To the Editor.—In the article by Cortes and Nelson1 that appeared in the March 1989 issue of the Archives, the authors presented data to suggest that they have detected errors in the estimation of energy expenditures in patients in a surgical intensive care unit. While this may be true, there are some concerns that need to be addressed in their protocol.
First, they evaluated 29 patients attached to mechanical ventilatory support while receiving central parenteral nutrition. The effect of the ventilator on energy expenditure is not discussed. The effect of central parenteral nutrition on the measured expenditure in the surgical patient not attached to a ventilator is also not discussed. They should not use this limited heterogeneous patient population to criticize other data that have been presented to show increases in specific groups of patients.2
The second concern is the definition of the stress factor. If the
LONG CL. Are Estimating Energy Expenditures in Hospitalized Patients Appropriate?. Arch Surg. 1989;124(12):1464-1465. doi:10.1001/archsurg.1989.01410120114025