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- Title
Are Current Protein Recommendations for the Critically Ill Adequate for Patients on VV ECMO: Experience From a High-Volume Center.
- Authors
Pelekhaty, Stacy L.; Galvagno, Samuel M.; Lantry, James H.; Dolly, Katelyn N.; Herr, Daniel L.; Kon, Zachary N.; Deatrick, Kristopher B.; Cornachione, Christopher R.; Scalea, Thomas M.; Menaker, Jay; Galvagno, Samuel M Jr
- Abstract
<bold>Background: </bold>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).<bold>Methods: </bold>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.<bold>Results: </bold>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).<bold>Conclusions: </bold>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.
- Subjects
CRITICALLY ill; EXTRACORPOREAL membrane oxygenation; BODY mass index; NITROGEN excretion; G proteins; RETROSPECTIVE studies; CATASTROPHIC illness; TREATMENT effectiveness; NUTRITIONAL status
- Publication
JPEN Journal of Parenteral & Enteral Nutrition, 2020, Vol 44, Issue 2, p220
- ISSN
0148-6071
- Publication type
journal article
- DOI
10.1002/jpen.1602