Pelekhaty Stacy, Gessler Julie, Dante Siddhartha, Rector Nicholas, Galvagno Samuel, Stachnik Stephen, Rabin Joseph, Tabatabai Ali
Department of Clinical Nutrition, University of Maryland Medical Center, Baltimore, Maryland, USA.
Department of Pediatrics, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Nutr Clin Pract. 2025 Feb;40(1):117-124. doi: 10.1002/ncp.11132. Epub 2024 Feb 20.
Overfeeding and underfeeding are associated with negative outcomes during critical illness. The purpose of this retrospective study was to assess the association between nutrition intake and outcomes for patients receiving venovenous (VV) extracorporeal membrane oxygenation (ECMO).
Adults who received VV ECMO August 2017 to June 2020 were screened. Patients with <3 ECMO nutrition support days were excluded. Age, sex, height, weight, ideal body weight (IBW), body mass index, sequential organ failure assessment score, respiratory ECMO survival prediction score, energy, and protein goals were collected. All nutrition intake was collected for the first 14 days of ECMO or until death, decannulation, or oral diet initiation. Outcomes analyzed included mortality and VV ECMO duration. The relationship between nutrition delivery and outcomes was tested with multivariate analysis. Univariate analyses were conducted on obese and nonobese subgroups.
A total of 2044 nutrition days in 178 patients were analyzed. The median estimated needs were 24 (interquartile range: 22.3-28.3) kcal/kg/day and 2.25 (interquartile range: 2.25-2.77) g/kg/day of protein using IBW in patients with obesity and actual weight in patients without obesity. Patients received 83% of energy and 63.3% of protein targets. Patients with obesity who received ≥2 g/kg IBW of protein had a significantly shorter ECMO duration (P = 0.037). Increased protein intake was independently associated with a reduced risk of death (odds ratio: 0.06; 95% confidence interval: 0.01-0.43).
Higher protein intake was associated with reduced mortality. Optimal energy targets for patients receiving ECMO are currently unknown and warrant further study.
在危重病期间，过度喂养和喂养不足均与不良结局相关。这项回顾性研究的目的是评估接受静脉-静脉（VV）体外膜肺氧合（ECMO）治疗的患者营养摄入与结局之间的关联。
对2017年8月至2020年6月期间接受VV ECMO治疗的成年人进行筛查。排除ECMO营养支持天数少于3天的患者。收集患者的年龄、性别、身高、体重、理想体重（IBW）、体重指数、序贯器官衰竭评估评分、呼吸ECMO生存预测评分、能量和蛋白质目标。收集ECMO治疗的前14天或直至死亡、拔管或开始经口饮食期间的所有营养摄入量。分析的结局包括死亡率和VV ECMO持续时间。通过多变量分析检验营养供给与结局之间的关系。对肥胖和非肥胖亚组进行单变量分析。
共分析了178例患者的2044个营养日。使用肥胖患者的IBW和非肥胖患者的实际体重计算，估计的蛋白质需求中位数分别为24（四分位间距：22.3 - 28.3）kcal/kg/天和2.25（四分位间距：2.25 - 2.77）g/kg/天。患者摄入了能量目标的83%和蛋白质目标的63.3%。接受≥2 g/kg IBW蛋白质的肥胖患者ECMO持续时间显著缩短（P = 0.037）。蛋白质摄入量增加与死亡风险降低独立相关（比值比：0.06；95%置信区间：0.01 - 0.43）。
较高的蛋白质摄入量与死亡率降低相关。目前尚不清楚接受ECMO治疗的患者的最佳能量目标，值得进一步研究。
