Adequacy of nutrition support during extracorporeal membrane oxygenation

MacGowan, Liisa; Smith, Elizabeth Viner; Elliott-Hammond, Charmaine; Sanderson, Barnaby; Ong, Dennis; Daly, Kathleen; Barrett, Nicholas; Whelan, Kevin; Bear, Danielle E.

doi:10.1016/j.clnu.2018.01.012

Cited by 41 publications

(138 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…10,11 A recently published retrospective study by MacGowan et al investigated the association between nutrition delivery and outcomes in patients on VV ECMO at a single center and found that patients who received optimal nutrition, defined as 80%-110% of their nutrition prescription, experienced longer stays on VV ECMO. 22 These findings draw attention to the potential consequences of applying recommendations for general critical illness to patients who require VV ECMO. Additionally, the authors noted that they provided less protein than the 2016 ASPEN/SCCM guidelines recommended, which may impact outcomes if insufficient protein is provided to support metabolic processes during critical illness.…”

Section: Discussionmentioning

confidence: 97%

“…These findings draw attention to the potential consequences of applying recommendations for general critical illness to patients who require VV ECMO. Additionally, the authors noted that they provided less protein than the 2016 ASPEN/SCCM guidelines recommended, which may impact outcomes if insufficient protein is provided to support metabolic processes during critical illness …”

Section: Discussionmentioning

confidence: 99%

“…Additionally, the authors noted that they provided less protein than the 2016 ASPEN/SCCM guidelines recommended, which may impact outcomes if insufficient protein is provided to support metabolic processes during critical illness. 22 The purpose of this study was to describe the degree of catabolism observed and investigate the adequacy of current protein dosing recommendations during VV ECMO. Patients were stratified into obese and nonobese categories prior to analysis because of differences in recommendations for protein dosing, not for the purpose of comparison.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

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

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

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

View full text Add to dashboard Cite

show abstract

“…Seven observational studies were found describing nutrition practices in patients receiving ECMO (both VV and VA) . In these studies (Table ), EN was most frequently commenced within 24 hours of starting ECMO, with several studies reporting a mean or median time to feeding of around 13 hours.…”

Section: Timing and Route Of Nutrition Supportmentioning

confidence: 99%

“…In these studies (Table ), EN was most frequently commenced within 24 hours of starting ECMO, with several studies reporting a mean or median time to feeding of around 13 hours. In the largest study, 96% of patients were fed within 24 hours. The reporting of adverse events is rare and likely to be impacted on by the predominantly retrospective nature of the studies, but in a prospective multicenter observational study of 107 patients, 5 patients (4.5%) were reported to have bowel ischemia .…”

Section: Timing and Route Of Nutrition Supportmentioning

confidence: 99%

Nutrition Support in Adult Patients Receiving Extracorporeal Membrane Oxygenation

2018

Self Cite

View full text Add to dashboard Cite

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)

show abstract

When is enteral nutrition indicated?

Bechtold

Brown

Escuro

et al. 2022

J Parenter Enteral Nutr

View full text Add to dashboard Cite

Enteral nutrition (EN) is a vital component of nutrition around the world. EN allows for delivery of nutrients to those who cannot maintain adequate nutrition by oral intake alone. Common questions regarding EN are when to initiate and in what scenarios it is safe. The answers to these questions are often complex and require an evidence‐based approach. The Board of Directors of the American Society for Parenteral and Enteral Nutrition (ASPEN) established an Enteral Nutrition Committtee to address the important questions surrounding the indications for EN. Consensus recommendations were established based on eight extremely clinically relevant questions regarding EN indications as deemed by the Enteral Nutrition Committee. These consensus recommendations may act as a guide for clinicians and stakeholders on difficult questions pertaining to indications for EN. This paper was approved by the ASPEN Board of Directors.

show abstract

Adequacy of nutrition support during extracorporeal membrane oxygenation

Cited by 41 publications

References 31 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

When is enteral nutrition indicated?

Contact Info

Product

Resources

About