy

success and

represent

the

Energy

requirements

mination

of total

reported

that

tune,

indirect

calorimetry,

The veston

most

and

energy

expendi-

Unit March

excisional port was

Introduction that

aggressive

and

mortality

However,

it is also

evident

that

excessive

energy

intake

cannot

nutritional after

in severely

completely

support

severe

burn

stressed overcome

has

to achieve energy patients with large ular

used

patients, the

equations

is reason overestimate

balance in burned burns. This beliefhas

used

are

not

based

to believe energy children, arisen

on

by these loss. In fact, conventional

maintain

(4, 5). The

constant by the

J C/in Nutr

fact

body that

body

l991;54:35-40.

weight weight

Printed

maintenance in USA.

by deter(6)

recently with

the

children

to formulate

requirements.

8). The

been the

equations are acpatients receiving recommendations is not

is complia suitable

© 1991 American

Downloaded from https://academic.oup.com/ajcn/article-abstract/54/1/35/4691060 by guest on 24 April 2018

majority

of the

Society

From

from

TX,

weight, hospital

Basal

energy

basal

The

energy

via

enteral

Evansville, mixtures. The University

followed. (85

independent

expenditure,

of 127

observations variables body

surface

of BSA with 3#{176} burn injury (% BSA burned), and days

expenditure

Unit,

supde-

analysis

children

percentage admission

on admission

with

Nutritional previously

Board, were

1985

uniformly

was

retrospective

in females).

age, on

the Metabolism

Review

in 56 burned

were

intake

at the GalMarch

Isocal (Mead-Johnson, or, milk-Isocal

Galveston,

43 observations

treated

of energy

was generated

injury

between

described (7). to the equations

Institutional

Branch,

REE

for burn Institute

patients.were

were either milk, (Mead-Johnson),

to predict

by observation

of energy

situation

treated

equations of Harris and Benedict from height and weight (10). The

particularly in because the pop-

measurements

energy requirements recommended tually necessary to avoid weight markedly less energy intake than

We

be

catabo-

as determined

burned

Burns

as previously according

of REE

postburn.

that currently requirements

1

Am

All ofthe

Medical

area (BSA), as estimated

protein

expenditure. The basis for success of these equations has generally weight maintenance (3, 4). However, it is unclear whether

cated

1989.

measurements in males,

injury.

catabolic response (1) and can have detrimental physiological effects (2). Consequently, it is important to accurately estimate energy requirements. There used equations significantly

be predicated

energy

were

Shriners

A database agreed

studied

standards

of Texas

morbidity

in many

ofthe

therapy standardized (4,

ethical

It is generally

would

while

(TEE).

children,

to predicting

children

fluids, which IN), Prosobee

burns

improved

because

intake

technique, is strongly correlated with resting (REE). This observation led us to examine

ofREE

approach

ideally

expenditure

in burned

labeled water expenditure

scribed

requirements,

TEE

mainly

energy

in fat synthesis continues (1).

should energy

therapy,

excess

Methods

from

Am JClin

requirements.

Nutritional

of nutritional because

expected to result predominantly lism of heavier lean body mass

equal

are derived

they

of the retention

a new

balance

X PBEE#{176}75), approximately equations

indicator of fluid

R Wolfe

commonly

burns.

achieve

and Robert

the determinants

predict

energy

J Peters,

doubly energy

described

the

to maintain

in

of REE

recently

is used,

of patients

+ (2.39

Because

only

in the elevation

addition

is significantly

that

REE

predictor

patients

especially

to ensure

with

powerful

requirement

recommendations,

required

most

surface

(% BSA burned)

variation

prediction.

