Inadequate Energy Delivery Is Frequent among COVID-19 Patients Requiring ECMO Support and Associated with Increased ICU Mortality.
COVID-19
ECMO
critical care
medical nutrition therapy
Journal
Nutrients
ISSN: 2072-6643
Titre abrégé: Nutrients
Pays: Switzerland
ID NLM: 101521595
Informations de publication
Date de publication:
27 Apr 2023
27 Apr 2023
Historique:
received:
07
04
2023
revised:
23
04
2023
accepted:
25
04
2023
medline:
13
7
2023
pubmed:
11
7
2023
entrez:
11
7
2023
Statut:
epublish
Résumé
Patients receiving extracorporeal membrane oxygenation (ECMO) support are at high risk for malnutrition. There are currently no general nutrition guidelines for coronavirus disease 2019 (COVID-19) patients during ECMO therapy. We conducted a retrospective analysis of COVID-19 patients requiring venovenous ECMO support at a large tertiary hospital center. Nutrition goals were calculated using 25 kcal/kg body weight (BW)/day. Associations between nutrition support and outcome were evaluated using Kaplan-Meier and multivariable Cox regression analyses. Overall, 102 patients accounted for a total of 2344 nutrition support days during ECMO therapy. On 40.6% of these days, nutrition goals were met. Undernutrition was found in 40.8%. Mean daily calorie delivery was 73.7% of calculated requirements, mean daily protein delivery was 0.7 g/kg BW/d. Mean energy intake of ≥70% of calculated targets was associated with significantly lower ICU mortality independently of age, disease severity at ECMO start and body mass index (adjusted hazard ratio: 0.372, Patients with a mean energy delivery of ≥70% of calculated targets during ECMO therapy had a better ICU survival compared to patients with unmet energy goals. These results indicate that adequate nutritional support needs to be a major priority in the treatment of COVID-19 patients requiring ECMO support.
Sections du résumé
BACKGROUND
BACKGROUND
Patients receiving extracorporeal membrane oxygenation (ECMO) support are at high risk for malnutrition. There are currently no general nutrition guidelines for coronavirus disease 2019 (COVID-19) patients during ECMO therapy.
METHODS
METHODS
We conducted a retrospective analysis of COVID-19 patients requiring venovenous ECMO support at a large tertiary hospital center. Nutrition goals were calculated using 25 kcal/kg body weight (BW)/day. Associations between nutrition support and outcome were evaluated using Kaplan-Meier and multivariable Cox regression analyses.
RESULTS
RESULTS
Overall, 102 patients accounted for a total of 2344 nutrition support days during ECMO therapy. On 40.6% of these days, nutrition goals were met. Undernutrition was found in 40.8%. Mean daily calorie delivery was 73.7% of calculated requirements, mean daily protein delivery was 0.7 g/kg BW/d. Mean energy intake of ≥70% of calculated targets was associated with significantly lower ICU mortality independently of age, disease severity at ECMO start and body mass index (adjusted hazard ratio: 0.372,
CONCLUSIONS
CONCLUSIONS
Patients with a mean energy delivery of ≥70% of calculated targets during ECMO therapy had a better ICU survival compared to patients with unmet energy goals. These results indicate that adequate nutritional support needs to be a major priority in the treatment of COVID-19 patients requiring ECMO support.
