ECMO patient energy requirements: A descriptive, retrospective cohort study.

Authors

Stacy L Pelekhaty, Raymond P Rector, Zhongjun J Wu, Alison Grazioli, Michael E Plazak, Bradley S Taylor, Bartley P Griffith, Aakash Shah, Deborah M Stein, Thomas M Scalea, Joseph Rabin

Published in

Nutrition in clinical practice : official publication of the American Society for Parenteral and Enteral Nutrition. Jun 08, 2025. Epub Jun 08, 2025.

Abstract

Indirect calorimetry (IC) in patients receiving extracorporeal membrane oxygenation (ECMO) is complicated. This study presents a novel IC method for this population and compares energy expenditure (EE) from IC with predictive equations.
IC was performed at the native lung using a Q-NRG+ indirect calorimeter. A CO₂ sensor connected to the ECMO oxygenator primary exhalation port collected FeCO₂ during IC studies. ECMO-VO₂ and ECMO-VCO₂ were calculated from sweep gas oxygen concentration, FeCO₂, and sweep flow. EE was calculated from the combined readings. EE was compared with 25 kcal/kg, 30 kcal/kg, and Mifflin St Jeor. Subanalysis compared EE over time (ECMO days 1-3, 4-10, 11-21, and >21) and between venoarterial and venovenous patients.
In total, 90 assessments in 52 patients were analyzed. The cohort was 67.3% male with a median age of 54 years, and median ECMO duration of 207 h. EE was 1523 ± 432 kcal/day (18.9 ± 6.9 kcal/kg/day). Energy needs did not vary significantly over time (P = 0.24); however, readings from days 11 to 21 were higher than days 1-3 (P = 0.0497). No significant differences between cannulation types were observed. EE was significantly lower than all predicted results (P < 0.001). Mean difference between EE and predicted energy ranged from 413 to 1099 kcal/day. No equation was strongly correlated with EE (r_s = 0.15-0.61) overall or after stratification by cannulation type.
This study presents a viable method for incorporating IC in patients receiving ECMO. Using this method, EE in patients receiving ECMO was significantly lower than predicted. Using IC may help prevent overfeeding.

PMID:
40483574
Bibliographic data and abstract were imported from PubMed on 08 Jun 2025.

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