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Patients with respiratory failure often have difficulty maintaining oral nutrition intake because of associated breathlessness and are at increased risk of malnutrition, given both their metabolic response to stress and their dependence on nutrition support. Predictive equations assist clinicians in determining specific energy (caloric) needs for patients with respiratory failure; however, they are inaccurate, complex, and difficult to calculate. Recent technological advances have allowed for commercially available bedside measurement of energy needs using indirect calorimetry. The purpose of this review is to describe how indirect calorimetry (IC) can be used to influence clinical decision\u2010making and nutrition care for patients with respiratory failure who are mechanically ventilated. 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