Measuring Energy Expenditure in extracorporeal lung support Patients (MEEP) – Protocol, feasibility and pilot trial

Wollersheim, Tobias; Frank, Sandra; Müller, Michael; Skrypnikov, Vladimir; Carbon, Niklas M.; Pickerodt, Philipp A.; Spies, Claudia; Mai, Knut; Spranger, Joachim; Weber‐Carstens, Steffen

doi:10.1016/j.clnu.2017.01.001

Cited by 45 publications

(73 citation statements)

References 33 publications

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“…Two studies have demonstrated it is possible to measure EE in patients receiving ECMO in 2 ways. De Waele et al described a method whereby EE is first measured in the native lung via the ventilator; then the metabolic cart is connected to the ECMO circuit to measure at the artificial lung.…”

Section: Dose Of Nutrition Supportmentioning

confidence: 99%

“…Along with the time‐consuming nature of this method, the authors report that they used an in‐house, custom‐made adaptor to connect the metabolic cart to the ECMO circuit, which is not available elsewhere. Wollersheim et al presented an alternative method that still requires measurement of gas exchange using IC at the native lung, but rather than connecting the IC to the ECMO circuit, blood gas is measured before and after the membrane oxygenator, with carbon dioxide and oxygen content being subsequently calculated using a referenced equation . The Weir equation is then used to determine EE.…”

Section: Dose Of Nutrition Supportmentioning

confidence: 99%

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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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Section: Dose Of Nutrition Supportmentioning

confidence: 99%

Section: Dose Of Nutrition Supportmentioning

confidence: 99%

Nutrition Support in Adult Patients Receiving Extracorporeal Membrane Oxygenation

2018

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“…Proposed methods to determine energy expenditure during VV ECMO have not been validated, and the use of indirect calorimetry in this population is technically limited 7 …”

Section: Introductionmentioning

confidence: 99%

“…Proposed methods to determine energy expenditure during VV ECMO 6 have not been validated, and the use of indirect calorimetry in this population is technically limited. 77 Serial nitrogen balance (NB) monitoring provides insight into the adequacy of a nutrition regimen, since inadequate energy delivery and inadequate protein delivery with adequate energy will both result in negative NB.…”

Section: Introductionmentioning

confidence: 99%

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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“…Methods to address this change in the site of ventilation during ECMO using values from preoxygenator and postoxygenator blood gasses or attaching a calorimeter to the oxygenator have been published but lack wide validation. [15][16][17] In addition, these methods require equipment not currently available at this institution and/or blood draws that are not part of routine patient care. Protein needs were estimated in the very high range at 3-4 g of protein/kg IBW related to elevated demand during CRRT and VV ECMO support.…”

Section: Case Studymentioning

confidence: 99%

Venovenous Extracorporeal Membrane Oxygenation in an Adult Patient With Prader‐Willi Syndrome: A Nutrition Case Report

Pelekhaty

Menaker

2018

Nut in Clin Prac

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Prader-Willi Syndrome (PWS) is a genetic condition that results in a constellation of symptoms and typically results in hyperphagia and obesity in adulthood. Critically ill adults with PWS present a unique challenge to the nutrition professional, particularly when they require support modalities such as extracorporeal membrane oxygenation (ECMO). The purpose of this case study is to review the nutrition care of a critically ill adult patient with PWS who required venovenous ECMO. The patient was successfully managed with a hypocaloric, high-protein approach, which did not result in the diagnosis of malnutrition during his hospitalization. The patient was ultimately transitioned off extracorporeal life support and discharged to a rehabilitation facility. (Nutr Clin Pract.

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Measuring Energy Expenditure in extracorporeal lung support Patients (MEEP) – Protocol, feasibility and pilot trial

Cited by 45 publications

References 33 publications

Nutrition Support in Adult Patients Receiving Extracorporeal Membrane Oxygenation

Nutrition Support in Adult Patients Receiving Extracorporeal Membrane Oxygenation

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

Venovenous Extracorporeal Membrane Oxygenation in an Adult Patient With Prader‐Willi Syndrome: A Nutrition Case Report

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