Energy expenditure of patients on ECMO: A prospective pilot study.
BACKGROUND
An optimal nutritional approach sustained by convenient monitoring of metabolic status and reliable assessment of energy expenditure (EE) may improve the outcome of critically ill patients on extracorporeal membrane oxygenation (ECMO). We previously demonstrated the feasibility of indirect calorimetry (IC)-the standard of care technique to determine caloric targets-in patients undergoing ECMO. This study aims to compare measured with calculated EE during ECMO treatment. We additionally provide median EE values for use in settings where IC is not available.


METHODS
IC was performed in seven stable ECMO patients. Gas exchange was analyzed at the ventilator, and ECMO side and values were introduced in a modified Weir formula to calculate resting EE. Results were compared with EE calculated with the Harris-Benedict equation and with the 25 kcal/kg/day ESPEN recommendation.


RESULTS
Total median oxygen consumption rate was 196 (Q1-Q3 158-331) mL/min, and total median carbon dioxide production was 150 (Q1-Q3 104-203) mL/min. Clinically relevant differences between calculated and measured EE were observed in all patients. The median EE was 1334 (Q1-Q3 1134-2119) kcal/24 hours or 18 (Q1-Q3 15-27) kcal/kg/day.


CONCLUSION
Compared with measured EE, calculation of EE both over- and underestimated caloric needs during ECMO treatment. Despite a median EE of 21 kcal/kg/day, large variability in metabolic rate was found and demands further investigation.
['De Waele|Elisabeth|E|0000-0002-5126-3500', 'Jonckheer|Joop|J|', 'Pen|Joeri J|JJ|', 'Demol|Joy|J|', 'Staessens|Kurt|K|', 'Puis|Luc|L|', 'La Meir|Mark|M|', 'Honoré|Patrick M|PM|', 'L N G Malbrain|Manu|M|', 'Spapen|Herbert D|HD|']
D000368:Aged D002153:Calorimetry, Indirect D002245:Carbon Dioxide D016638:Critical Illness D004734:Energy Metabolism D015199:Extracorporeal Membrane Oxygenation D005260:Female D006801:Humans D008297:Male D008875:Middle Aged D010101:Oxygen Consumption D010865:Pilot Projects D011446:Prospective Studies D011659:Pulmonary Gas Exchange D012146:Rest
nutrition extracorporeal membrane oxygenation indirect calorimetry ICU resting energy expenditure