Medical nutrition therapy in patients receiving ECMO: Evidence-based guidance for clinical practice.

Ellen Dresen, Omy Naidoo, Aileen Hill, Gunnar Elke, Matthias Lindner, Joop Jonckheer, Elisabeth De Waele, Patrick Meybohm, Ranna Modir, Jayshil J Patel, Kenneth B Christopher, Christian Stoppe

Journal: JPEN. Journal of parenteral and enteral nutrition 2023;47(2):220-235

PMID: 36495215

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Abstract

Patients receiving extracorporeal membrane oxygenation (ECMO) inherit substantial disease-associated metabolic, endocrinologic, and immunologic modifications. Along with the technical components of ECMO, the aforementioned alterations may affect patients' needs and feasibility of adequate macronutrient and micronutrient supply and intake. Thus, patients receiving ECMO are at increased risk for iatrogenic malnutrition and require targeted individual medical nutrition therapy (MNT). However, specific recommendations for MNT in patients receiving ECMO are limited and, with some exceptions, based on an evidence base encompassing general patients who are critically ill. Consequently, clinician decision-making for MNT in patients receiving ECMO is unguided, which may further increase nutrition risk, culminating in iatrogenic malnutrition and ultimately affecting patient outcomes. The purpose of this article is to provide educational background and highlight specific points for MNT in adult patients receiving ECMO, which might serve as evidence-based guidance to develop institutional standard operating procedures and nutrition protocols for daily clinical practice.

Address: Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany.; Newtricion Wellness Dieticians, PMB Healthcare Centre, Pietermaritzburg, South Africa.; Department of Anesthesiology and Intensive Care Medicine, University Hospital RWTH Aachen, Aachen, Germany.; Department of Anesthesiology and Intensive Care Medicine, University Medical Center Schleswig-Holstein, Campus Kiel, Kiel, Germany.; Department of Intensive Care, Universitair Ziekenhuis Brussel, Brussels Health Campus, Jette, Belgium.; Department of Intensive Care, Universitair Ziekenhuis Brussel, Brussels Health Campus, Jette, Belgium.; Department of Clinical Nutrition, Universitair Ziekenhuis Brussel, Brussels Health Campus, Jette, Belgium.; Vrije Universiteit Brussel, Brussels Health Campus, Jette, Belgium.; Stanford University Medical Center, Stanford, California, USA.; Department of Medicine, Division of Pulmonary and Critical Care Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.; Renal Division, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, USA.; Department of Anaesthesiology, Intensive Care, Emergency and Pain Medicine, University Hospital Wuerzburg, Wuerzburg, Germany.; Department of Cardiac Anesthesiology and Intensive Care Medicine, Charité Berlin, Berlin, Germany.

DOI: 10.1002/jpen.2467

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https://doi.org/10.1002/jpen.2467

MeSH Terms: Adult, Humans, Extracorporeal Membrane Oxygenation, Enteral Nutrition, Nutritional Status, Malnutrition, Critical Illness, Iatrogenic Disease