Cagua Ordoñez, Jaen
Thumbnail Image
Preferred name
Cagua Ordoñez, Jaen
Main Affiliation
Ambato

Research Output

Filters

2
2
2
Reset filters

Settings
Now showing 1 - 2 of 2
No Thumbnail Available
Publication

Phase-Related Resting Energy Expenditure in Critically Ill Adults: Metabolic Phenotypes and Determinants of Weight-Normalized Indices—A Retrospective Study

2026 , Sebastián Chapela , Cagua Ordoñez, Jaen , Angamarca Iguago, Jaime , Daniel Tettamanti , Claudia Kecskes , Jesica Asparch , Facundo Javier Gutierrez , Natalia Llobera , Mariana Rella , Martha Montalván , María Jimena Reberendo , Mario Omar Pozo , Ludwig Álvarez-Córdova , Daniel Simancas-Racines

Precise measurement of resting energy expenditure (REE) is essential in the intensive care unit (ICU), where metabolic requirements evolve throughout the course of critical illness. Predictive equations frequently fail to capture this variability, and limited data describe phase-dependent changes in REE using indirect calorimetry (IC). This study aimed to evaluate phase-related variation in REE and metabolic phenotypes in mechanically ventilated adults and to identify clinical and physiological correlates of both absolute REE and REE normalized by ideal body weight (REE/IBW). Methods: We conducted an observational, retrospective cross-sectional study in two ICUs at different hospitals. A total of 149 mechanically ventilated adults with a valid IC measurement were included and classified by illness phase: acute (0–3 days), intermediate (4–14 days), or chronic (>14 days). Differences in metabolic and gas-exchange variables were assessed using ANOVA or Kruskal–Wallis tests. Two multivariable linear regression models were fitted, one using absolute REE and a second using REE/IBW, incorporating metabolic phenotype categories to account for body-size heterogeneity. Results: Metabolic profiles differed across illness phases. Median REE increased from the acute (1664 kcal/day) to the intermediate (1869 kcal/day) and chronic (2074 kcal/day; p = 0.024) phases. Hypometabolic profiles were more frequent in the acute phase (64%), whereas hypermetabolic profiles were more prevalent in later phases (48%). RQ values were higher in the chronic phase compared with the acute phase (median 0.99 vs. 0.80; p < 0.001). In multivariable analyses, illness severity scores showed weak or inconsistent associations with REE after adjustment for gas-exchange variables. VCO2 was independently associated with absolute REE (adjusted R2 = 0.83). In the REE/IBW model, VCO2, RQ, BMI, and metabolic phenotype were associated with normalized energy expenditure, with higher adjusted R2 (0.87) and lower prediction error metrics. Conclusions: Resting energy expenditure and metabolic phenotypes vary across phases of critical illness. Gas-exchange variables, particularly VCO2, were more closely associated with measured energy expenditure than severity scores. Normalization of REE by ideal body weight reduced variability and improved model performance, highlighting the analytical value of indirect calorimetry for characterizing phase-dependent metabolic patterns in critically ill adults.

View
No Thumbnail Available
Publication

Interpreting Resting Energy Expenditure in Critically Ill Patients with Obesity: Clinical Impact of Weight Adjustment

2026 , Sebastián Chapela , Cagua Ordoñez, Jaen , Parise Vasco, Juan Marcos , Daniel Tettamanti Miranda , Claudia Kecskes , Natalia Llobera , Jesica Asparch , Mariana Rella , María Victoria Peroni , Martha Montalvan , María Jimena Reberendo , Facundo Gutierrez , Mario O. Pozo , Ludwig Álvarez-Córdova , Simancas Racines, Daniel

Accurately estimating resting energy expenditure (REE) in critically ill obese patients remains a significant clinical challenge, as predictive equations are consistently inadequate. Metabolic heterogeneity across obesity classes and the role of substrate utilization are insufficiently characterized. Objective: To evaluate the impact of different weight-normalization methods on the interpretation of REE and to identify independent metabolic determinants of weight-adjusted energy expenditure in critically ill patients with obesity. Methods: Bicentric cross-sectional study of 148 critically ill adults with obesity undergoing indirect calorimetry. REE normalized by actual body weight (REE/kg), ideal body weight (REE/IBW), and adjusted body weight (REE/AdjBW) was calculated. Multivariable models with robust standard errors (HC3), stratified analyses by obesity class (I–III) with a Chow test, and internal validation were performed using 10-fold cross-validation and bootstrap resampling (1000 iterations). Results: Absolute REE did not differ significantly between BMI categories (p = 0.679), while REE/kg progressively decreased from normal weight (27.8 kcal/kg/day) to class III obesity (16.9 kcal/kg/day; p < 0.001). The respiratory quotient (RQ) emerged as the most robust independent correlate of adjusted REE (β = −13 to −15 kcal·kg−1·day−1; p < 0.001), whereas clinical severity scores (SOFA, APACHE II) and comorbidity (Charlson) did not show significant associations. Stratified analyses revealed significant structural heterogeneity between obesity classes (F = 4.545, p = 0.0001), with no significant predictors identified in class III obesity, likely reflecting limited statistical power in this subgroup. Conclusions: Normalizing REE using different weight indices fundamentally alters its metabolic interpretation. RQ surpasses traditional clinical scores as a correlate of adjusted REE, consistent with a phenotype of metabolic inflexibility. The heterogeneity between obesity classes underscores the need for individualized indirect calorimetry rather than reliance on predictive equations.

View