Not Every Patient Is the Same: Comparing Energy Needs for Wound Healing Using Predictive Equations vs. Measured Using Indirect Calorimetry

Introduction: The purpose of this study was to validate the use of an Indirect Calorimetry (IC) reading to determine a more accurate picture of the caloric need per individual patient with a goal of wound healing. We hypothesized that the “one-size-fits-all” predictive equation of 30-35 kcal/kg would not match the patient’s measured resting and total energy expenditures (REE/TEE). Methods: Participants needed to have a chronic wound. After a 5 hour fast, they completed an IC reading monthly for a minimum of 2 measure- ments and up to healing. The machine would analyze the carbon dioxide and oxygen exchange rate to determine the resting energy expenditure. The reading would take 10-20 minutes. REE was then multiplied by an activity factor based on individual lifestyle (0.1 for normal daily activities - 0.2 for moderate exercise) to provide a measured TEE. Results: The resulting data showed that there was a significant differ- ence in the measured TEE vs. the predictive equation. The predictive equation in every case either over- or under-estimated the patient’s calo- rie needs; in most cases it grossly over-estimated the patient’s need. The predictive equation of 30 kcal/kg was the closest to the measured TEE, however it was still more than the patient actually needed. Discussion: We concluded from our study that the IC should be a tool utilized in the outpatient setting to give our patients a more individual- ized plan of care. Additionally, through the process we discovered that most patients had no understanding of how nutrition played a role in healing. This ultimately lead our Wound Clinic to to hiring a dietitian as part of the staff who is now part of every patient’s plan of care with us.