Identifiants
pubmed: 37432241
pii: nu15092098
doi: 10.3390/nu15092098
pmc: PMC10181417
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Références
JPEN J Parenter Enteral Nutr. 2013 Mar;37(2):281-4
pubmed: 22750804
N Engl J Med. 2018 May 24;378(21):1965-1975
pubmed: 29791822
Acta Anaesthesiol Scand. 2021 Jul;65(6):792-800
pubmed: 33635540
Clin Nutr. 2022 Dec;41(12):3026-3031
pubmed: 34134915
Medicine (Baltimore). 2021 Aug 13;100(32):e26900
pubmed: 34397917
Mayo Clin Proc. 2005 Dec;80(12):1558-67
pubmed: 16342648
N Engl J Med. 2011 Aug 11;365(6):506-17
pubmed: 21714640
Intensive Care Med. 2011 Apr;37(4):601-9
pubmed: 21340655
Clin Nutr. 2021 Feb;40(2):380-387
pubmed: 32534949
Sci Rep. 2020 Nov 6;10(1):19275
pubmed: 33159150
Intensive Care Med Exp. 2014 Dec;2(1):29
pubmed: 26266926
Curr Opin Crit Care. 2018 Aug;24(4):269-276
pubmed: 29847341
JPEN J Parenter Enteral Nutr. 2004 Sep-Oct;28(5):295-300
pubmed: 15449567
Clin Nutr. 2019 Feb;38(1):48-79
pubmed: 30348463
JAMA. 2020 Nov 10;324(18):1899-1901
pubmed: 32970139
Nutr Clin Pract. 2021 Feb;36(1):98-104
pubmed: 33078433
Clin Nutr. 2022 Dec;41(12):2887-2894
pubmed: 36216665
Crit Care Resusc. 2015 Sep;17(3):183-9
pubmed: 26282256
Clin Nutr. 2022 Dec;41(12):2903-2909
pubmed: 35504769
Clin Nutr. 2020 Aug;39(8):2617-2623
pubmed: 31839430
Intensive Care Med. 2013 Nov;39(11):1989-94
pubmed: 23949702
J Surg Res. 2019 Dec;244:257-264
pubmed: 31302323
JPEN J Parenter Enteral Nutr. 2022 Jan;46(1):12-41
pubmed: 34784064
Crit Care. 2020 Mar 18;24(1):109
pubmed: 32188500
Clin Nutr. 2022 Dec;41(12):3096-3099
pubmed: 33933297
Clin Nutr. 2020 Jul;39(7):2327-2328
pubmed: 32425291
N Engl J Med. 1997 Jan 2;336(1):41-8
pubmed: 8970939
Nutr Clin Pract. 2021 Feb;36(1):88-97
pubmed: 33373481
Cochrane Database Syst Rev. 2018 Jun 08;6:CD012276
pubmed: 29883514
Intensive Care Med. 2021 Jan;47(1):60-73
pubmed: 33211135
Clin Nutr. 2019 Feb;38(1):324-331
pubmed: 29395370
Clin Nutr. 2018 Feb;37(1):301-307
pubmed: 28143666
Crit Care Resusc. 2010 Dec;12(4):230-4
pubmed: 21143082
Crit Care. 2020 Sep 28;24(1):581
pubmed: 32988390
World Rev Nutr Diet. 2013;105:154-159
pubmed: 23075597
Med Sci Monit. 2015 Sep 04;21:2621-9
pubmed: 26336861
Chest. 2018 Apr;153(4):788-791
pubmed: 29355550
Acta Anaesthesiol Scand. 2015 Nov;59(10):1296-302
pubmed: 26046372
ASAIO J. 2020 Jul;66(7):707-721
pubmed: 32604322
Nutrition. 1996 Jan;12(1):23-9
pubmed: 8838832
JPEN J Parenter Enteral Nutr. 2021 Jan;45(1):32-42
pubmed: 32613660
Intensive Care Med. 2017 Sep;43(9):1306-1318
pubmed: 28470346
Clin Nutr. 2020 Jun;39(6):1631-1638
pubmed: 32305181
Clin Nutr ESPEN. 2021 Jun;43:383-389
pubmed: 34024544
Lancet. 2013 Feb 2;381(9864):385-93
pubmed: 23218813
Intensive Care Med. 2018 Aug;44(8):1258-1265
pubmed: 30030574
Clin Nutr ESPEN. 2021 Jun;43:377-382
pubmed: 34024543
Artif Organs. 2022 Jul;46(7):1240-1248
pubmed: 35230717
JPEN J Parenter Enteral Nutr. 2020 Sep;44(7):1234-1236
pubmed: 32559309