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Measuring the Resting Energy Expenditure in Children on Extracorporeal Membrane Oxygenation: A Prospective Pilot
Linette J Ewing1,2, Michele B Domico2, Rogelio Ramirez2
1From the Department of Pediatric Critical Care, Harbor-UCLA Medical Center, Torrance, California.
Insights
Resting energy expenditure (REE) in critically ill children on extracorporeal membrane oxygenation (ECMO) support varies widely. Individual REE testing is crucial for optimal nutrition and care in these patients.
Area of Science:
- Pediatric critical care medicine
- Nutritional support
- Metabolic monitoring
Background:
- Overfeeding and underfeeding critically ill children pose significant risks.
- Accurate assessment of energy needs is vital for patient outcomes.
Purpose of the Study:
- To evaluate resting energy expenditure (REE) in pediatric patients requiring extracorporeal membrane oxygenation (ECMO) support.
- To compare measured REE with predicted values.
Main Methods:
- Prospective pilot study using indirect calorimetry to measure oxygen consumption and carbon dioxide production.
- Combined data from mechanical ventilators and ECMO circuits to calculate REE.
- Measurements taken at multiple time points: day 2 of ECMO, pre-discontinuation, and post-decannulation.
Main Results:
- Significant variability in REE was observed, ranging from 26 to 154 Kcal/kg/day on day 2 of ECMO.
- Patients with septic shock showed REE >300% above predicted values.
- Post-decannulation, REE was consistently below predicted values (<90%).
Conclusions:
- Indirect calorimetry is feasible for measuring REE in children on ECMO.
- ECMO does not guarantee metabolic rest, highlighting the need for individualized nutrition.
- Tailoring caloric intake to measured REE is recommended for optimal patient management.
Abstract:
Both overfeeding and underfeeding critically ill children are problematic. This prospective pilot study evaluated the resting energy expenditure in infants and children requiring extracorporeal membrane oxygenation (ECMO) support. An indirect calorimeter was used to measure oxygen consumption (VO 2 ) and carbon dioxide production (VCO 2 ) from the mechanical ventilator. Blood gases were used to determine VO 2 and VCO 2 from the ECMO circuit. Values from the mechanical ventilator and ECMO circuit were added, and the resting energy expenditure (REE) (Kcal/kg/day) was calculated. Measurements were obtained > 24 hours after ECMO support was initiated (day 2 of ECMO), 1 day before ECMO discontinuation or transfer, and 1 day after decannulation. Data were compared with the predicted energy expenditure. Seven patients aged 3 months to 13 years were included. The REE varied greatly both above and below predicted values, from 26 to 154 KCal/kg/day on day 2 of ECMO support. In patients with septic shock, the REE was > 300% above the predicted value on day 2 of ECMO. Before ECMO discontinuation, two of six (33%) children continued to have a REE > 110% of predicted. Three patients had measurements after decannulation, all with a REE < 90% of predicted. REE measurements can be obtained by indirect calorimetry in children receiving ECMO support. ECMO may not provide metabolic rest for all children as a wide variation in REE was observed. For optimal care, individual testing should be considered to match calories provided with the metabolic demand.
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