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Background & aims: The ICALIC project was initiated for developing an accurate, reliable and user friendly indirect calorimeter (IC) and aimed at evaluating its ease of use and the feasibility of the EE measurements in intensive care unit (ICU).Methods: This was a prospective unblinded, observational, multi-center study. Simultaneous IC measurements in mechanically ventilated ICU patients were performed using the new IC (Q-NRG®) and currently used devices. Time required to obtain EE was recorded to evaluate the ease of use of Q-NRG® versus currently used ICs and EE measurements were compared. Conventional descriptive statistics were used: data as mean ± SD.Results: Six centers out of nine completed the required number of patients for the primary analysis. Mean differences in the time needed by Q-NRG® against currently used ICs were -32.3 ± 2.5 min in Geneva (vs. Deltatrac®; p < 0.01), -32.3 ± 3.1 in Lausanne (vs. Quark RMR®; p < 0.05), -33.7 ± 1.4 in Brussels (vs. V-Max Encore®; p < 0.05), -26.4 ± 7.8 in Tel Aviv (vs. Deltatrac®; p < 0.05), -28.5 ± 3.5 in Vienna (vs. Deltatrac®; p < 0.05), and 0.3 ± 1.2 in Chiba (vs. E-COVX®; p = 0.17). EE (kcal/day) measurements by the Q-NRG® were similar to the Deltatrac® in Geneva and Vienna (mean differences±SD: -63.1 ± 157.8 (p = 0.462) and -22.9 ± 328.2 (=0.650)), but significantly different in Tel Aviv (307.4 ± 324.5, p < 0.001). Significant differences were observed in Lausanne (Quark RMR®: -224.4 ± 514.9, p = 0.038) and in Brussels (V-max®: -449.6 ± 667.4, p < 0.001), but none was found in Chiba (E-COVX®; 55.0 ± 204.1, p = 0.165).Conclusion: The Q-NRG® required a much shorter time than most other ICs to determine EE in mechanically ventilated ICU patients. The Q-NRG® is the only commercially available IC tested against mass spectrometry to ensure gas accuracy, while being very easy-to use.

The aim of this study was to assess the perioperative invasiveness of endoscopic submucosal dissection for colorectal cancer quantitatively by using energy metabolism. In fifty-three patients who underwent endoscopic submucosal dissection for colorectal cancer, resting energy expenditure using an indirect calorimeter, body weight and basal energy expenditure using the Harris-Benedict equation before and after endoscopic submucosal dissection. Resting energy expenditure/body weight and resting energy expenditure/basal energy expenditure were 19.7 ± 2.5 kcal/kg/day and 0.96 ± 0.12 on the day of endoscopic submucosal dissection, whereas one day after the endoscopic submucosal dissection they increased to 21.0 ± 2.9 kcal/kg/day and 1.00 ± 0.13 (p

International audience; Indirect calorimetry (IC) is considered as the gold standard to determine energy expenditure,by measuring pulmonary gas exchanges. It is a non-invasive technique that allows clinicians topersonalize the prescription of nutrition support to the metabolic needs and promote a better clinicaloutcome. Recent technical developments allow accurate and easy IC measurements in spontaneouslybreathing patients as well as in those on mechanical ventilation. The implementation of IC inclinical routine should be promoted in order to optimize the cost–benefit balance of nutrition therapy.This review aims at summarizing the latest innovations of IC as well as the clinical indications,benefits, and limitations.

