Question

How should a critically ill patient's energy delivery be modified in response to resting energy expenditure (REE) measured by indirect calorimetry?

1: reduced by 10% if respiratory quotient exceeds 1.0.
2: increased by a stress factor of 1.2-1.5 for sepsis or trauma.
3: adjusted by a thermogenesis factor for enterally fed patients.
4: used as the caloric target without addition of stress or activity factors.

Answer 1

Critically ill patients should have their energy delivery modified based on the REE measured by indirect calorimetry, considering factors like the RQ, the presence of sepsis or trauma, whether they are enterally fed, and any necessary stress or activity factors. The correct option is 1.

Step-by-step explanation:

When addressing how a critically ill patient's energy delivery should be modified in response to resting energy expenditure (REE) measured by indirect calorimetry, several factors should be considered:

1. If the respiratory quotient (RQ) exceeds 1.0, indicating a predominance of carbohydrate metabolism possibly leading to lipogenesis, the energy delivery should be reduced by 10% to avoid overfeeding and the potential complications associated with it.
2. In the case of sepsis or trauma, the energy delivery should be increased, often using a stress factor of 1.2-1.5, to address the heightened physiological demands of these conditions.
3. For enterally fed patients, an adjustment by a thermogenesis factor is necessary to account for the energy required for digestion and absorption of nutrients.
4. REE measurements by indirect calorimetry can be used as the caloric target, but it is crucial to consider whether additional stress or activity factors should be incorporated based on the patient's condition.

It is essential that energy delivery be personalized to the patient's specific needs and conditions to optimize their nutritional status and overall recovery. The correct option is 1.