Nitrogen Balance During Venovenous Extracorporeal Membrane Oxygenation Support: Preliminary Results of a Prospective, Observational Study

Pelekhaty, Stacy; Galvagno, Samuel M.; Hochberg, Eric; Herr, Daniel; Lantry, James; Kon, Zachary N.; Deatrick, Kristopher B.; Menaker, Jay

doi:10.1002/jpen.1176

Cited by 11 publications

(14 citation statements)

References 28 publications

(49 reference statements)

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“…Preliminary findings of NB results suggested that utilizing guidelines for general critical illness for patients on VV ECMO may be sufficient to meet the needs of nonobese patients but appeared suboptimal in obese patients. 8 However, in our current larger sample set, it appears that both nonobese and obese patients on VV ECMO may require more than the SCCM/ASPEN recommendations of 1.2-2 g protein/kg ABW in patients with BMI < 30 kg/m 2 , >2 g protein/kg IBW in patients with BMI 30-39.9 kg/m 2 , and ࣙ2.5 g protein/kg IBW in patients with BMI ࣙ 40 kg/m 2 . Cohort 1 contained a higher concentration of NB results completed in obese patients, whereas 80% of the NB results in cohort 2 were completed in nonobese patients.…”

Section: Discussionmentioning

confidence: 99%

“…Preliminary work on NB demonstrated the catabolic nature of patients during VV ECMO support, with an average urinary urea nitrogen (UUN) excretion twice the normal range. Additionally, obese patients, defined as a body mass index (BMI) ≥ 30 kg/m 2 , exhibited significantly higher catabolism as measured by UUN excretion . Adequate nutrition support is pivotal to preventing or minimizing malnutrition of acute illness during such profound catabolism.…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, obese patients, defined as a body mass index (BMI) ࣙ 30 kg/m 2 , exhibited significantly higher catabolism as measured by UUN excretion. 8 Adequate nutrition support is pivotal to preventing or minimizing malnutrition of acute illness during such profound catabolism.…”

Section: Introductionmentioning

confidence: 99%

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Are Current Protein Recommendations for the Critically Ill Adequate for Patients on VV ECMO: Experience From a High‐Volume Center

Pelekhaty

Galvagno

Lantry

et al. 2019

J Parenter Enteral Nutr

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Background The nutrition needs of patients requiring extracorporeal membrane oxygenation (ECMO) have not been established in the literature. The purpose of this study is to investigate if current protein recommendations are adequate to achieve nitrogen equilibrium in patients on venovenous ECMO (VV ECMO). Methods Patients aged ≥18 years on VV ECMO admitted November 2016 through January 2018 with a documented nitrogen balance (NB) study were included. Patients were stratified by body mass index (BMI) into obese (BMI ≥ 30 kg/m2) and nonobese (BMI < 30 kg/m2) categories for analysis. Results After exclusions, 55 NB studies in 29 patients were analyzed. Twelve nonobese patients received a median of 2.1 g protein/kg actual body weight (ABW) (interquartile range [IQR]: 1.7–2.5), and median NB was −2.2 g/d (IQR: −7.4 to 2.8). In 17 obese patients, median protein delivery of 2 g protein/kg ideal body weight (IBW) (IQR: 1.7–2.5) achieved a median NB of −7.3 g/d (IQR: −12.6 to −2.8). Obese patients exhibited greater urinary urea nitrogen excretion than nonobese patients did (24.6 vs 17.6 g/d, P < 0.0001). Conclusions Obese and nonobese patients undergoing VV ECMO may require more protein than is currently recommended for critical illness. Monitoring nutrition delivery and serial NB to assess prescription adequacy should be incorporated into routine patient care. Further research is needed to confirm these findings and create specific guidelines for patients on VV ECMO.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Are Current Protein Recommendations for the Critically Ill Adequate for Patients on VV ECMO: Experience From a High‐Volume Center

Pelekhaty

Galvagno

Lantry

et al. 2019

J Parenter Enteral Nutr

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“…Only 1 study aiming to investigate optimum protein intakes in patients receiving ECMO exists. This small study investigated the nitrogen balance in obese and nonobese adult patients receiving VV ECMO . Protein targets were set at 1.5–2.0 g/kg/d for nonobese patients and 2.0–2.5 g/kg/d for obese patients, with around 85% of this target being delivered.…”