energy

size

enchil-

body

significantly

burn

ofthe

of 1.2 for burn

the average

is 1.55

24%

The single

improve factor

(PBEE),

correlated and

Edward

of resting in 56 burned

expenditure

weight

1.29

N Herndon,

the determinants

127 observations

energy

(BSA), =

that

in

David

was

predicted

(9) and BSA % BSA burned

in the usual

Shriners

manner,

Burns

from

the

was calculated was estimated

Institute,

and

we made

and the De-

partments of Anesthesiology and Surgery, University of Texas Medical Branch, Galveston, TX. 2 Supported by NIH grant GM-41089 and a grant from the Shriners Hospitals. 3 Address reprint requests to RR Wolfe, Shriners Burns Institute, 610 Texas Avenue, Galveston, TX 77550. Received September 14, 1990. Accepted for publication December 5, 1990. for Clinical

Nutrition

35

36

GORAN

TABLE I Description

of data group

ET

AL

TABLE 2 Individual correlations potential predictors

analyzed1

between

Resting

energy

expenditure

and

Variable Independent Age(y)

9±5

Weight (kg) Days Postburn BSA (m2) 30 Burn size (% BSA)

32.6 25 1.06 57

Predicted BEE (Mi/d)

4.76

17.6 20 0.39 24

± ± ± ±

PBEE (Mild)1 BSA (m2) Weight (kg)

(5.6-77.6)

(0-99) (0.28-1.94) (4-98)

SD (range).

6.19 1480 n

2.58 (1.41-15.70) 616 (337-3755)

± ±

127. BSA, body surface

=

PBEE,

basal

to adjust

this

factor and

to account

carbon calorimetry

indirect

metabolic cart (Fullerton, as previously described

REE, resting

for

coverage

tempt respect

was to

made fever,

usual

clinical

was

to control infection,

around the time was to examine

dioxide-production rates by use of a Beckman

were not

performed interrupted

for standardizing antibiotics, pain

of measurement. the determinants conditions.

available in the same measurements.

patients,

repeated they

were

in the early and no at-

conditions medication,

Our rationale of measured

When

which

was

diverse

age

3 mo-21

and

burn

thropometric basal energy burned, compare

(with etc)

for this approach REE under the

measurements treated

were

as independent

REE analysis

were constructed by by using the measured

of REE as the dependent variable. The independent were the potential predictors of REE and were the measurements expenditure

observed (PBEE),

energy

multiplied

requirements,

by the

use of value

variables usual an-

in burn patients [predicted BSA, weight, age, % BSA

Harris-Benedict

with

respect

y; body injury

to anthropometric

weight

(3#{176} burns

5.6-77.6 covering

measurements

4-98%

made

variables

kg; BSA

between

(eg,

0.28-1.94

of BSA). 0 and

m2); The

data

99 d after

burn

Prediction

ofresting

Table and

energy

2 summarizes

the

between

REE

the correlation

independent

ranged weight).

from The

primarily

variables.

on body

by indirect

diture, as predicted in Figure 1. The

postburn

the

ratio

% BSA

of REE

burned

are

is shown

to PBEE

during shown

REE expen-

equations,

in REE

(REE:

treatment in Figures

counted for only 2 1% and 24%, respectively, ofthe variation the elevation of REE above predicted normal. The single most powerful predictor of REE in this group

in

the

and % BSA burned

2

ac-

was

postburn

energy

thus

patients

Days

BSA, and is therefore between

basal

the Hams-Benedict

of the elevation and

and 3, respectively.

and

(r2)

coefficients

The relationship

size.

between

a reflection

days

analysis correlation

calorimetry,

from

relationships

PBEE),

The

0. 15 (% BSA burned) to 0.76 (PBEE, observed rate ofREE in burned children

dependent

as measured

expenditure

of

PBEE:

REE

=

1.29

X

(1)

PBEE

Three predicted

factor

study in burn

1.2. This

in which patients

components of energy expenditure (by use of the Harris-Benedict

sured

by indirect

calorimetry;

and

factor

of 1.2. Energy

REE by an activity expressed

as

MJ/d

and

are

TEE

Spreadsheet MA)

software or the

(Lotus

BMDP

activity

the (6).

