Comparison of nutritional adequacy in adult patients with acute respiratory distress syndrome with and without veno-venous extracorporeal membrane oxygenation: a single-center experience

Year 2023, Volume: 9 Issue: 5 - September 2023, 1114 - 1123, 04.09.2023

Gülbahar Çalışkan , Nermin Kelebek Girgin

https://doi.org/10.18621/eurj.1310881

Abstract

Objectives: Limited data is available regarding nutrition practices for patients with acute respiratory distress syndrome (ARDS) who are also receiving veno-venous-extracorporeal membrane oxygenation (VV-ECMO). The aim of the study was to describe the nutritional status of patients receiving VV-ECMO and compared with those who did not.

Methods: Patients (>18 years-old) diagnosed with ARDS who received VV-ECMO (≥72 hours) were included in this retrospective study. The daily achievement of an energy target (%) and average protein intake during 2 weeks after initiation of VV-ECMO were calculated. Adequate feeding was defined as achieving 80-110% of the calculated target. The duration before initiating parenteral (PN) and enteral nutrition (EN), feeding route, length of intensive care, and hospital stay were evaluated. Data was compared between groups.

Results: In this study, 24 patients were included, of whom 12 received VV-ECMO. EN was started in a median 1.5 and 1 days in the VV-ECMO and non-ECMO groups, respectively. In the VV-ECMO group, 75% of the patients could achieve nutritional adequacy (>80% energy goal) and 83.3% in the non-ECMO group (p = 0.615). PN being required in 4 (33.3%) patients who received VV-ECMO and 3 (25%) patients who did not (p = 0254). Ten of all patients experienced inadequate EN because of hemodynamic instability (n = 3), prone position (n=4), gastric distension (n = 2) and diarrhea (n = 1).

Conclusions: VV-ECMO was not an obstacle for adequate nutrition, but prone position and hemodynamic instability were common causes of enteral feeding interruptions and inadequate energy delivery.

Keywords

Acute respiratory distress syndrome, veno-venous-extracorporeal membrane oxygenation, nutrition, enteral, parenteral, critically ill

