Department of Clinical Nutrition, University of Maryland Medical Center, Baltimore, Maryland, USA.
Department of Anesthesiology, University of Maryland School of Medicine, Baltimore, Maryland, USA.
JPEN J Parenter Enteral Nutr. 2020 Mar;44(3):548-553. doi: 10.1002/jpen.1176. Epub 2018 May 25.
Current literature is insufficient to support specific guidelines for estimating nutrition needs during extracorporeal membrane oxygenation (ECMO). The purpose of this single-center observational study was to investigate protein catabolism during venovenous (VV) ECMO support and assess whether current nutrition recommendations were adequate.
All patients admitted to the Lung Rescue Unit between November 2016 and June 2017 were screened for eligibility. Patients with a documented nitrogen balance (NB) study were included in the data set. NB results were excluded for a change in blood urea nitrogen ≥10 mg/dL during the urine collection or unquantified nitrogen losses. Demographics, ECMO-specific data, NB, nutrition prescription, and infusion were recorded in a prospective, observational manner.
After exclusions, 25 NB results in 16 patients were included for analysis. Nonobese (body mass index [BMI] ˂ 30 kg/m ) and obese (BMI ≥ 30 kg/m ) patients received 85% and 84% of their prescribed protein, respectively. Nonobese patients had a mean NB of -1.7 ± 5.7, whereas obese patients had a mean NB of -11.5 ± 9.6. Obese patients displayed significantly higher urine urea nitrogen (26.7 ± 7.7 vs 13.5 ± 4.3; P = .00004).
These preliminary findings suggest that current guidelines for estimating protein needs in critically ill patients may be adequate for nonobese patients receiving VV ECMO. However, current protein recommendations for critically ill obese patients may not be adequate during VV ECMO support, possibly related to significantly higher rates of catabolism. Future studies with a larger cohort of patients are needed to confirm these results.
目前的文献不足以支持体外膜肺氧合（ECMO）期间营养需求的具体指南。本单中心观察性研究的目的是调查静脉-静脉（VV）ECMO 支持期间的蛋白质分解代谢，并评估当前的营养建议是否充足。
筛选 2016 年 11 月至 2017 年 6 月期间入住肺抢救病房的所有患者，以确定其是否符合入选条件。将有记录的氮平衡（NB）研究的患者纳入数据集。如果在尿液收集过程中血尿素氮变化≥10mg/dL 或氮损失无法量化，则排除 NB 结果。以前瞻性、观察性方式记录人口统计学、ECMO 特定数据、NB、营养处方和输注。
排除后，16 名患者的 25 项 NB 结果被纳入分析。非肥胖（体重指数[BMI]＜30kg/m ）和肥胖（BMI≥30kg/m ）患者分别接受了 85%和 84%的规定蛋白质。非肥胖患者的平均 NB 为-1.7±5.7，而肥胖患者的平均 NB 为-11.5±9.6。肥胖患者的尿尿素氮明显更高（26.7±7.7 vs 13.5±4.3；P=.00004）。
这些初步发现表明，目前估计危重症患者蛋白质需求的指南可能适用于接受 VV ECMO 的非肥胖患者。然而，目前危重症肥胖患者接受 VV ECMO 支持时的蛋白质推荐量可能不足，这可能与更高的分解代谢率有关。需要对更多患者的队列进行进一步研究，以证实这些结果。