20

factor

doubly

labeled r

are discussed: PBEE equations); REE meaderived

> 0 0

by multiplying

expenditure

accompanied

by

the

by using

either

Development

statistical

software

0 76

15

10

and intake caloric LU LU

equivalent (kcal/d) in parentheses. All statistical analyses were performed Cambridge,

was used to developed. for predicting REE

equations

activity

was derived in our recent water technique was used

5

the Lotus

Corporation, (BMDP

Inc,

Angeles).

0 0

2

4

FBEE

Results Data

from

and days postburnl. A predictive analysis the forecasting precision of the equations

To predict

Los

predicted

injury.

and

Equations for predicting stepwise-linear-regression

1-2-3

and

CA) with a face mask for gas collections (1). REE was derived by using the equa-

tion of Weir ( 1 1 ). Measurements morning. Continuous feeding

are

expenditure

of wounds.

Oxygen-consumption were measured by

were

energy

equations.

set included attempt

-0.28 0.15

area; BEE, basal energy

expenditure as predicted from the Harris-Benedict equations; energy expenditure as measured by indirect calorimetry.

no

0.73

Days posthurn % BSA burned

1.22 (1.78-8.00) (426-1914)

±

0.76 0.76 0.76

Age

I

Measured REE (Mild) (kcal/d)

healing

r2

1 138 ± 292

(kcalld)

I

variable

(0.33-21)

set

Table

1 summarizes

in 56 burned

children.

the data We treated

for 127 measurements the data

as one

entire

of REE group,

Downloaded from https://academic.oup.com/ajcn/article-abstract/54/1/35/4691060 by guest on 24 April 2018

6

8

10

(MJ/day)

FIG 1. Relationship between resting energy sured by indirect calorimetry and basal energy dicted by the equations of Harris and Benedict

expenditure expenditure (9).

(REE) mea(PBEE) pre-

ENERGY

EXPENDITURE

IN

BURNED

TABLE Percent

3 relative

LU

37

CHILDREN

Percent

error

in predicting

resting

energy

expenditure1

Percent

of patients

relative

errort

LU % C-

0 10 25 50

LU LU

DAYS

POST

where

r2

any

0.96

=

other

when

variables

above

predicted

value

(REE/PBEE)

as a

the

is fixed

equation

at zero.

did

not

Addition

improve

of equation

measurements cent

of the

predicted value,

ofthe

energy

pre-

were REE,

with

respect

REE

within

were

±45%

in the

127

Fifty

per-

to predicted

± 17%

within

(Table

determined

basal

energy

residual

95th

random

vari-

expenditure.

oftotal

energy

Use of the activity (6) allowed derivation

requirements

percentile

was

to be

equation

factor ofan

TEE Because value

this

equation

of PBEE,

have

a TEE

1.2 from our previous publication equation to predict the average TEE: =

is the

was

percentile,

patients, our

the

less than

can

value

be derived

analysis,

the

the

for TEE

of the

value

given

the standard expenditure

of TEE by using

standard

value

one-half

the average value ofTEE and a given value of basal energy 95th

average

approximately

that

(2)

1.55 X PBEE

that

would

in equation

is exceeded

(1.55

=

X PBEE)

+ (2.39

the energy

at least

enough

value

normal

multiplied the

(3)

X PBEE#{176}75)

required energy

was

distribution,

to ensure to reach

that

a state

95%

of

of energy

The resulting value for an average patient in this study 1 ) is 9.32 MJ/d (2229 kcal/d), which is approximately to twice

the PBEE

5 displays by four

other

[9.5 1 MJ/d

the energy

(2276

kcal/d)].

requirements

equations

that would

currently

in use

be pre-

in addition

to

were prewith a burn

injury

in Figure

covering

either

30%

or 80%

BSA.