Section: Dose Of Nutrition Supportmentioning

confidence: 99%

Nutrition Support in Adult Patients Receiving Extracorporeal Membrane Oxygenation

2018

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The use of extracorporeal membrane oxygenation (ECMO) for both severe respiratory and cardiac failure is increasing. Because these patients are some of the sickest in the intensive care unit, a multidisciplinary approach to their treatment, including appropriate nutrition therapy, is warranted. Currently, limited data exist on the optimal timing, type, and amount of nutrition to be provided. This review focuses on describing the current nutrition practices in patients receiving ECMO, details research that is currently being undertaken, and lists important research questions that require exploration in this field. Observational data suggest that early enteral nutrition is safe and that although nutrition targets can be met, underfeeding is still common. Until further research is available, these patients should be fed according to guidelines for the general critically unwell population. (Nutr Clin Pract. 2018;33:738-746)

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“…Ainda com relação às proteínas, um estudo realizado com o objetivo de investigar o catabolismo proteico durante o suporte da ECMO VV sugeriu que o estado nutricional dos pacientes pode influenciar no balanço nitrogenado. O resultado do balanço nitrogenado demonstrou que pacientes não obesos tiveram menor catabolismo do que pacientes com obesidade, respectivamente -1,7 ± 5,7 vs. -11,5 ± 9,6 29 . Entretanto, tratou-se de estudo observacional com amostra pequena, portanto, são necessários mais estudos para validar este dado.…”

Section: Necessidades Nutricionaisunclassified

Terapia nutricional no paciente adulto em oxigenação por membrana extracorpórea: revisão de literatura

Rocha¹,

Shima²,

Freitas³

et al. 2020

Braspen J

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Introduction: Extracorporeal membrane oxygenation (ECMO) provides partial or total cardiopulmonary support to patients with severe, acute and reversible cardiac or pulmonary failure. Despite the increasing use of the technique in adult patients, information on nutritional care is scarce. The objective was to investigate available data on the nutritional support of adult patients using ECMO in order to assist in the development of institutional protocols. Methods: A narrative review of the literature was led in order to showing the management of nutritional support, reasons for low nutritional adequacy, nutritional needs and the role of nutrition in ECMO complications. Results: Search strategies identified studies published up to October 11th, 2019. Only primary studies, indexed in the MEDLINE, Scopus and Web of Science data bases were evaluated, resulting in the inclusion of 11 studies. There is evidence that early enteral nutrition is safe and well tolerated and can be initiated via the gastric route. Gastrointestinal dysfunction with high gastric residual volumes is a common finding. However, there is positive evidence of treatment with prokinetic drugs, with the option of using a nasojejunal tube and parenteral nutrition. It is possible to achieve nutritional adequacy (>80%), which is associated with lower mortality. However, malnutrition is recurrent, among the main reasons is the interruption of the diet for therapeutic/diagnostic procedures. Supplemental parenteral nutrition is an important strategy, but it requires special care with the associated administration of glucose and fats. Data on nutritional needs are controversial, as well as the differences in nutritional support and intercurrences between types of ECMO (VA and VV). Conclusion: It is concluded that although most studies are observational retrospective, the evidence shows that nutrition is safe, well tolerated and is associated with lower mortality of patients on ECMO.

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Nitrogen Balance During Venovenous Extracorporeal Membrane Oxygenation Support: Preliminary Results of a Prospective, Observational Study

Cited by 11 publications

References 28 publications

Are Current Protein Recommendations for the Critically Ill Adequate for Patients on VV ECMO: Experience From a High‐Volume Center

Are Current Protein Recommendations for the Critically Ill Adequate for Patients on VV ECMO: Experience From a High‐Volume Center

Nutrition Support in Adult Patients Receiving Extracorporeal Membrane Oxygenation

Terapia nutricional no paciente adulto em oxigenação por membrana extracorpórea: revisão de literatura

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