High protein intake and nitrogen balance in patients receiving venovenous extracorporeal membrane oxygenation: A descriptive cohort study

Abstract

BackgroundThis retrospective cohort study sought to describe the ability of high protein regimens to achieve nitrogen equilibrium in patients on venovenous extracorporeal membrane oxygenation (VV‐ECMO)MethodsPatients ≥18 years with a documented nitrogen balance study (NB) on VV‐ECMO between February 2018 and December 2021 were included. NB with incomplete 24‐hour urine collections or changes in blood urea nitrogen ≥10 mg/dL were excluded. Data were summarized, correlation between first NB and potentially contributing variables was assessed with Kendall's Tau. Sub‐analysis described findings after stratifying for weight class (obese vs non‐obese) and duration of VV ECMO at the time of NB.ResultsA total of 68 NB in 30 patients were included; 47% of the cohort had obesity. The number of NB per patient was 2.2 ± 1.1, which were completed on a median of 31.5 (interquartile range: 16, 53.8) days on ECMO. Nitrogen equilibrium or positive balance was achieved in 72% of studies despite elevated nitrogen excretion. Patients received 87.9 ± 16.8% of prescribed protein on NB days for average intakes of 2.4 ± 0.4 g/kg actual weight/day and 2.4 ± 0.5 g/kg ideal weight/day in patients without and with obesity. Median NB in non‐obese was −1.46 (−8.96, 2.98) g/day, and −0.21 (−10.58, 4.04) g/day in patients with obesity. A difference in median NB after stratification for timing was observed (p=0.029).ConclusionNitrogen equilibrium can be achieved with high protein intake in adults on VV‐ECMO. NB monitoring is one tool to individualize protein prescriptions throughout the course of VV ECMO.This article is protected by copyright. All rights reserved.