Critical Illness (CI) Impact of Environmental Factors on Resting Metabolic Rate Measurement: Physical Comfort/Posture - Critical Illness

Click here to see the explanation of recommendation ratings (Strong, Fair, Weak, Consensus, Insufficient Evidence) and labels (Imperative or Conditional). To see more detail on the evidence from which the following recommendations were drawn, use the hyperlinks in the Supporting Evidence Section below.

Recommendation(s)

CI: Environmental Factors and RMR

Ensure that each critically ill patient is in a physically comfortable posture before proceeding with the test, because discomfort will result in erroneously high RMR measures. Make sure that repeated measures are taken in the same position to ensure comparability of data.

Rating: Insufficient Evidence
Imperative

Risks/Harms of Implementing This Recommendation

No potential risks and harms are associated with the application of this recommendation.

Conditions of Application

Patient may be too uncomfortable or anxious to achieve an accurate measurement.

Potential Costs Associated with Application

No obvious costs are associated with the application of this recommendation.

Recommendation Narrative

One positive quality primary research study (Brandi et al, 1996) addressed the effects of physical comfort in thoracic surgical patients, but it is unclear whether the causative factor was posture or pain on RMR measures.

Recommendation Strength Rationale

The conclusion statement is Grade V, based on the opinion of the indirect calorimetry expert panel and limited primary research that addressed the question directly.

Supporting Evidence

The recommendations were created from the evidence analysis on the following questions. To see detail of the evidence analysis, click the blue hyperlinks below (recommendations rated consensus will not have supporting evidence linked).

In ill adult patients, are certain body positions associated with an increased metabolic rate when measuring by indirect calorimetry?

References

Brandi LS, Bertolini R, Janni A, Gioia A, Angeletti CA. Energy metabolism of thoracic surgical patients in the early postoperative period. Effect of posture. Chest. 1996;109:630-637.

Feurer I, Mullen JL. Bedside measurement of resting energy expenditure and respiratory quotient via indirect calorimetry. Nutr Clin Prac 1986; 1: 43-49.

References not graded in Academy of Nutrition and Dietetics Evidence Analysis Process

Compher C, Frankenfield D, Keim N, Roth-Yousey L; Evidence Analysis Working Group. Best practice methods to apply to measurement of resting metabolic rate in adults: a systematic review. J Am Diet Assoc. 2006 Jun;106(6):881-903. Review.