References

• 1. Meyer NJ, Gattinoni L, Calfee CS. Acute respiratory distress syndrome. Lancet 2021;398:622-37.
• 2. Saguil A, Fargo MV. Acute respiratory distress syndrome: diagnosis and management. Am Fam Physician 2020;101:730-8.
• 3. Bear DE, Halslam J, Camporota L, Shankar-Hari M, Barrett NA. An international survey of nutrition practices in adult patients receiving veno-venous ECMO. Intensive Care Med Exp 2015;3(suppl 1):A295.
• 4. Al Tamimi D, Ahmad M. Risk of malnutrition and clinical outcomes among mechanically ventilated patients in intensive care units. Dimens Crit Care Nurs 2022;41:18-23.
• 5. Wang N, Wang MP, Jiang L, Du B, Zhu B, Xi XM. Association between the modified Nutrition Risk in Critically Ill (mNUTRIC) score and clinical outcomes in the intensive care unit: a secondary analysis of a large prospective observational study. BMC Anesthesiol 2021;21:220.
• 6. MacGowan L, Smith E, Elliott-Hammond C, Sanderson B, Ong D, Daly K, et al. Adequacy of nutrition support during extracorporeal membrane oxygenation. Clin Nutr 2019;38:324-31.
• 7. Extracorporeal Life Support Organization. ELSO General Guidelines for all ECLS Cases. ELSO Guidel 1-26 https://www.elso.org/ecmo-resources/elso-ecmo-guidelines.aspx
• 8. Nandwani V, Tauber A, McCarthy P, Herr D. 333. Nutrition practice patterns in adult ECMO patients: results of an international survey. Crit Care Med 2014;42(12 suppl 1):A1440.
• 9. Farías MM, Olivos C, Díaz R. Nutritional implications for the patient undergoing extracorporeal membrane oxygenation. Nutr Hosp 2015;31:2346-51
• 10. Ferrie S, Herkes R, Forrest P. Nutrition support during extracorporeal membrane oxygenation (ECMO) in adults: a retrospective audit of 86 patients. Intensive Care Med 2013;39:1989-94.
• 11. Umezawa Makikado LD, Flordelís Lasierra JL, Pérez-Vela JL, Colino Gómez L, Torres Sánchez E, Maroto Rodríguez B, et al. Early enteral nutrition in adults receiving venoarterial extracorporeal membrane oxygenation: an observational case series. JPEN J Parenter Enteral Nutr 2013;37:281-4.
• 12. Hardy G, Camporota L, Bear DE. Nutrition support practices across the care continuum in a single centre critical care unit during the first surge of the COVID-19 pandemic - A comparison of VV-ECMO and non-ECMO patients. Clin Nutr 2022;41:2887-94.
• 13. ARDS Definition Task Force, Ranieri VM, Rubenfeld GD, Thompson BT, Ferguson ND, Caldwell E, Fan E, Camporota L, Slutsky AS. Acute respiratory distress syndrome: the Berlin Definition. JAMA 2012;307:2526-33.
• 14. Singer P, Blaser AR, Berger MM, Alhazzani W, Calder PC, Casaer MP, et al. ESPEN guideline on clinical nutrition in the intensive care unit. Clin Nutr 2019;38:48-79.
• 15. McClave SA, Taylor BE, Martindale RG, Warren MM, Johnson DR, Braunschweig C, et al; Society of Critical Care Medicine; American Society for Parenteral and Enteral Nutrition. Guidelines for the Provision and Assessment of Nutrition Support Therapy in the Adult Critically Ill Patient: Society of Critical Care Medicine (SCCM) and American Society for Parenteral and Enteral Nutrition (A.S.P.E.N.). JPEN J Parenter Enteral Nutr 2016;40:159-211.
• 16. Lukas G, Davies AR, Hilton AK, Pellegrino VA, Scheinkestel CD, Ridley E. Nutritional support in adult patients receiving extracorporeal membrane oxygenation. Crit Care Resusc 2010;12:230-4.
• 17. Lu MC, Yang MD, Li PC, Fang HY, Huang HY, Chan YC, et al. Effects of nutritional intervention on the survival of patients with cardiopulmonary failure undergoing extracorporeal membrane oxygenation therapy. In Vivo 2018;32:829-34.
• 18. Weijs PJM, Mogensen KM, Rawn JD, Christopher KB. Protein intake, nutritional status and outcomes in ICU survivors: A single center cohort study. J Clin Med 2019;8:43.
• 19. Compher C, Chittams J, Sammarco T, Nicolo M, Heyland DK. Greater protein and energy intake may be associated with improved mortality in higher risk critically ill patients: a multicenter, multinational observational study. Crit Care Med 2017;45:156-63.
• 20. Tavares de Araujo VM, Gomes PC, Caporossi C. Enteral nutrition in critical patients; should the administration be continuous or intermittent? Nutr Hosp 2014;29:563-7.
• 21. Chowdhury AH, Murray K, Hoad CL, Costigan C, Marciani L, Macdonald IA, et al. Effects of bolus and continuous nasogastric feeding on gastric emptying, small bowel water content, superior mesenteric artery blood flow, and plasma hormone concentrations in healthy adults: a randomized crossover study. Ann Surg 2016;263:450-7.
• 22. Heffernan AJ, Talekar C, Henain M, Purcell L, Palmer M, White H. Comparison of continuous versus intermittent enteral feeding in critically ill patients: a systematic review and meta-analysis. Crit Care 2022;26:325.
• 23. Patel JJ, Rice T, Heyland DK. Safety and outcomes of early enteral nutrition in circulatory shock. JPEN J Parenter Enteral Nutr 2020;44:779-84.
• 24. Davis RC 2nd, Durham LA 3rd, Kiraly L, Patel JJ. Safety, tolerability, and outcomes of enteral nutrition in extracorporeal membrane oxygenation. Nutr Clin Pract 2021;36:98-104.
• 25. Mentec H, Dupont H, Bocchetti M, Cani P, Ponche F, Bleichner G. Upper digestive intolerance during enteral nutrition in critically ill patients: frequency, risk factors, and complications. Crit Care Med 2001;29:1955-61.
• 26. Saez de la Fuente I, Saez de la Fuente J, Quintana Estelles MD, Garcia Gigorro R, Terceros Almanza LJ, Sanchez Izquierdo JA, et al. Enteral nutrition in patients receiving mechanical ventilation in a prone position. JPEN J Parenter Enteral Nutr 2016;40:250-5.
• 27. Reignier J, Thenoz-Jost N, Fiancette M, Legendre E, Lebert C, Bontemps F, et al. Early enteral nutrition in mechanically ventilated patients in the prone position. Crit Care Med 2004;32:94-9.
• 28. Scott LK, Boudreaux K, Thaljeh F, Grier LR, Conrad SA. Early enteral feedings in adults receiving venovenous extracorporeal membrane oxygenation. JPEN J Parenter Enteral Nutr 2004;28:295-300.
• 29. Park J, Heo E, Song IA, Cho J, Namgung H, Lee E, et al. Nutritional support and clinical outcomes in critically ill patients supported with veno-arterial extracorporeal membrane oxygenation. Clin Nutr 2020;39:2617-23.
• 30. Ohbe H, Jo T, Yamana H, Matsui H, Fushimi K, Yasunaga H. Early enteral nutrition for cardiogenic or obstructive shock requiring venoarterial extracorporeal membrane oxygenation: a nationwide inpatient database study. Intensive Care Med 2018;44:1258-65.
• 31. Hunt MF, Pierre AS, Zhou X, Lui C, Lo BD, Brown PM, et al. Nutritional support in postcardiotomy shock extracorporeal membrane oxygenation patients: a prospective, observational study. J Surg Res 2019;244:257-64.
• 32. Bellani G, Laffey JG, Pham T, Fan E, Brochard L, Esteban A, et al. Epidemiology, patterns of care, and mortality for patients with acute respiratory distress syndrome in intensive care units in 50 countries. JAMA 2016;315:788-800.
• 33. Dai Q, Wang S, Liu R, Wang H, Zheng J, Yu K. Risk factors for outcomes of acute respiratory distress syndrome patients: a retrospective study. J Thorac Dis 2019;11:673-85.