Resting energy expenditure in non-ventilated, non-sedated patients recovering from serious traumatic brain injury: Comparison of prediction equations with indirect calorimetry values

Background & aims: Little is known about energy requirements in brain injured (TBI) patients, despite evidence suggesting adequate nutritional support can improve clinical outcomes. The study aim was to compare predicted energy requirements with measured resting energy expenditure (REE) values, in patients recovering from TBI.

Methods: Indirect calorimetry (IC) was used to measure REE in 45 patients with TBI. Predicted energy requirements were determined using FAO/WHO/UNU and Harris–Benedict (HB) equations. Bland– Altman and regression analysis were used for analysis.

Results: One-hundred and sixty-seven successful measurements were recorded in patients with TBI. At an individual level, both equations predicted REE poorly. The mean of the differences of standardised areas of measured REE and FAO/WHO/UNU was near zero (9 kcal) but the variation in both directions was substantial (range 591 to þ573 kcal). Similarly, the differences of areas of measured REE and HB demonstrated a mean of 1.9 kcal and range 568 to þ571 kcal. Glasgow coma score, patient status, weight and body temperature were signi?cant predictors of measured REE (p < 0.001; R²⁼ 0.47).

Conclusions: Clinical equations are poor predictors of measured REE in patients with TBI. The variability in REE is substantial. Clinicians should be aware of the limitations of prediction equations when estimating energy requirements in TBI patients.

Waterfront retrieved. Buenos Aires’ contrasting leisure experience

The southern waterfront of the city of Buenos Aires has been recovered. Now that more than 20 years have passed since the projects began, we are able to get some perspective on these developments and can confront them with the integral history of this area. The areas of Puerto Madero, Costanera Sur, Reserva Ecológica and Santa María del Plata have distinctive characteristics and these are reflected in urban landscape, architecture and especially through the use of these spaces. Real estate developments cohabit with public space, tourism with local leisure facilities, and the most expensive office floors with local choripan1 stands, all of these in a development in which the state, the municipality, international corporations and real estate companies have collaborated and discussed to produce a hybrid new space for the city.