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Trial registered on ANZCTR

Registration number
Ethics application status
Date submitted
Date registered
Date last updated
Type of registration
Retrospectively registered

Titles & IDs
Public title
Determining energy expenditure during critical illness: a comparison of three instruments for indirect calorimetry in mechanically ventilated patients.
Scientific title
In mechanically ventilated adult ICU patients, how well do gas exchange measurements by two indirect calorimetry devices (E-sCOVX and Quark RMR) agree with the reference method (Deltatrac II)?
Secondary ID [1] 285927 0
Universal Trial Number (UTN)
Trial acronym
Linked study record

Health condition
Health condition(s) or problem(s) studied:
Critical illness 293854 0
Condition category
Condition code
Metabolic and Endocrine 294156 294156 0 0
Other metabolic disorders
Diet and Nutrition 294157 294157 0 0
Other diet and nutrition disorders

Study type
Description of intervention(s) / exposure
All study instruments will be connected in parallel, a mandatory 10 minute period is then provided before commencement of gas exchange measurements to allow the Deltatrac mixing chamber to equilibrate with expired gas from the patient after the initial break in the ventilator circuit during connection. Simultaneous measurements with Deltatrac II and either Quark RMR or E-sCOVX will then be performed in a randomized order. After measuring with the first device, another parallel measurement will be performed with the second device and Deltatrac II. Average values for energy expenditure (EE), VO2, VCO2, minute ventilation (MV) and respiratory quotient (RQ) will be registered after a 20 minute period. Measurements where the reference method registers a mean RQ of <0.6 or >1.2 will be discarded.

All aspects of the patient's ICU therapy are determined by the attending physician. Changes in ventilator settings, disconnection of the ventilator circuit or patient mobilization are to be avoided during and one hour previous to measurements unless deemed necessary by medical staff. In such event the ongoing measurement will be discontinued and restarted after a 15 minute resting period.
Intervention code [1] 290903 0
Treatment: Devices
Comparator / control treatment
Energy expenditure as determined by the Deltatrac II is considered the reference method for statistical analysis when compared to the two other devices (E-sCOVX and Quark RMR).
Control group

Primary outcome [1] 293950 0
The primary outcome is the level of agreement between energy expenditure as determined by the two study devices (E-sCOVX, Quark RMR) and the reference method (Deltatrac II).
Timepoint [1] 293950 0
Time of study measurements.
Secondary outcome [1] 312220 0
Respiratory quotient as determined by all three devices (E-sCOVX, Quark RMR, Deltatrac II).
Timepoint [1] 312220 0
Time of study measurements.

Key inclusion criteria
Critically ill patients receiving invasive mechanical ventilation.
Minimum age
18 Years
Maximum age
No limit
Both males and females
Can healthy volunteers participate?
Key exclusion criteria
Fraction of inspired oxygen concentration >0.6, respiratory rate >35, uncontrolled gas leaks in ventilatory circuit (chest drains, pneumothorax, bronchoesophageal fistula), leak in ventilator circuit >10% of minute volume, ECMO/NO-therapy, absence of informed consent by patient or relative.

Study design
Purpose of the study
Allocation to intervention
Randomised controlled trial
Procedure for enrolling a subject and allocating the treatment (allocation concealment procedures)
All ICU patients at the institution that fulfill inclusion criteria during the recruitment period will be screened for participation. Randomisation to order of measurement with different instruments is performed by drawing of sealed opaque envelopes.
Methods used to generate the sequence in which subjects will be randomised (sequence generation)
The sequence generation will be determined by a simple randomisation procedure (computerised sequence generation).
Masking / blinding
Open (masking not used)
Who is / are masked / blinded?

Intervention assignment
Other design features
This study is not interventional in nature as the performed measurements will have no effect on determining treatment or outcomes of recruited patients. The data is observational and gathered prospectively. It is listed as such due to the registry form which precludes description of randomization for observational studies.
Not Applicable
Type of endpoint(s)
Statistical methods / analysis
Limits of agreement and bias between VO2/VCO2 as measured by study instruments (E-sCOVX/Quark RMR) and the reference method (Deltatrac II) will be compared using Bland-Altman plots. Agreement of energy expenditure values as measured by study devices and the reference method will also be compared with the Bland-Altman method, although it is a dependent variable calculated from VO2 and VCO2. A sample size of 50 measurements in at least 20 patients is considered sufficient to determine limits of agreement within +/- 2.0 SD, and coefficients of variation between repeated measurements with the same instrument (n =/>15 for each device).