As seen

5,

our predictions are well below the lowest value. The equation designed to include 95% of patients (Eq 3) is approximately equal to the value ofequation 2 X PBEE, promulgated by Wolfe (12), which predicts energy requirements that are -20% lower than

for the

LU

those

predicted

by the

Long

equation

(13).

by 5% of the

linear

of TEE

50% of energy

our new equations 2 and 3. The energy requirements dicted for the average patient in the present study

2. If

deviation ofTEE are known, then

weighted

deviation

for a given

patients

found

predicts

receive

balance. (Table

dicted

this

of the standard

patients

equal

X PBEE#{176}75.When

5% point

Figure Prediction

1.29 X PBEE.

relative error of 127 predictions. Thus, 17% from the observed rate of resting

upper

TEE This

as a

4 as a function

show

as 1 .452

by the

and

expressed

in Figure

residuals

by using the equation

percent deviated by

of the

±30%,

3). The

predicted),

is displayed

4, these

within

were

minus

As seen in Figure

REE

was determined.

predictions

(measured

of measured

ation

for

ofthe

predictions

ofPBEE.

children

values

75%

expenditure

percent

1 in predicting

in 56 burned

measured 90%

Values

timated reliability

44.84 189.0

of

the

diction. The

30.10

90 100

t The median predictions expenditure.

the intercept into

75

BURN I

FIG 2. Elevation in REE function of days postburn.

0.41 4.42 9.34 17.08

regression.

predictions

In

was

LU

200

-

150

-

100

-

es-

2.5 r=0.24 I

LU

2.0

.. . ‘-,

LU I

..

:

I

1.0 S

I

(1’) LU

:.

#{149} #{149}

2

4

PBEE

I

20

40

60

SIZE

80

#{149}#{149}#{149}

I

,: #{149}#{149}S.

#{149}.

50 0

BURN FIG function

:

#{149}#{149}.#{149}

I

0.5

0

1t2

I

0

0 I

0.0

,S.

-J

I

C-

#{149}

.1

1.5

LU LU

50

.

6

8

10

(MJ/day)

100

(% TBSA)

3. Elevation in REE above predicted value (REE/PBEE) of burn size [% total body surface burned (% TBSA)J.

Downloaded from https://academic.oup.com/ajcn/article-abstract/54/1/35/4691060 by guest on 24 April 2018

as a

FIG 4. Residual of the predicted REE vs PBEE. The residual is the difference between the observed REE and the REE predicted by equation 1 (REE = 1.29 x predicted basal) and expressed as a percentage of the measured REE.

38

ET AL

GORAN I-

z

20

LU

::::i

LU

30%

burn

80%

burn

15

C

LU LL

>-0

0

10

LU LU’

F

5

0 LU

I-

0-

(I) LU

1 .55.PBEE

1 .55.PBEE

2.PBEE

Long

Galveston

Curreri

+

2.39.PBEEP75 FIG 5. Total energy requirements (I Mi/d = 239.2 kcal/d) for energy balance in burned children, as predicted by various equations. Energy requirements were estimated for the average patient in this study with either a 30% or an 80% burn. Requirements were estimated by using the following equations: 1.55 X PBEE, equation 2; (1.55 X PBEE) + (2.39 X PBEE#{176}75), equation 3; 2 X PBEE, reference 12; 2.52 X PBEE, Long equation (13); Galveston equation (4); Mi/d = (6.27 X BSA) + (6.27 X burn in m2), kcal/d = (1500 X BSA) + (1500 X burn in m2), Curreri equation (3); Mi/d = (0. 105 X weight) + (0. 167 X % of BSA burned), kcal/d = (25 X weight) + (40 X % of BSA burned). PBEE, basal energy expenditure predicted from Harris-Benedict equations (9); BSA, body surface area (m2); weight, body weight (kg).

The

most

important

presented

and

equations

is that

of the from burns, trative

the

burn.

difference

popular the

The

new

equations

are dependent

latter

discrepancy

in Figure

the

(4, 8) and

between

the various equations such as the 80% burn purposes

between

Galveston

the

equations

Curreri

of basal

et al (3) on the

estimations

size

derived

is particularly evident chosen as representative

with large for illus-

5.

energy

equations

recovery recovery

study

burned

represents

children.

