Are Estimating Energy Expenditures in Hospitalized Patients Appropriate?-Reply

In Reply.—I thank Dr Long for his comments regarding our article. He has pointed out a problem common to most clinical investigations: heterogeneous patient populations. The patients entered in the study represent a sample of the sickest patients in the surgical intensive care unit. The severity of illness and presence or absence of sepsis and organ system failure account for the wide variability in the metabolic requirements and urinary urea nitrogen excretion values. The variability of the patients represents the reality of surgical intensive care. Patients were treated to similar cardiac, pulmonary, and nutritional end points.

The purpose of this article was not to "criticize" data gathered by others on specific patient populations or to demean the importance of stress or injury factors applied almost universally in the nutritional assessment of critically ill patients. The purpose was to point out that the clinical impression of severity of illness in