Summary Rationale Accurate evaluation of the energy needs is required to optimize nutrition support of critically ill patients. Recent evaluations of indirect calorimeters revealed significant differences among the devices available on the market. A new indirect calorimeter (Q-NRG®, Cosmed, Roma, Italy) has been developed by a group of investigators supporting the international calorimetry study initiative (ICALIC) to achieve ultimate accuracy for measuring energy expenditure while being easy to use, and affordable. This study aims to validate the precision and the accuracy of the Q-NRG® in the in-vitro setting, within the clinically relevant range for adults on mechanical ventilation in the ICU. Mass spectrometry is the reference method for the gas composition analysis to evaluate the analytic performances of the Q-NRG®. Methods The accuracy and precision of the O2 and CO2 measurements by the Q-NRG were evaluated by comparing the measurements of known O2 and CO2 gas mixtures with the measurements by the mass spectrometer (Extrel, USA). The accuracy and precision of the Q-NRG® for measurements of VO2 (oxygen consumption) and VCO2 (CO2 production) at clinically relevant ranges (150, 250 and 400 ml/min STPD) were evaluated by measuring simulated gas exchange under mechanically ventilated setting at different FiO2 settings (21–80%), in comparison to the reference measurements by the mass spectrometer-based mixing chamber system. Results The measurements of gas mixtures of predefined O2 and CO2 concentrations by the Q-NRG® were within 2% accuracy versus the mass spectrometer measurements in Passing Bablok regression analysis. In a mechanically ventilated setting of FiO2 from 21 up to 70%, the Q-NRG® measurements of simulated VO2 and VCO2 were within 5% difference of the reference mass spectrometer measurements. Conclusion In vitro evaluation confirms that the accuracy of the Q-NRG® indirect calorimeter is within 5% at oxygen enrichment to 70%; i.e. maximum expected for clinical use. Further recommendations for the clinical use of the Q-NRG® by will be released once the ongoing multi-center study is completed.

Reduced moderate-to-vigorous physical activity (MVPA) and increased sedentary behavior (SB) are common following stroke, which can limit stroke recovery and contribute to greater cognitive decline. Hence, the MVPA and SB of adults with stroke should be measured concurrently using objective methods. One currently available method for objectively measuring MVPA and SB is the MotionWatch8© (MW8). However, adults with stroke can have significant mobility restrictions (depending on stroke severity) and thus it is important to determine separate MVPA and SB cut-points for adults with stroke, as well as validate separate cut-points: (1) when the MW8 is worn on the stroke affected side compared to the non-affected side; and (2) for adults with mild stroke versus adults with moderate-to-severe stroke. In the current study, we concurrently measured MW8 actigraphy (worn on both the stroke affected side and the non-affected side) and indirect calorimetry during 10 different activities of daily living for 43 adults with stroke (aged 55–87 years). Using intra-class correlations (ICC), we first investigated the agreement of the MW8 when placed on the affected side as compared to the non-affected side for: (1) all participants irrespective of stroke severity; (2) participants with mild stroke, classified as a Fugl Meyer motor score of ≥79/100; and (3) participants with moderate-to-severe stroke (i.e., Fugl Meyer < 79/100). We then determined cut-points for all participants—as well as separate cut-points based on stroke severity—on both the stroke affected side and non-affected side for SB and MVPA using receiver operating characteristic curves. The results of our analyses indicate that the agreement in MW8 output between the stroke affected and non-affected sides was moderate across all participants (ICC = 0.67), as well as for each sub-group (mild stroke: ICC = 0.64; moderate-to-severe stroke: ICC = 0.77). Additionally, the results of our cut-point analyses support using different cut-points for different levels of stroke severity and also for the stroke affected side. We determined the following cut-points: (1) for the affected side, adults with mild stroke have cut-points of SB ≤134 counts per minute (CPM) and MVPA ≥704 CPM, while adults with moderate-to-severe stroke have cut-points of SB ≤281 CPM and MVPA ≥468 CPM; and (2) the non-affected side, adults with mild stroke have cut-points of SB ≤162 CPM and MVPA ≥661 CPM, while adults with moderate-to-severe stroke have cut-points of SB ≤281 CPM and MVPA ≥738 CPM. Hence, these data provide a new measure for concurrently examining the dynamic relationships between MVPA and SB among adults with stroke.

The aim of this study was to investigate the change in the energy metabolism and invasiveness in the perioperative period of endoscopic submucosal dissection for early gastric cancer. Fifty-two consecutive patients were enrolled into the study between July 2013 and May 2014 and examined resting energy expenditure using an indirect calorimeter, body weight and basal energy expenditure using the Harris-Benedict equation before and after endoscopic submucosal dissection. Resting energy expenditure/body weight and resting energy expenditure/basal energy expenditure were 20.2 ± 3.0 kcal/kg/day and 0.96 ± 0.11 on the day of endoscopic submucosal dissection, whereas one day after the endoscopic submucosal dissection they were 21.7 ± 3.2 kcal/kg/day and 1.03 ± 0.14, showing significant increases (p

The incidence of patients requiring ICU admission is as high as 32-55% after major abdominal surgeries due to severe abdominal complications. Mechanical ventilation is sometimes necessary during intensive treatment. Prognosis remains poor with mortality rate of 29-42%. Success in weaning from mechanical ventilation in these patients remains a big problem.