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

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.