For descriptive statistics continuous variables with parametric distribution will be analyzed for significance using a two-tailed Student's t-test for paired samples and Mann-Whitney U-test for non-parametric data, an alpha level of =/<0.05 considered as significant.

Recruitment status
Date of first participant enrolment
Date of last participant enrolment
Date of last data collection
Sample size
Accrual to date
Recruitment outside Australia
Country [1] 6580 0
State/province [1] 6580 0

Funding & Sponsors
Funding source category [1] 290511 0
Government body
Name [1] 290511 0
Regional Agreement on Medical Training and Clinical Research (ALF) between Stockholm County Council and Karolinska Institutet
Address [1] 290511 0
Stockholm County Council
Stockholms lans landsting
Box 22550
104 22 Stockholm
Country [1] 290511 0
Primary sponsor type
Prof Jan Wernerman
Karolinska Institutet
Inst. for klinisk vetenskap, intervention och teknik
Enheten for anestesi
Karolinska Universitetssjukhuset, Huddinge, K32
141 86 Stockholm
Secondary sponsor category [1] 289205 0
Name [1] 289205 0
Address [1] 289205 0
Country [1] 289205 0
Other collaborator category [1] 278283 0
Commercial sector/Industry
Name [1] 278283 0
GE Healthcare
Address [1] 278283 0
Kuortanegatan 2
Country [1] 278283 0

Ethics approval
Ethics application status
Ethics committee name [1] 292163 0
Regionala etikprovningsnamnden i Stockholm
Ethics committee address [1] 292163 0
Box 289 (Nobels vag 12 A)
171 77 Stockholm
Ethics committee country [1] 292163 0
Date submitted for ethics approval [1] 292163 0
Approval date [1] 292163 0
Ethics approval number [1] 292163 0

Brief summary
Determining an optimal provision of nutritional therapy in ICU patients continues to challenge clinicians. Indirect calorimetry can accurately determine energy expenditure in individual patients, but previous studies (Sundstrom et al, Clin Nutr. 2013 Feb;32(1), Graf et al Clin Nutr. 2014 Jan 21) have demonstrated varying agreement between instruments.

The aim of this study is to determine the level of agreement of gas exchange measurements between three instruments for indirect calorimetry in mechanically ventilated ICU patients: the E-sCOVX (GE, Helsinki, Finland), Quark RMR (Cosmed, Rome, Italy) and the Deltatrac in mechanically ventilated ICU patients. We hypothesize that all instruments measure oxygen comsumption (VO2) and carbon dioxide production (VCO2) with equal precision and accuracy.
Trial website
Trial related presentations / publications
Public notes

Principal investigator
Name 53846 0
Prof Jan Wernerman
Address 53846 0
Karolinska Institutet Inst. for klinisk vetenskap, intervention och teknik Enheten for anestesi Karolinska Universitetssjukhuset, Huddinge, K32 141 86 Stockholm
Country 53846 0
Phone 53846 0
+46 8-58586395
Fax 53846 0
Email 53846 0
Contact person for public queries
Name 53847 0
Dr Martin Sundstrom
Address 53847 0
Karolinska Institutet Inst. for klinisk vetenskap, intervention och teknik Enheten for anestesi Karolinska Universitetssjukhuset, Huddinge, K32 141 86 Stockholm
Country 53847 0
Phone 53847 0
Fax 53847 0
Email 53847 0
Contact person for scientific queries
Name 53848 0
Dr Martin Sundstrom
Address 53848 0
Karolinska Institutet Inst. for klinisk vetenskap, intervention och teknik Enheten for anestesi Karolinska Universitetssjukhuset, Huddinge, K32 141 86 Stockholm
Country 53848 0
Phone 53848 0
Fax 53848 0
Email 53848 0

No information has been provided regarding IPD availability
Summary results
Have study results been published in a peer-reviewed journal?
Other publications
Have study results been made publicly available in another format?
Results – basic reporting
Results – plain English summary