High protein intake and nitrogen balance in patients on venovenous extracorporeal membrane oxygenation: a descriptive cohort study.

BACKGROUND

This retrospective cohort study sought to describe the ability of high protein regimens to achieve nitrogen equilibrium in patients on venovenous extracorporeal membrane oxygenation (VV-ECMO) METHODS: Patients ≥18 years with a documented nitrogen balance study (NB) on VV-ECMO between February 2018 and December 2021 were included. NB with incomplete 24-hour urine collections or changes in blood urea nitrogen ≥10 mg/dL were excluded. Data were summarized, correlation between first NB and potentially contributing variables was assessed with Kendall's Tau. Sub-analysis described findings after stratifying for weight class (obese vs non-obese) and duration of VV ECMO at the time of NB.

RESULTS

A total of 68 NB in 30 patients were included; 47% of the cohort had obesity. The number of NB per patient was 2.2 ± 1.1, which were completed on a median of 31.5 (interquartile range: 16, 53.8) days on ECMO. Nitrogen equilibrium or positive balance was achieved in 72% of studies despite elevated nitrogen excretion. Patients received 87.9 ± 16.8% of prescribed protein on NB days for average intakes of 2.4 ± 0.4 g/kg actual weight/day and 2.4 ± 0.5 g/kg ideal weight/day in patients without and with obesity. Median NB in non-obese was -1.46 (-8.96, 2.98) g/day, and -0.21 (-10.58, 4.04) g/day in patients with obesity. A difference in median NB after stratification for timing was observed (p=0.029).

CONCLUSION

Nitrogen equilibrium can be achieved with high protein intake in adults on VV-ECMO. NB monitoring is one tool to individualize protein prescriptions throughout the course of VV ECMO. This article is protected by copyright. All rights reserved.

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This article is protected by copyright. All rights reserved.