Kerstein Jason S, Pane Caroline R, Sleeper Lynn A, Finnan Emily, Thiagarajan Ravi R, Mehta Nilesh M, Mills Kimberly I
Department of Cardiology, Boston Children's Hospital, Boston, MA, USA.
Department of Pediatrics, Harvard Medical School, Boston, MA, USA.
Pediatr Cardiol. 2024 Aug 26. doi: 10.1007/s00246-024-03628-0.
Nutrition provision for children with heart disease supported with extracorporeal membrane oxygenation (ECMO) involves nuanced decision making. We examined nutrition provision while on ECMO in the CICU and the relationship between energy and protein adequacy and end organ function as assessed by pediatric sequential organ failure assessment (pSOFA) scores in children with heart disease supported with ECMO. Children (≤ 21 years-old) with congenital or acquired heart disease who received ECMO in the cardiac intensive care unit were included. There were 259 ECMO runs in 252 patients over an 8-year study period (2013-2020). Median energy delivery and adequacy were 26.1 [8.4, 45.9] kcal/kg/day and 58.3 [19.8, 94.6]%, respectively. Median protein delivery and adequacy were 0.98 [0.36, 1.64] g/kg/day and 35.7 [13.4, 60.3]%, respectively. pSOFA increased by a median of four points during the ECMO run. Change in pSOFA score was not associated with energy or protein adequacy (p = 0.46 and p = 0.72, respectively). Higher energy and protein adequacy-from parenteral nutrition-correlated with increased hospital-acquired infections (HAIs, p = 0.031 and p = 0.003, respectively). Achieving nutritional adequacy was dependent on the use of parenteral nutrition. Similar clinical outcomes with regard to end organ function but with an increased incidence of HAIs suggests the need to explore the role of optimal enteral nutrition delivery on ECMO.
为接受体外膜肺氧合（ECMO）支持的心脏病患儿提供营养需要细致入微的决策。我们研究了在心脏重症监护病房（CICU）接受ECMO治疗期间的营养供应情况，以及能量和蛋白质充足程度与终末器官功能之间的关系，终末器官功能通过小儿序贯器官衰竭评估（pSOFA）评分来评估，该评分用于评估接受ECMO支持的心脏病患儿。纳入了在心脏重症监护病房接受ECMO治疗的先天性或后天性心脏病患儿（≤21岁）。在为期8年的研究期间（2013 - 2020年），252例患者共进行了259次ECMO治疗。能量输送中位数及充足率分别为26.1[8.4, 45.9]千卡/千克/天和58.3[19.8, 94.6]%。蛋白质输送中位数及充足率分别为0.98[0.36, 1.64]克/千克/天和35.7[13.4, 60.3]%。在ECMO治疗期间，pSOFA评分中位数增加了4分。pSOFA评分的变化与能量或蛋白质充足程度无关（p分别为0.46和0.72）。通过肠外营养实现的更高能量和蛋白质充足程度与医院获得性感染（HAIs）增加相关（p分别为0.031和0.003）。实现营养充足依赖于肠外营养的使用。终末器官功能方面临床结果相似，但HAIs发生率增加，这表明需要探索优化的肠内营养输送在ECMO上的作用。
