An international survey of nutrition practices in adult patients receiving veno-venous ECMO

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

“…Protein needs were estimated as 1.5–2 g/kg actual body weight (ABW) for nonobese patients (BMI < 30 kg/m 2 ), >2 g/kg ideal body weight (IBW) for patients with a BMI of 30–39.9 kg/m 2 , and >2.5 g/kg IBW for patients with a BMI of ≥40 kg/m 2 . Energy needs were estimated using the Penn State Equation with minute ventilation entered as zero, and an additional 10%–20% was added to account for the increased inflammation associated with extracorporeal life support; this was cross‐referenced with 20–30 kcal/kg ABW based on international consensus . Permissive underfeeding was not routinely employed to guide the energy prescription for obese patients, as it has not been studied in obese patients requiring VV ECMO.…”

“…Energy needs were estimated using the Penn State Equation 9 with minute ventilation entered as zero, and an additional 10%-20% was added to account for the increased inflammation associated with extracorporeal life support; this was cross-referenced with 20-30 kcal/kg ABW based on international consensus. 10,11 Permissive underfeeding was not routinely employed to guide the energy prescription for obese patients, as it has not been studied in obese patients requiring VV ECMO. Nutrition prescriptions were revised as indicated based on serial NB results in an effort to achieve −4 to +4 g/d.…”

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

“…However, current research on nutrition during VV ECMO has not established the optimal timing, composition, or amount of nutrition support . Two surveys of nutrition assessment practices at ECMO centers found variation in the preferred route of nutrition support, assessment of nutrition status, and estimation of nutrient needs . This variability is likely related to the absence of evidence‐based nutrition assessment guidelines for patients receiving ECMO, which results in practitioners relying on expert experience and general critical illness guidelines.…”

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

“…Based on international surveys, current practice among ECMO centers is to provide 20-30 kcal/kg and 1.2-2 g protein/kg. 13,14 The practice at this institution incorporates cross-referencing this kilocalorie per kilogram (kcal/kg) range with the Penn State equation with modifications because of the alterations in minute ventilation on VV-ECMO to reduce the risk for overfeeding.…”

“…12 Energy demand during VV ECMO has yet to be established, therefore institutional practice is to add an additional 10%-20% to the Penn State equation with minute ventilation of 0 L/min. International practice surveys have established 20-30 kcal/kg as the most commonly used method of estimating energy needs on VV ECMO 13,14 ; therefore, this is calculated as a cross-reference. Due to the novel nature of this patient, basal metabolic rate was also calculated.…”