PP192-SUN MEASURED VERSUS CALCULATED RESTING ENERGY EXPENDITURE IN CRITICALLY ILL ADULT PATIENTS. DO MATHEMATICS MATCH THE GOLDEN STANDARD?

Nutritional techniques and formulations Conclusion: An increase in glucose concentration and the absence of lipid independently reduced growth of E. coli and E. durans in PN. Both factors need to be considered when developing policies on the maximum duration of PN bag infusion. Acknowledgement The 2012 Galen Award from Pharmacy Research UK. Disclosure of Interest: P. Austin Grant/Research Support: Funding through the Pharmacy Research UK 2012 Galen Award, K. Hand: None Declared, J. Palmer: None Declared, K. Longmaid: None Declared, C. Willis: None Declared, D. Lamph: None Declared, M. Elia: None Declared

PP192-SUN MEASURED VERSUS CALCULATED RESTING ENERGY EXPENDITURE IN CRITICALLY ILL ADULT PATIENTS. DO MATHEMATICS MATCH THE GOLDEN STANDARD? E. De Waele1 , T. Opsomer1 , S. Mattens1 , M. Diltoer1 , P.M. Honor´ e1 , H. Spapen1 , L. Huyghens1 . 1 Intensive Care, UZ Brussel, Brussel, Belgium Rationale: Indirect calorimetry (IC) is considered to be the standard method for estimating energy requirements in intensive care unit (ICU) patients. However, most ICU clinicians still rely on various mathematical formulas to calculate caloric requirements in their patients. We assessed whether measurements obtained by IC correlated with the results of such commonly used equations. Methods: Retrospective study in consecutively hospitalized patients in a mixed medicosurgical adult ICU. In all patients, resting energy expenditure (REE) was measured by IC as a standard part of the development of a nutritional care plan between January 2011 and December 2012 and simultaneously calculated from 10 distinct predictive equations. IC was performed with the VmaxTM Encore 29n calorimeter (VIASYS Healthcare Inc, Yorba Linda, CA). The Bland-Altman method and regression analysis was used to assess agreement between measured and calculated REE. Results: 191 critically ill patients were studied (age 62; 57% males), 161 subjects (84%) were mechanically ventilated. Measured REE was 1571±423.5 kcal/24 h with VO2 0.23±0.06 L/min and VCO2 0.18±0.05 L/min. Calculated values very weakly correlated with IC-derived measurements with none of the equations reaching an R2 > 0.5 with the exception of the Swinamer equation (R2 0.51). Formulas that are widely used in daily ICU practice such as the Harris Benedict 1984, Faisy-Fagon and ESICM ‘98 statement equations reached R2 values of respectively 0.44, 0.49, and 0.41. Under-as well as overestimations occurred. Conclusion: In critically ill adult patients, measured resting energy expenditure poorly correlated with calculated values, regardless what formula was used. Our findings underscore the important role of IC to adequately estimate energy requirements in this particular frail population. Disclosure of Interest: None Declared

S95 PP193-SUN A NON-COAGULATING PROTEIN BLEND CAN ACCELERATE GASTRIC EMPTYING OF ENTERAL NUTRITION: A DOUBLEBLIND RANDOMIZED CROSS-OVER TRIAL BY MAGNETIC RESONANCE IMAGING S. Kuyumcu1 , M. Dieter2 , J. Curcic3 , O. Goetze1 , M. Klebach4 , E. Abrahamse4 , Z. Hofman4 , M. Fried1 , W. Schwizer1 , A. Steingoetter3 . 1 Division of Gastroenterology and Hepatology, University Hospital Zurich, Zurich, Switzerland; 2 Menne Biomed Consulting, T¨ ubingen, Germany; 3 Institute for Biomedical Engineering, University and ETH Zurich, Zurich, Switzerland; 4 Nutricia Advanced Medical Nutrition, Danone Research, Utrecht, Netherlands Rationale: The gastric accumulation of enteral nutrition in tube fed patients leads to an increased risk of regurgitation. Various studies have suggested that the protein source in enteral nutrition might affect gastric emptying, probably due to secretion induced differences in coagulation. This study used magnetic resonance imaging to non-invasively assess the half-emptying time (T50 ) of enteral nutritions differing in protein composition. Methods: 3 isocaloric and isovolumetric enteral nutrition compositions (Nutrison Energy® , with P4 protein blend (NU), Fresubin Energy® (FR) and Osmolite HiCal® (OS) both with a casein dominant protein blend) were compared in a doubleblind, randomized, cross-over study in 21 healthy volunteers. Coagulation properties were defined in a previous in vitro study [1]. Emptying curves were fitted with the LinExp model to compute T50 and the parameter ú that is a measure of gastric secretion. T50 was compared between coagulating (FR+OS) and non-coagulating (NU) compositions. In addition ranks of T50 were compared. Results: As indicated by values for ú > 1, all solutions induced gastric secretion. A reduction of T50 for the noncoagulating enteral nutrition compared to the two coagulating compositions was detected after exclusion of one outlier (p = 0.049). Furthermore the non-coagulating nutrition was emptied fastest in 74% of all subjects (p = 0.004). Conclusion: This study suggests that non-coagulating protein blends in enteral nutrition can improve T50 and thus may help in the reduction of unwanted side effects like vomiting and regurgitation thereby reducing upper digestive intolerance in patients using tube feeding. References [1] Abrahamse et al, Gastric non-coagulation of enteral tube feed yields faster gastric emptying of protein in dynamic in vitro model, Clinical Nutrition Supplements Vol. 7, Issue 1, Page 119 Disclosure of Interest: S. Kuyumcu Grant/Research Support: Danone Research, M. Dieter Grant/Research Support: Danone Research, J. Curcic: None Declared, O. Goetze: None Declared, M. Klebach Paid Instructor for: Danone Research, E. Abrahamse Paid Instructor for: Danone Research, Z. Hofman Paid Instructor for: Danone Research, M. Fried: None Declared, W. Schwizer: None Declared, A. Steingoetter: None Declared