Department of Critical Care Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea; Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
Food and Nutrition Team, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.
Nutrition. 2021 Sep;89:111222. doi: 10.1016/j.nut.2021.111222. Epub 2021 Feb 28.
There are concerns about adverse events related to early enteral nutrition (EN) in people receiving extracorporeal membrane oxygenation (ECMO). This was a retrospective study evaluating. This nutritional support of people receiving ECMO, factors that may confer benefits in outcomes.
60 adults on ECMO who survived for more than 48 h were enrolled in the study. We evaluated energy and protein intake and the associations of the timing, adequacy, and route of nutrition with in-hospital mortality.
Thirty-three participants (55%) were successfully weaned off ECMO, and 30 (50%) survived. EN was initiated on day 2 of ECMO (interquartile range, 1-3), and the mean energy intake on day 7 of ECMO was 94.1% ± 41.8% of the energy requirement. Although early EN significantly decreased in-hospital mortality (hazard ratio, 0.413; 95% confidence interval, 0.174-0.984; P = 0.046), neither adequate energy intake (hazard ratio, 0.982; 95% confidence interval, 0.292-3.301; P = 0.977) nor EN-dominant nutritional support (hazard ratio, 0.394; 95% confidence interval, 0.138-1.128; P = 0.083) in the first week influenced survival.
Although adequate nutritional support and EN-dominant nutritional support were not associated with changes in outcome, early EN was associated with reduced in-hospital mortality. Therefore, even when EN is not the dominant route of nutritional support, early EN may be recommended for better outcomes in people on ECMO.
体外膜肺氧合（ECMO）患者早期肠内营养（EN）相关不良事件备受关注。本研究旨在评估 ECMO 患者的营养支持方式，以及可能影响预后的因素。
纳入 60 例 ECMO 治疗超过 48 h 且存活的成年患者。评估能量和蛋白质摄入情况，并分析营养支持时机、充分性和途径与院内死亡率的相关性。
33 例（55%）患者成功撤机，30 例（50%）存活。EN 于 ECMO 第 2 天开始（四分位距，1-3 天），第 7 天的能量摄入量为预计需求量的 94.1%±41.8%。尽管早期 EN 显著降低了院内死亡率（风险比，0.413；95%置信区间，0.174-0.984；P=0.046），但能量摄入充足（风险比，0.982；95%置信区间，0.292-3.301；P=0.977）和以 EN 为主的营养支持（风险比，0.394；95%置信区间，0.138-1.128；P=0.083）在第 1 周并未影响患者的生存。
尽管充分的营养支持和以 EN 为主的营养支持与预后变化无关，但早期 EN 与降低院内死亡率相关。因此，即使 EN 不是主要的营养支持途径，在 ECMO 患者中早期 EN 可能有助于改善预后。
