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In a recent article, Stapel et al. [1] gave a practical and easy solution for the evaluation of energy expenditure in critically ill patients. Predictive equations are routinely used to determine energy needs and to guide the prescription of calories in critically ill patients [2]. However, their accuracy is very poor, resulting in both over- and underfeeding [3], and thus confounding the validity of many studies based on these equations. Indirect calorimetry remains the gold standard to determine calorie requirements, as well as to calculate energy expenditure (EE) from oxygen consumption (VO2), carbon dioxide production (VCO2) and nitrogen excretion (NM) measurements [4]. These devices are still seldom used since they may be expensive, require expertise and have several technical limitations [5]. Moreover, the most accurate device, the Deltatrac II (GE, Finland) is not widely available and other new devices have still to achieve its accuracy [6].

Simple equations for complex physiology: can we use VCO2 for calculating energy expenditure?