The

dren is primarily of the elevation liably predicted

the

most

analysis

extensive

revealed

analysis

that

REE

dependent on body size, and in REE above predicted normal from the extent of burn injury.

of REE

during

this period

in burned

chil-

REE

dicted

basal

mean

of 271

size

was

was

expenditure injury

surprising

useful

state

to the recovered

ulation

such

not

other

set of equations

cifically dren

designed (14).

ments

equations

(WHO)

of energy data

greater

than

that

for children.

with those basal

WHO

3. 1 ± 7.5%

when

comparison.

The

energy

expenditure

expenditure

in children

predictions.

aged

thus




50% of BSA. and protein

Similarly, metabolism

in the many conducted

EXPENDITURE

studies in our

IN

of carbohydrate, laboratory (1, 2),

BURNED

27%

ofthe

coefficient

described

It is difficult

to assess

we never observed a significant effect of burn size in patients with a burn size > 40% of BSA. Equations estimating energy requirements based on percent burn size in patients with large

al equation

because

burns

first

fat,

are thus

not

It is unclear presence

based

on established

how much

of burn

injury

of the elevation itself

and

explained by energy expenditure effect of feeding. For example, the

entire

effect

elevation

of feeding.

expenditure

in We

REE

have

associated

ivation

of the

new

metabolic

how

in REE

much

in burn

patients effect

by using

the

the

of feeding

relationship

feel

that

physical

it is appropriate

activity

for other

increases

with

patients.

This

convalescence

of TEE to REE will generally be higher later during the initial stages. Therefore the factor overestimate

the

prediction

of TEE

from

energy

requirements

contain

a factor

actual

measurements

in burned for burn

children.

size,

Whereas

neither

ofenergy

equation

expenditure.

the

ratio

(MJ/d)

Using

from

our database,

x burn

TEE

(kcal/d)

=

(1 180 X BSA

Both coefficients than

x

derived

X burn

in this equation

are substantially

used

be explained

by Hildreth burned volume water

by the fact that

et al (4) was

children of fluid vaporization

based

size in m2)

the original

(4) lower

[kcal/d = (1800 large discrepancy

approach

on observations

described

of fluid

in

during the initial 48-h resuscitation phase. The loss was then multiplied by the energy cost of to derive

the coefficient.

This

factor

is there-

fore

inappropriate on two accounts. First, it is based only on observations made in patients treated during acute resuscitation, and second, it is not based on actual measurements of energy expenditure. and

Similarly, % BSA

when TEE was expressed in terms of body weight burned, an equation comparable to the Curreri et

al (3) equation TEE

(MJ/d)

was generated:

(0. 147

=

X weight

in kg)

+ (0.045 TEE

(kcal/d)

=

(35.2

X weight

determined

X % BSA burned)

in kg)

+ (10.8 Our experimentally

body-weight

coefficient

weight

during

the

X % BSA burned) for % BSA burned

Downloaded from https://academic.oup.com/ajcn/article-abstract/54/1/35/4691060 by guest on 24 April 2018

requirements.

the

predictive

3 are limited.

were

dependent

The

power

of the

observation

within

and,

±17%

that

as already

ofthe

discussed,

the

interpre-

weight in burn patients is complex and may not reflection of metabolically active tissue. Second,

of body likely

that

therapy

involved,

patient,

and

to control the

a combination

(5)

is

use

presence for these

determinants

treated

offactors

our

of excisional offever

in addition

early

treated

conditions

Institute

because under

to PBEE

could

our

natural

they

are

excision

not

hormonal

status

We made aim

of

no attempt

was to examine

clinical

circumstances

laboratory conditions. Although our in a population of burn children

excision,

without

surgery,

or infection.

of REE

to controlled were developed

with

detect

likely

because any

to be appropriate

a previous

difference

report

in REE

in

from

in adults

with and without excisional surgery (19). In a recent publication, Allard et al (20) assessed the performance of a complex equation for predicting REE in burn patients, which includes factors to account for % BSA burned, treated

energy

loss

estimated

used,

2 and

50% ofpredictions

patients

in the actual Galveston equation BSA in m2) + (2200 x burn size in m2)]. This

can

those

size in m2)

in m2)

