Nutrition support during extracorporeal membrane oxygenation (ECMO) in adults

Makikado, Luis Daniel Umezawa; Lasierra, José Luis Flordelís; Pérez-Vela, J.L.; García-Arriaza, Juan

doi:10.1007/s00134-013-3128-0

Cited by 4 publications

(8 citation statements)

References 5 publications

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“…Despite not meeting the ideal target of above 80% nutrition adequacy, a nutrition adequacy of 76% was observed in this study, which is higher when compared to the majority of previously conducted studies which reported nutrition adequacies of between 55% and 80% 3–8 . As observed in previous work, VA ECMO was associated with poorer nutrition adequacy compared to those that received VV ECMO 4,6 .…”

Section: Discussioncontrasting

confidence: 73%

“…Gastro‐intestinal dysfunction may manifest as intolerance to enteral nutrition (EN) in adults during ECMO, with studies reporting nutrition adequacy of between 55% and 80% 3–8 . One study reported 38% of patients had significant enteral feeding intolerance in the first 5 days of ECMO and another noted 71% required pro‐kinetic drugs to aid enteral feeding 4,6 .…”

Section: Introductionmentioning

confidence: 99%

“…This is in contrast to a VV ECMO circuit, where there is preserved cardiac function with physiological pulsatility. Patients on VA ECMO also often receive higher doses of vasopressor and inotropic drugs, which may then compromise splanchnic circulation, further decreasing perfusion to the gut 5 . Common to both ECMO modalities is the ECMO circuit itself which has been shown in new‐born piglet studies to cause a systemic inflammatory response leading to apoptosis of intestinal epithelium, release of inflammatory cytokines and bacterial translocation 11–13 .…”

Section: Introductionmentioning

confidence: 99%

“…Patients on VA ECMO also often receive higher doses of vasopressor and inotropic drugs, which may then compromise splanchnic circulation, further decreasing perfusion to the gut. 5 Common to both ECMO modalities is the ECMO circuit itself which has been shown in new-born piglet studies to cause a systemic inflammatory response leading to apoptosis of intestinal epithelium, release of inflammatory cytokines and bacterial translocation. [11][12][13] It is also known that aggressive fluid resuscitation in ECMO is often used to maintain flow rates on ECMO, adequate to ensure systemic oxygenation, especially in VV ECMO.…”

Section: Introductionmentioning

confidence: 99%

“…1,2 Gastro-intestinal dysfunction may manifest as intolerance to enteral nutrition (EN) in adults during ECMO, with studies reporting nutrition adequacy of between 55% and 80%. [3][4][5][6][7][8] One study reported 38% of patients had significant enteral feeding intolerance in the first 5 days of ECMO and another noted 71% required pro-kinetic drugs to aid enteral feeding. 4,6 Early EN, as well as achieving greater than 80% of nutrition adequacy on ECMO, has been associated with lower mortality and better outcomes, but limited data exist to understand why issues with nutrition adequacy exist in this population.…”

Section: Introductionmentioning

confidence: 99%

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Nutrition adequacy, gastrointestinal, and hepatic function during extracorporeal membrane oxygenation in critically ill adults: A retrospective observational study

et al. 2022

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Aims To identify clinical and biochemical markers associated with nutrition adequacy and gastrointestinal and liver dysfunction in adults on extracorporeal membrane oxygenation (ECMO). Methods A retrospective, observational, study was conducted at 2 centres in Australia. Adult patients who received ECMO from July 2011 to June 2015 were included. Mode of ECMO used, fluid balance, number of systemic inflammatory response syndrome (SIRS) criteria present, vasoactive‐inotropic scores (VIS) and liver function tests (LFTs) were collected for the duration of ECMO until 7 days after ECMO cessation. Multiple regression models were used to determine if the collected variables were associated with nutrition adequacy. The mean LFTs during ECMO were also compared to mean LFTs post ECMO cessation. Results During the first 5 days of ECMO commencement, mean nutrition adequacy was 10% higher in the veno‐venous (VV) ECMO group than in the veno‐arterial (VA) group (95% confidence interval [CI], 2% to 17%). For every 5000 ml increase of fluid balance, an associated decrease in nutrition adequacy was observed (−8%, 95% CI: −15% to −2%). A doubling of bilirubin and VIS were associated with a mean reduction in nutrition adequacy of −5% (95% CI –8% to −2%) and − 2% (95% CI: −3% to −1%), respectively. Conclusions In the first 5 days of ECMO commencement, higher nutrition adequacy was associated with the VV mode of ECMO and reduced nutrition adequacy with increased fluid balance, more vasopressor and inotropic support and raised bilirubin. Prospective investigation is required to confirm whether these associations have a causal relationship.

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Section: Discussioncontrasting

confidence: 73%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Nutrition adequacy, gastrointestinal, and hepatic function during extracorporeal membrane oxygenation in critically ill adults: A retrospective observational study

et al. 2022

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Impact of Early Initiation of Enteral Nutrition on Survival During Pediatric Extracorporeal Membrane Oxygenation

Greathouse

Sakellaris

Tumin

et al. 2017

J Parenter Enteral Nutr

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Introduction: Pediatric data related to safety, tolerance, and outcomes of enteral nutrition (EN) for patients requiring extracorporeal membrane oxygenation (ECMO) are lacking. The objectives of this study were to evaluate early nutrition status and timing of EN initiation on survival during pediatric ECMO.Methods: A single center institutional review board–approved retrospective chart review was performed on all pediatric patients requiring ECMO from October 2008 through December 2013. Demographics, ECMO variables, laboratory values, vasoactive inotropic score (VIS), and nutrition data on day 5 (d5) were collected. Patients receiving parenteral nutrition (PN) were compared with those receiving any EN on d5. Analyses were conducted to identify factors influencing survival to completion of ECMO and to discharge.Results: Forty‐nine patients aged 53 ± 76 months met inclusion criteria. Kaplan‐Meier curves demonstrated greater survival to discharge in patients receiving any EN, compared with only receiving PN (P = .031). EN on d5 of ECMO support (P = .040) and a higher percentage of daily energy intake achieved (P = .013) were protective, whereas a higher VIS was associated with increased mortality (P = .010). Multivariable analysis demonstrated EN was no longer associated with survival to discharge (P = .139), whereas energy intake (P = .021) and VIS (P = .013) remained significant.Conclusions: Pediatric patients who received nutrition that was closer to goal energy intake, as well as those who received any EN early during ECMO, had improved survival to hospital discharge.

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Enteral omega-3 fatty acid supplementation in adult patients with acute respiratory distress syndrome: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis

Zhu

Zhang

et al. 2014

Intensive Care Med

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Nutrition support during extracorporeal membrane oxygenation (ECMO) in adults

Cited by 4 publications

References 5 publications

Nutrition adequacy, gastrointestinal, and hepatic function during extracorporeal membrane oxygenation in critically ill adults: A retrospective observational study

Nutrition adequacy, gastrointestinal, and hepatic function during extracorporeal membrane oxygenation in critically ill adults: A retrospective observational study

Impact of Early Initiation of Enteral Nutrition on Survival During Pediatric Extracorporeal Membrane Oxygenation

Enteral omega-3 fatty acid supplementation in adult patients with acute respiratory distress syndrome: a systematic review of randomized controlled trials with meta-analysis and trial sequential analysis

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