+ (845

was a retrospective

in body

measured value can be explained by a number of factors. First, the predictions of basal energy expenditure that we used were determined by the equations of Harris and Benedict (9), and as already stated, these may be inappropriate for children. Moreover, whichever equation is used, the predictions ofbasal energy expenditure are only

as opposed equations + (3.53

of the

database

equations

it is also

equations

both

are

also affect REE. These might include nutritional status of the patient at the time of REE measurement, activity ofthe subject (eg, dressing change) preceding measurement, time between measurement and most recent surgery, type of medication and

of predicting

was derived

20%

large

be an accurate et al equation

x BSA in m2)

(4.93

=

only

the

proposed

tation

we rederived equations with similar general structures to the Galveston and Current equations. When TEE is expressed in terms of BSA and m2 burn (cf, the original Galveston approach), the following was obtained: TEE

received

Despite

measurements

in the early stages of recovery. The Galveston equations (4, 8) and the Curreri (3) are probably the most commonly used means

study

changes

et

rationale

weight

in recovery than 1.2 may tend to

REE

(3). Their

and

or even

in der-

is because

so that

paper

data

(3).

in the Curreri

20 d of recovery in nine burn patients. Change in body weight was plotted against actual dietary intake, expressed as a

between

REE and TEE. This factor (1.2) was determined experimentally in a limited number of patients by using the doubly labeled water technique to measure TEE (6). Although this factor was derived in a patient group studied in the latter stages of recovery,

we

supportive

intake

et al equation

for the factors

energy

thermic

for the

no

in the original ofdietary

in the Curreri

the basis

percentage of ideal caloric intake calculated by the Curreni formula. Even the original data presented by Curreri et a! (3) argue against the validity of the equation because patients receiving significantly less energy intake than prescribed by the equation nonetheless maintained body weight. The only patient who lost

be potentially

by

accounted

the thermic

equations

is due to the

can

associated with the thermic Allard et al (18) accounted for

indirectly

with

processes.

provided analysis

39

CHILDREN

intake,

PBEE,

complex

equation

not

that

clear

temperature,

is cumbersome

significant

power

energy

requirements

PBEE.

If we had included

et al (20) in our analysis,

by the the

and

days

to use and is added

consideration

postburn.

furthermore

to the

This

it is

predictions

of factors

other

of than

the additional factors used by Allard r2 ofour predictive equation would

have decreased. In addition to the problems of formulating a good equation, it must be realized that there is a certain amount of variation in REE that is not explained by body size or body composition even in normal volunteers (2 1, 22). It is of further concern that the error assessment presented in Table 3 does not include the error in predicting TEE from REE. From our previous experiment in a limited number of patients in whom both REE and TEE were measured (6), equation 2 functioned poorly in predicting TEE even though there was a significant correlation between TEE and REE. In summary, the most reliable estimates of energy requirements are obtained by actual measurements of REE on an in-

40

GORAN

dividual basis in conjunction which is 1.2 in the convalescent of REE that

is not

if energy

patients

will

to their

feasible, receive

desirable

to

x PBEE

to energy

paper

twice

an amount

In severely

stressed of energy

energy

according

this will be sufficient

the

support

the

PBEE,

patients

intake who it may

to

equation

to maintain

all equal

are unable

excess, the

notion

virtually

of energy

side effects

provide

because

in this

at about

at least

expenditure. potential

close

the data

is provided

to tolerate

with an appropriate activity factor, burned child (6). If measurement

be more 1.55

most patients

U

balance.

We are grateful to Manu Dessai who allowed us ments ofresting energy expenditure in patients under we thank Tom Rutan, James Richardson, and the staffofthe Shriners Burns Institute for performing calorimetry measurements.

to perform measurehis cane. In addition, Respiratory Therapy some ofthe indirect

References 1. iahoor F, Desai M, Herndon DN, Wolfe RR. Dynamics ofthe protein metabolic response to burn injury. Metabolism 1988;37:330-7. 2. Wolfe RR. Nutrition and metabolism in burns. Crit Care Med l986;7: 19-63.

3. Curreri PW, Richmond D, Marvin i, Baxter CR. Dietary requirements of patients with major burns. i Am Diet Assoc 1974;65: 415-7. 4. Hildreth MA, Herndon DN, Desai MH, Duke MA. Caloric needs of adolescent patients with burns. i Burn Cane Rehabil 1989;l00: 523-6. 5. Cunningham ii, Lydon MK, Russell WE. Calorie and protein provision from severe burns in infancy and young children. Am i Clin Nutr l990;51:553-7. 6. Goran MI, Peters El, Herndon DN, Wolfe RR. Total energy cxpenditure in burned children using the doubly labeled water technique. Am J Physiol l990;259:E576-85. 7. Herndon DN, Curreri PW, Abston 5, Rutan TC, Barrow RE. Treatment ofburns. Curr Probl Surg 1987;2:347-97.

Downloaded from https://academic.oup.com/ajcn/article-abstract/54/1/35/4691060 by guest on 24 April 2018

ET

AL

8. Hildreth MA, Carvajhal HF. Caloric requirements in burned children: a simple formula to estimate daily caloric requirements. i Burn Care Rehabil l982;3:78-80. 9. Harris iA, Benedict FG. A biometric study of basal metabolism in man. Washington, DC: Carnegie Institute of Washington, 1919. (Publication no. 279.) 10. Du Bois D, Du Bois EF. A formula to estimate the approximate surface area if height and weight are known. Arch Intern Med 19 16; 17:863-7 1. I 1. Weir deJB. New methods for calculating metabolic rate with special reference to protein metabolism. J Physiol l949;l09:l-9. 12. Wolfe RR. Caloric requirements of the burned patient. i Trauma 198 1;2 l(suppl):7 12-4. 13. Long C. Energy expenditure of major burns. i Trauma 1979;19: 904-6. 14. World Health Organization. Energy and protein requirements. WHO Tech Rep 5cr 1985:724. 15. Wilmore DW, Long JM, Mason AD, Streen AW, Pruitt BA Jr. Catecholamines: mediator of the hypermetabolic response to thermal injury. Ann Surg 1974;l80:653-69. 16. Caldwell FT ir, Bowser BH, Crabtree JH. The effect of occlusive dressings on the energy metabolism of severely burned children. Ann Surg 198 l;193:579-9l. 17. Bradham GB. Direct measurement oftotal metabolism ofa burned child. Arch Surg l972;105:4l0-3. 18. Allard JP, ieejheebhoy KN, Whitwell J, Pashutinski L, Peters Wi. Factors influencing energy expenditure in patients with burns. i Trauma l988;28: 199-202. 19. Rutan TC, Herndon DN, Van Osten T, Abston S. Metabolic rate alterations in early excision and grafting versus conservative treatment. J Trauma l986;26:l40-2. 20. Allard iP, Pichard C, Hoshino E, et al. Validation ofa new formula for calculating the energy requirements of burn patients. JPEN 1990;14:l 15-8.

21.

22.

Fontain ER, Savard A, Trembly iP, Despres E, Poehlman ET, Bouchard C. Resting metabolic rate in monozygotic and dyzygotic twins. Acta Genet Med Gemellol (Roma) I985;34:4 1-7. Ravussin E, Lillioja S, Anderson TE, Christin L, Bogardus C. Dcterminants of 24-hour energy expenditure in man. Methods and results using a respiratory chamber. i Gin Invest 1986;78:1568-78.

Estimating energy requirements in burned children: a new approach derived from measurements of resting energy expenditure.

We examined the determinants of resting energy expenditure (REE) in 127 observations in 56 burned children. Predicted basal energy expenditure (PBEE),...
983KB Sizes 0 Downloads 0 Views